Positive EGFR mutation status is a risk of recurrence in pN0–1 lung adenocarcinoma when combined with pathological stage and histological subtype: A retrospective multi-center analysis. (March 2020)

• Record Type: Journal Article
• Authors: Ito, Masaoki; Miyata, Yoshihiro; Tsutani, Yasuhiro; Ito, Hiroyuki; Nakayama, Haruhiko; Imai, Kentaro; Ikeda, Norihiko; Okada, Morihito
• Is Part Of: Lung cancer. Volume 141(2020)
• Page Start: 107
• Page End: 113
• Publication Date: 2020-03
• Subjects: EGFR -- Lung adenocarcinoma -- Recurrence -- Surgery -- Predominant subtype; Lungs -- Cancer -- Periodicals; Lung Neoplasms -- Abstracts; Lung Neoplasms -- Periodicals; Poumons -- Cancer -- Périodiques; Lungs -- Cancer; Periodicals; Electronic journals; Electronic journals; 616.99424
• DOI: 10.1016/j.lungcan.2020.01.018
• Languages: English
• ISSNs: 0169-5002

Abstract

Highlights: Risk of recurrence changes by pStage and histological subtype in adenocarcinoma. Distribution of EGFR mutation also varies among pStage and histological subtypes. Risk of postoperative relapse should be discussed among cases with recurrent risks. EGFR mutant cases showed worse RFS in pStageIA1–IB/high risk type and pStgaeIIA–IIIA. EGFR status can be recurrence risk by considering pStage and histological subtype. Abstract: Objectives: Recurrence risk of resected lung adenocarcinoma is represented by pathological stage (pStage), histological subtype, and potentially by EGFR mutation. However, the relationship among these factors and their combined impact on prognosis are unclear. Materials and Methods: Using a multicenter database, we retrospectively investigated the prognostic impact of EGFR mutation status in relation to pStage and histological subtype in resected pN0–1M0 lung adenocarcinoma. Results: Among 1155 pN0–1M0 adenocarcinoma cases, pStage 0 and IA1–IB were confirmed predominantly in EGFR -positive cases. AIS, MIA, and lepidic predominant adenocarcinoma were also more frequently found in EGFR -positive cases and showed no/little recurrence regardless of EGFR mutation status. The 5-year recurrence-free survival (RFS) of papillary, acinar, solid, and micropapillary predominant adenocarcinoma was stratified by pStage (IA1–IB, IIA–IIIA) or histological malignant subtype (intermediate or high malignant subtype), and more finely subdivided by EGFR mutation status. Positive EGFR mutation cases showed worse RFS in both classifications. Low malignant subtype and pStage IA1–IB intermediate malignant subtype showed low frequency of recurrence. Whereas, in pStage IA1–IB high malignant subtype and pStage IIA–IIIA cases, EGFR- positive cases showed poorer 5-year RFS than EGFR -negative (49.6% and 75.6%, respectively, hazard ratio [HR] = 1.84, 95% CI = 1.38–7.42, p < 0.01) and multivariate analysis indicated positive EGFR mutation status was significantly related to poorer PRF (HR = 2.005, 95% CI = 1.029–3.906, p = 0.041). Conclusion: EGFR mutation harbored primarily in early-stage or low-malignant histological subtypes with no/little recurrence. In pN0–1M0 adenocarcinoma with higher risk of recurrence, positive EGFR mutation cases showed worse RFS. EGFR mutation status enables better stratification of recurrence risk when considering pStage and histological malignant subtype.