{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T17:08:45Z","timestamp":1778692125294,"version":"3.51.4"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2025,11,23]],"date-time":"2025-11-23T00:00:00Z","timestamp":1763856000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Object\u0131ves<\/jats:title>\n                    <jats:p>T4 non-small-cell lung cancer comprises a biologically and anatomically heterogeneous group. The 9th edition of the Tumour-Node-Metastasis staging system introduced refined T4 definitions and subdivided N2 disease into single- and multi-station involvement. This study aimed to assess long-term survival and prognostic factors in surgically treated T4 non-small-cell lung cancer patients, focusing on T4 subgroups and nodal status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analysed patients who underwent resection for pathologically confirmed T4 non-small cell lung cancer between 2006 and 2024. Patients were categorized based on T4 criteria: tumour diameter &amp;gt;7 cm, adjacent structure invasion, or multiple T4 features. Survival outcomes were assessed using Kaplan-Meier, Aalen-Johansen and Cox regression analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 191 patients were analysed. The 5-year overall survival rate was 34.1%, varying across subgroups: 38.7% (size), 29.9% (invasion), and 6.1% (multiple criteria) (P\u2009&amp;lt;\u2009.001). Adjuvant chemotherapy was associated with improved overall survival (hazard ratio [HR]: 0.511; P\u2009=\u2009.001), while N2 disease (HR: 1.750; P\u2009=\u2009.012) and multiple T4 features (HR: 2.590; P\u2009&amp;lt;\u2009.001) predicted worse outcomes. Similar patterns were observed in recurrence-free survival. N2 involvement was particularly adverse in the invasion group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclus\u0131ons<\/jats:title>\n                    <jats:p>T4 aetiology and nodal status significantly impact survival following surgery. These findings support the prognostic utility of the 9th Tumour-Node-Metastasis edition and underscore the value of tailored surgical strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/icvts\/ivaf276","type":"journal-article","created":{"date-parts":[[2025,11,22]],"date-time":"2025-11-22T12:55:48Z","timestamp":1763816148000},"source":"Crossref","is-referenced-by-count":1,"title":["Subgroup and Prognostic Factor Analysis in T4 Lung Cancer Based on the 9th Tumour-Node-Metastasis Classification"],"prefix":"10.1093","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5083-8088","authenticated-orcid":false,"given":"Bekir","family":"Elma","sequence":"first","affiliation":[{"name":"Department of Thoracic Surgery, Faculty of Medicine, Gaziantep University , 27310 Gaziantep,","place":["Turkey"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3068-408X","authenticated-orcid":false,"given":"Ahmet","family":"Ulu\u015fan","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Faculty of Medicine, Gaziantep University , 27310 Gaziantep,","place":["Turkey"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6548-1664","authenticated-orcid":false,"given":"Maruf","family":"\u015eanl\u0131","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Faculty of Medicine, Gaziantep University , 27310 Gaziantep,","place":["Turkey"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8687-3819","authenticated-orcid":false,"given":"Ahmet Ferudun","family":"I\u015f\u0131k","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Faculty of Medicine, Gaziantep 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