Prognostic and Diagnostic Value of Node-RADS for Non-Small Cell Lung Cancer Following Neoadjuvant Therapy: A Multicenter Cohort Study

Background/Objectives: The aim of this study was to evaluate the performance of the Node-RADS scoring system for predicting lymph node metastasis in patients with non-small cell lung cancer (NSCLC) after neoadjuvant therapy and to assess its prognostic value for overall survival (OS) and event-free survival (EFS). Methods: A total of 247 patients with non-small cell lung cancer (NSCLC) from three centers who underwent surgery after neoadjuvant therapy were retrospectively enrolled. Post-treatment Node-RADS scores were reassessed by radiologists based on preoperative contrast-enhanced CT images. Logistic regression analysis was used to evaluate the predictive value of Node-RADS for postoperative pathological lymph node metastasis, while Cox regression analysis was performed to assess its associations with OS and EFS. Kaplan–Meier analysis was used to compare survival differences among different Node-RADS risk groups. Results: A total of 247 patients were included in this study, comprising 211 men and 36 women, with a mean age of 63.40 ± 7.58 years. Post-treatment Node-RADS score was significantly associated with both OS and EFS. In multivariable Cox regression analysis, Node-RADS remained independently associated with OS (HR = 1.79, 95% CI: 1.50–2.15, p < 0.001) and EFS (HR = 1.41, 95% CI: 1.23–1.62, p < 0.001). Using a Node-RADS score of 3 as the cutoff value, patients in the high-risk group had significantly worse OS and EFS than those in the low-risk group (both p < 0.01). For the prediction of lymph node metastasis, the inclusion of post-treatment Node-RADS markedly improved the discriminatory performance of the model, with an AUC of 0.769, a sensitivity of 46.2%, and a specificity of 87.6%. Conclusions: The Node-RADS score may provide useful imaging information for patient-level assessment of residual lymph node metastasis risk and survival stratification in patients with NSCLC after neoadjuvant therapy. These findings suggest that the scoring system may support patient-level post-treatment risk assessment.