Feasibility and outcomes of curative-intent surgery for clinically node-positive non-small cell lung cancer with interstitial lung disease.

[PURPOSE] This study aimed to evaluate the feasibility and outcomes of curative-intent surgery in patients with clinically node-positive non-small cell lung cancer (NCSLC) and interstitial lung disease (ILD).

[METHODS] We retrospectively evaluated patients with clinically node-positive NSCLC and ILD, who underwent curative-intent surgery between 2012 and 2022. Survival outcomes and complications were also assessed. Risk stratification for acute exacerbations of ILD (AE-ILD) was performed using the Japanese Association for Chest Surgery (JACS) score.

[RESULTS] Twenty-eight patients were included in the study. Postoperative AE-ILD developed in 17.9% of patients within 30 days and 25.0% within 90 days. The incidence was lower in the low-risk group than in the intermediate-risk group (30 days: 12.5 vs. 20.0%; 90 days: 12.5 vs. 30.0%). No ILD-related deaths occurred within one year postoperatively in the low-risk group, whereas 71.4% of the deaths in the intermediate-risk group were ILD-related. The median overall survival (OS) and recurrence-free survival (RFS) were 19.5 and 13.7 months, respectively. Patients with cN1 or cN2a had favorable outcomes (OS: 28.5 and 28.6 months; RFS: 13.7 and 28.6 months, respectively), whereas those with cN2b showed poor survival (OS/RFS: 2.4 months).

[CONCLUSIONS] Curative-intent surgery may offer survival benefits for selected patients, particularly those with limited nodal disease and a low risk of AE-ILD.