Increased risk of recurrence in resected EGFR‐positive pN0M0 invasive lung adenocarcinoma

Abstract

BackgroundThis study was conducted to evaluate the prognostic and recurrent impact of EGFR mutation status in resected pN0M0 lung adenocarcinoma with consideration of the histological subtype.MethodsFollowing retrospective analysis of whole 474 consecutive pathological N0M0 lung adenocarcinoma patients, the prognostic significance of EGFR mutation status was evaluated in limited 394 subjects. Overall survival and recurrence‐free interval (RFI) were estimated using the Kaplan–Meier method and compared using a log‐rank test. Univariate and multivariate analyses were performed using Cox proportional hazard models.ResultsThe five‐year RFI was 85.7% and 93.3% for EGFR positive (n = 176) and negative (n = 218) cases, respectively (hazard ratio [HR] 1.992, 95% confidence interval [CI] 1.005–3.982; P = 0.048). Following the exclusion of specific subtypes free from recurrence or EGFR mutation (adenocarcinoma in situ, minimally invasive adenocarcinoma, and invasive mucinous adenocarcinoma), the five‐year RFI was obviously poorer in EGFR positive compared to negative cases (80.7% and 92.1%, respectively; HR 2.163, 95% CI 1.055–4.341; P = 0.035). Multivariate analysis excluding the specific subtypes confirmed that male sex, age, current or Ex‐smoking status, pleural invasion, and EGFR‐positive status were independently associated with shorter RFI. No significant differences in five‐year overall survival were found between the EGFR mutation positive and negative groups (88.7% and 93.7%, respectively; HR 1.630, 95% CI 0.787–3.432; P = 0.2).Conclusion EGFR mutations are associated with recurrence in pN0M0 lung adenocarcinoma. EGFR mutation status and histological subtype should be considered when evaluating the risk of recurrence in resected lung adenocarcinoma patients.

The role of EGFR mutations in predicting recurrence in early and locally advanced lung adenocarcinoma following definitive therapy

“…Our study reports a novel finding of increased metastatic recurrence in patients with early and locally advanced EGFR-mutated NSCLC undergoing definitive therapy compared to EGFR-wildtype disease. The increased rate of metastatic recurrence found is consistent with prior multi-variate analysis showing decreased relapse-free survival in cases of EGFR-mutated disease [19,20]. We did not observe any statistically significant change to survival based on EGFR status (PFS 59% in EGFR-mutant vs 60% in EGFR-wildtype at 5 years).…”

Transition of Treatment for Ground Glass Opacity–Dominant Non-Small Cell Lung Cancer

“…We previously evaluated gene expression of NSCLC comprehensively. Ito M et al evaluated typical driver mutation for lung cancer, EGFR mutation, in 394 resected pN0M0 lung adenocarcinomas (24). In this study, we revealed that the frequency of EGFR mutation is higher in adenocarcinoma with a concomitant lepidic component, such as AIS and MIA.…”

Clinicopathologic features and prognostic value of epidermal growth factor receptor mutation in patients with pT1a and pT1b invasive lung adenocarcinoma after surgical resection

“…However, our study found that the rate of EGFR mutation was similar in pT1a and pT1b (57.1% vs. 65.1%, P=0.286), it might be explained that our study excluded adenocarcinoma in situ (AIS) and microinvasive adenocarcinoma (MIA) patients, which trend to be have a (13,15,26,27). EGFR mutation status has been reported to be a prognostic factor in several studies; some studies believed that EGFR mutation was a good prognostic factor for lung adenocarcinoma (5,8,10,28), while others believed that it was a poor prognostic factor including our previous study (12,13). To sum up, there remains controversial in the prognostic value of EGFR mutation.…”

“…However, whether the EGFR mutation itself has an impact on the prognosis of lung adenocarcinoma patients remains controversial. Several previous studies demonstrated that the status of EGFR mutation could predict the prognosis in lung adenocarcinoma patients (5,(8)(9)(10)(11)(12)(13). In contrast, some studies revealed that EGFR mutation was not a risk factor for postoperative recurrence of lung adenocarcinoma (3,(14)(15)(16)(17)(18)(19)(20).…”