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EGFR mutation impacts recurrence in high-risk early-stage lung adenocarcinoma in the IASLC grading system

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Abstract

Introduction

The developments of perioperative treatments for patients with high-risk early-stage lung cancer are ongoing, however, real-world data and evidence of clinical significance of genetic aberration are lacking in this population. This study aimed to identify patients with early-stage lung adenocarcinoma at high risk for recurrence based on pathological indicators of poor prognosis, including the International Association for the Study of Lung Cancer (IASLC) grade, and elucidate the prognostic impact of epidermal growth factor receptor mutation (EGFRm) status.

Methods

This retrospective study included 494 consecutive patients who underwent complete resection for pathological stage I lung adenocarcinoma between 2011 and 2016. The patients were evaluated for EGFRm and IASLC grade. Multivariable analysis was used to identify pathological factors for poor prognosis associated with recurrence-free survival (RFS) and overall survival (OS). Patients with any one of these factors were classified into the high-risk group. The prognostic impact of EGFRm was evaluated using RFS, OS, and cumulative recurrence proportion.

Results

Multivariable analysis for RFS and OS revealed that IASLC grade 3, pathological invasion size>2 cm, and presence of lymphovascular invasion were indicators of poor prognosis. EGFRm-positive patients had a higher incidence of all types of recurrence, including central nervous system (CNS) metastasis and distant metastasis in high-risk group, but not in low-risk group.

Conclusions

This study provides evidence that patients with EGFRm-positive stage I lung adenocarcinoma in the high-risk group have an increased risk of recurrence, including CNS metastasis. These findings highlight the need for development of adjuvant treatment in this population.

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Acknowledgements

Supported by the National Cancer Center Research and Development Funds (23-A-16, 23-A-18, 26-A-4, 29-A-3).

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Authors and Affiliations

  1. Department of Thoracic Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan

    Kotaro Nomura, Keiju Aokage, Yasunori Kaminuma, Yutaro Koike, Tomohiro Miyoshi, Kenta Tane, Joji Samejima & Masahiro Tsuboi

  2. Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Chiba, Japan

    Yasunori Kaminuma, Tokiko Nakai, Tetsuro Taki & Genichiro Ishii

  3. Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Tokyo, Japan

    Yasunori Kaminuma & Genichiro Ishii

  4. Biostatistics Division, Center for Research Administration and Support, National Cancer Center Hospital East, Kashiwa, Japan

    Masashi Wakabayashi

  5. Clinical Research Support Office, National Cancer Center Hospital East, Kashiwa, Japan

    Takashi Ikeno

  6. Division of Innovative Pathology and Laboratory Medicine, Exploratory Oncology Research & Clinical Trial Center, National Cancer Center, Kashiwa, Chiba, Japan

    Genichiro Ishii

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  1. Kotaro Nomura
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Correspondence to Keiju Aokage.

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Nomura, K., Aokage, K., Kaminuma, Y. et al. EGFR mutation impacts recurrence in high-risk early-stage lung adenocarcinoma in the IASLC grading system. Int J Clin Oncol 29, 248–257 (2024). https://doi.org/10.1007/s10147-023-02464-1

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  • DOI: https://doi.org/10.1007/s10147-023-02464-1

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