Simple SummaryMultimodal treatment strategies for non-small cell lung cancer (NSCLC) with lymph node metastases are controversial. This study aimed to investigate the risk factors for poor postoperative survival and recurrence in patients with NSCLC and nodal metastasis who were surgically treated and did not receive any induction treatments. Multiple-node metastases are risk factors for both poor survival and recurrence; thus, surgery should be considered for patients with NSCLC and single-node metastasis. Currently, platinum-based adjuvant chemotherapy is considered insufficient in patients with squamous cell carcinoma. Additional perioperative therapies may be required, especially in these patients.AbstractThis study aimed to investigate the appropriate subgroups for surgery and adjuvant chemotherapy in patients with non-small-cell lung cancer (NSCLC) and nodal metastases. We retrospectively reviewed 210 patients with NSCLC and nodal metastases who underwent surgery and examined the risk factors for poor overall survival (OS) and recurrence-free probability (RFP) using multivariate Cox proportional hazards analysis. Pathological N1 and N2 were observed in 114 (52.4%) and 96 (47.6%) patients, respectively. A single positive node was identified in 102 patients (48.6%), and multiple nodes were identified in 108 (51.4%). Multivariate analysis revealed that vital capacity < 80% (hazard ratio [HR]: 2.678, 95% confidence interval [CI]: 1.483–4.837), radiological usual interstitial pneumonia pattern (HR: 2.321, 95% CI: 1.506–3.576), tumor size > 4.0 cm (HR: 1.534, 95% CI: 1.035–2.133), and multiple-node metastases (HR: 2.283, 95% CI: 1.517–3.955) were significant independent risk factors for poor OS. Tumor size > 4.0 cm (HR: 1.780, 95% CI: 1.237–2.562), lymphatic permeation (HR: 1.525, 95% CI: 1.053–2.207), and multiple lymph node metastases (HR: 2.858, 95% CI: 1.933–4.226) were significant independent risk factors for recurrence. In patients with squamous cell carcinoma (n= 93), there were no significant differences in OS or RFP between those who received platinum-based adjuvant chemotherapy (n= 25) and those who did not (n= 68), atp= 0.690 andp= 0.292, respectively. Multiple-node metastases were independent predictors of poor OS and recurrence. Patients with NSCLC and single-node metastases should be considered for surgery despite N2 disease. Additional treatment with platinum-based adjuvant chemotherapy may be expected, especially in patients with squamous cell carcinoma.