N2 stage disease constitutes approximately 20%–30% of all non-small cell lung cancer (NSCLC). Concurrently, surgery remains the first-choice treatment for patients with N2 NSCLC if feasible. However, the role of pneumonectomy in N2 NSCLC has rarely been investigated and remains controversial.

We enrolled 26,798 patients with T1–4N2M0 NSCLC (stage IIIA/IIIB) from the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2015. We compared the overall survival (OS) and cancer-specific survival (CSS) between patients who received pneumonectomy and those who did not receive surgery. The Kaplan–Meier method, Cox regression analyses, and propensity score matching (PSM) were applied to demonstrate the effect of pneumonectomy.

Patients receiving pneumonectomy had a significantly better OS and CSS than those without pneumonectomy both before [adjusted-HR (95% CI): 0.461 (0.425–0.501) for OS, 0.444 (0.406–0.485) for CSS] and after PSM [adjusted-HR (95% CI): 0.499 (0.445–0.560) for OS, 0.457 (0.405–0.517) for CSS] with all p-values <0.001. Subgroup analysis demonstrated concordant results stratified by demographic or clinicopathological variables. In sensitivity analysis, no significant difference was observed between patients receiving single pneumonectomy and chemoradiotherapy without surgery in OS and CSS both before [unadjusted-HR (95% CI): 1.016 (0.878–1.176) for OS, 0.934 (0.794–1.099) for CSS, p = 0.832] and after PSM [unadjusted-HR (95% CI): 0.988 (0.799–1.222) for OS, 0.938 (0.744–1.182) for CSS] with all p-values >0.4.

For patients with T1–4N2M0 NSCLC (stage IIIA/IIIB), pneumonectomy is an independent protective factor of OS and should be considered when applicable.

N2 期疾病约占所有非小细胞肺癌 (NSCLC) 的 20%–30%。同时，如果可行，手术仍然是 N2 NSCLC 患者的首选治疗方法。然而，肺切除术在 N2 NSCLC 中的作用很少被研究并且仍然存在争议。

我们在 2004 年至 2015 年期间从监测、流行病学和最终结果 (SEER) 数据库中招募了 26,798 名 T1–4N2M0 NSCLC（IIIA/IIIB 期）患者。我们比较了总生存期 (OS) 和癌症特异性生存期 (CSS)接受全肺切除术的患者和未接受手术的患者。应用 Kaplan-Meier 方法、Cox 回归分析和倾向评分匹配 (PSM) 来证明全肺切除术的效果。

接受肺切除术的患者在 [调整后的 HR (95% CI)：OS 为 0.461 (0.425–0.501)，CSS 为 0.444 (0.406–0.485)] 和 PSM [调整后- HR (95% CI)：OS 为 0.499 (0.445–0.560)，CSS 为 0.457 (0.405–0.517)]p-值 <0.001。亚组分析显示了按人口统计学或临床病理学变量分层的一致结果。在敏感性分析中，在 OS 和 CSS 之前接受单次全肺切除术和未手术放化疗的患者之间没有观察到显着差异 [unadjusted-HR (95% CI)：OS 为 1.016 (0.878–1.176)，OS 为 0.934 (0.794–1.099) CSS，p= 0.832] 和 PSM [unadjusted-HR (95% CI): 0.988 (0.799–1.222) for OS, 0.938 (0.744–1.182) for CSS] with allp-值 > 0.4。

对于 T1–4N2M0 NSCLC（IIIA/IIIB 期）患者，全肺切除术是 OS 的独立保护因素，应在适用时予以考虑。