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

Abstract

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 harboring 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 tumors and 296 had subsolid tumors. In solid tumors, 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 = 0.02 and HR, 2.62 [95% CI: 1.46, 4.73]; p = 0.001, respectively). In subsolid tumors, older age and VPI were independent risk factors for shorter OS (HR, 1.05 [95% CI: 1.02, 1.09]; p = 0.002 and HR, 2.74 [95% CI: 1.52, 4.95]; p = 0.001, 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.