# Prognostic Implications of Lymph Node Status in Non-Small-Cell Lung Cancer Patients Before and After Neoadjuvant Chemoimmunotherapy: A Multicenter Retrospective Study.

**Tumor:** CPNM (cáncer de pulmón)
**Autores:** Ma R, Yang H, Ge Y et al
**Revista:** Clin Lung Cancer (2025)
**PMID:** 40316494 | **PMCID:** —
**DOI:** [10.1016/j.cllc.2025.04.004](https://doi.org/10.1016/j.cllc.2025.04.004)
**Fuente:** PubMed (abstract only)

## Relevancia
CPNM resecable tras quimio-inmunoterapia neoadyuvante (CheckMate-816, NADIM, KEYNOTE-671): downstaging mediastínico (ypN0/N1), tasas de pCR ganglionar y supervivencia. Paralelo importante con mama: la conversión nodal patológica predice EFS/OS y orienta la extensión de la disección ganglionar.

## Abstract
In patients with non-small-cell lung cancer (NSCLC) treated with neoadjuvant chemoimmunotherapy, lymph node (LN) status is classified as ypN0 and ypN+. However, ypN0 includes patients who either had LN metastasis before neoadjuvant therapy (cN+/ypN0) or those who never developed LN metastasis (cN0/ypN0). The prognostic implications of these different LN statuses are not well understood.

A retrospective analysis was conducted on patients with NSCLC who underwent surgery after neoadjuvant chemoimmunotherapy at 4 centers in China from 2019 to 2022. Patients were grouped by their LN status into ``natural'' N0 (cN0/ypN0), ``downstaged'' N0 (cN+/ypN0), and ypN+ (cN+/ypN+).

Out of 527 initially enrolled patients, 186 met the inclusion criteria: 34 (18.3%) had ``natural'' N0, 95 (51.1%) had ``downstaged'' N0, and 57 (30.6%) had ypN+. The median follow-up was 24 months (11-64 months). Disease-free survival (DFS) and overall survival (OS) were significantly lower in ypN+ compared to ``natural'' N0 and ``downstaged'' N0 (DFS: P < .001; OS: P < .001). However, no significant difference in either DFS (P = .695) or OS (P = .814) were observed between ``natural'' N0 and ``downstaged'' N0. Subgroup analysis showed that the MPR/ypN0 group had significantly better DFS compared to the non-MPR/ypN0 (P = .008), MPR/ypN+ (P = .028), and non-MPR/ypN+ groups (P < .001). For OS, MPR/ypN0 group was significantly superior to non-MPR/ypN+ (P < .001) and showed a trend toward better OS than non-MPR/ypN0 (P = .067) and MPR/ypN+ (P = .067). Notably, no significant differences were observed in either DFS (P = .908) or OS (P = .943) between non-MPR/ypN0 and MPR/ypN+ groups. The non-MPR/ypN+ group had the poorest survival outcomes in both DFS and OS.

Achieving ypN0 status after neoadjuvant chemoimmunotherapy strongly predicts favorable outcomes in patients with NSCLC, regardless of pretreatment cN status. Combining MPR with LN status effectively differentiates patient prognoses.

## Acceso
Vía [DOI](https://doi.org/10.1016/j.cllc.2025.04.004) o suscripción institucional.

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*Datos de PubMed. Citar: doi 10.1016/j.cllc.2025.04.004*
