Risk factors for poor survival outcomes in patients with resected stage I lung cancer harbouring epidermal growth factor receptor mutations.

OBJECTIVES

To identify risk factors in patients with surgically-resected pathological stage I non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) mutations dichotomized according to the presence of ground-glass opacity (GGO).

METHODS

Patients with pathological stage I NSCLC harbouring EGFR mutations who underwent curative resection between 2010 and 2020 were retrospectively included. Cox regression was used to investigate risk factors for overall survival (OS).

RESULTS

Out of 461 patients (mean age, 61.7 ± 9.9 years; 306 women), 165 had solid tumours and 296 had subsolid tumours. In solid tumours, visceral pleural invasion (VPI) and a central location were independent risk factors for shorter OS (hazard ratio [HR], 1.95 [95% CI: 1.09, 3.49]; P = .02 and HR, 2.62 [95% CI: 1.46, 4.73]; P = .001, respectively). In subsolid tumours, older age and VPI were independent risk factors for shorter OS (HR, 1.05 [95% CI: 1.02, 1.09]; P = .002 and HR, 2.74 [95% CI: 1.52, 4.95]; P = .001, respectively). Patients with VPI(+) or central solid lung cancers exhibited the worst prognoses, whereas those with VPI(+) subsolid lung cancers exhibited comparable prognoses to those with VPI(-) or peripheral solid lung cancers.

CONCLUSION

In EGFR-mutated pathological stage I NSCLC, VPI was a common risk factor for shorter OS in patients with both subsolid and solid lung cancers. Patients with solid lung cancer with VPI or a central location had the worst prognoses.

ADVANCES IN KNOWLEDGE

Adjuvant EGFR-tyrosine kinase inhibitor may be beneficial for those with solid lung cancer with visceral pleural invasion or a central location.