Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) recommended for the patients with subsolid nodule in early lung cancer stage is not routinely. The clinical value and impact in patients with EGFR mutation on survival outcomes is further needed to be elucidated to decide whether the application of EGFR-TKIs was appropriate in early lung adenocarcinoma (LUAD) stage appearing as subsolid nodules. The inclusion of patients exhibiting clinical staging of IA-IIB subsolid nodules. Clinical information, computed tomography (CT) features before surgical resection and pathological characteristics including tertiary lymphoid structures of the tumors were recorded for further exploration of correlation with EGFR mutation and prognosis. Finally, 325 patients were enrolled into this study, with an average age of 56.8 ± 9.8 years. There are 173 patients (53.2%) harboring EGFR mutation. Logistic regression model analysis showed that female (OR = 1.944, p = 0.015), mix ground glass nodule (OR = 2.071, p = 0.003, bubble-like lucency (OR = 1.991, p = 0.003) were significant risk factors of EGFR mutations. Additionally, EGFR mutations were negatively correlated with TLS presence and density. Prognosis analysis showed that the presence of TLS was associated with better recurrence-free survival (RFS)(p = 0.03) while EGFR mutations were associated with worse RFS(p = 0.01). The RFS in patients with TLS was considerably excel those without TLS within EGFR wild type group(p = 0.018). Multivariate analyses confirmed that EGFR mutation was an independent prognostic predictor for RFS (HR = 3.205, p = 0.037). In early-phase LUADs, subsolid nodules with EGFR mutation had specific clinical and radiological signatures. EGFR mutation was associated with worse survival outcomes and negatively correlated with TLS, which might weaken the positive impact of TLS on prognosis. Highly attention should be paid to the use of EGFR-TKI for further treatment as agents in early LUAD patients who carrying EGFR mutation.

中文翻译：

---

I-II期LUAD等亚实性结节患者与EGFR突变相关的放射学特征、三级淋巴结构和生存状态。

表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKIs）推荐用于早期肺癌亚实性结节患者并不常规。需要进一步阐明EGFR突变患者的临床价值和对生存结果的影响，以决定EGFR-TKIs的应用是否适合出现亚实性结节的早期肺腺癌（LUAD）阶段。纳入临床分期为 IA-IIB 亚实性结节的患者。记录肿瘤的临床信息、手术切除前的计算机断层扫描（CT）特征以及肿瘤的三级淋巴结构等病理特征，以进一步探讨与EGFR突变和预后的相关性。最终，325 名患者纳入本研究，平均年龄为 56.8 ± 9.8 岁。有173名患者（53.2%）携带EGFR突变。 Logistic回归模型分析显示，女性（OR = 1.944，p = 0.015）、混合毛玻璃结节（OR = 2.071，p = 0.003）、气泡状透明结节（OR = 1.991，p = 0.003）是EGFR突变的显着危险因素。此外，EGFR 突变与 TLS 的存在和密度呈负相关。预后分析显示，TLS 的存在与较好的无复发生存期 (RFS) 相关（p = 0.03），而 EGFR 突变与较差的 RFS 相关（p = 0.01） ). EGFR 野生型组中 TLS 患者的 RFS 明显优于无 TLS 的患者 (p = 0.018)。多变量分析证实 EGFR 突变是 RFS 的独立预后预测因素 (HR = 3.205, p = 0.037)。 Ⅲ期LUAD、EGFR突变的亚实性结节具有特异的临床和影像学特征，EGFR突变与较差的生存结局相关，与TLS呈负相关，可能削弱TLS对预后的积极影响。 EGFR-TKI 作为药物进一步治疗携带 EGFR 突变的早期 LUAD 患者。