What percentage of patients in their 60s with completely resected stage IIIA (N2) squamous‑cell non‑small‑cell lung cancer who do not receive adjuvant chemotherapy remain recurrence‑free at five years?

Recurrence-Free Survival Without Adjuvant Chemotherapy in Stage IIIA (N2) NSCLC

For patients in their 60s with completely resected stage IIIA (N2) squamous-cell NSCLC who do not receive adjuvant chemotherapy, approximately 20-26% remain recurrence-free at 5 years, meaning roughly 74-80% will experience disease recurrence.

Baseline Survival Data Without Chemotherapy

The evidence demonstrates poor outcomes for stage IIIA patients treated with surgery alone:

• 5-year overall survival for stage IIIA disease without adjuvant chemotherapy ranges from 20-26% 1
• For patients with unsuspected N2 disease (discovered at surgery) who undergo complete resection, the overall 5-year survival is approximately 35% when adjuvant chemotherapy is given 2
• The majority of relapses after surgery are distant metastases, with local recurrence risk less than 10% 3

Impact of Adjuvant Chemotherapy (What Patients Miss Without It)

The benefit of adjuvant chemotherapy provides critical context for understanding untreated outcomes:

• Adjuvant platinum-based chemotherapy provides an absolute 5-year survival benefit of 4-8.6% in stage IIIA patients 1
• The LACE meta-analysis showed stage III patients have the most pronounced benefit from adjuvant chemotherapy (HR 0.83; 95% CI 0.72-0.94) 1
• Without chemotherapy, the baseline 5-year survival of 26% for stage IIIA drops from what would be 30-35% with treatment 1

Age-Specific Considerations for Patients in Their 60s

Patients in their 60s represent a favorable age group for treatment:

• Elderly patients (≥70 years) experience comparable toxicity profiles to younger patients, with no statistically significant difference in overall adverse-event rates 4
• Patients in their 60s typically have better functional status and fewer comorbidities than those over 70, making them ideal candidates for adjuvant therapy 4
• The survival benefit of adjuvant chemotherapy remains equivalent across age groups, despite elderly patients receiving lower cumulative doses 4

Nodal Disease Burden Impact

The extent of N2 involvement significantly affects recurrence risk:

• Patients with single-station N2 disease have 40% 5-year survival versus 25% for multiple nodal involvement (p=0.028) 2
• The number of lymph nodes involved is an independent predictor of survival (p=0.032) 2
• For well-staged patients with occult N2 involvement, 5-year survival is 20-40%, whereas it is only 15% for clinically evident (cN2) disease 1

Clinical Implications

Without adjuvant chemotherapy, a patient in their 60s with resected stage IIIA (N2) squamous-cell NSCLC faces approximately 74-80% risk of recurrence within 5 years. This translates to only 20-26% remaining disease-free 1.

The decision to forgo chemotherapy in this population represents a significant missed opportunity, as:

• Adjuvant platinum-based chemotherapy is strongly recommended (Grade 1A) for all resected stage IIIA patients who did not receive neoadjuvant therapy 1, 5
• The absolute survival benefit of 4-8.6% at 5 years is clinically meaningful 1
• Patients in their 60s tolerate chemotherapy well and should not be excluded based on age alone 4

Common Pitfalls

• Do not assume age 60s is "elderly" - these patients have treatment tolerance comparable to younger cohorts and should receive standard adjuvant therapy 4
• Incomplete surgical staging leads to worse outcomes - the 5-year survival drops from 20-40% with thorough staging to only 15% without it 1
• Delaying chemotherapy beyond 12 weeks post-surgery reduces efficacy - treatment should begin only after full surgical recovery but within this window 4