Prognostic implication of EGFR gene mutations and histological classification in patients with resected stage I lung adenocarcinoma

<div><p>Introduction</p><p>The prognostic value of epidermal growth factor receptor (EGFR) mutations and the correlation between EGFR mutations and the new International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society (IASLC/ATS/ERS) histological classification remain controversial. The current study aimed to investigate the pure prognostic role of EGFR mutations in treatment-naïve patients with resected stage I lung adenocarcinoma.</p><p>Methods</p><p>We retrospectively reviewed 373 patients with stage I pulmonary non-small-cell lung cancer who underwent complete surgical resection between January 2010 and May 2014. The tumors were classified according to IASLC/ATS/ERS criteria. EGFR mutation status was determined by established methods.</p><p>Results</p><p>A total of 120 patients were included for analysis; 87 had tumors with EGFR mutations and 33 had wild-type tumors. More low- and intermediate-grade tumors had EGFR mutations, and nearly half of the high-grade tumors were wild-type (75.7% versus 46.2%, p = 0.041). Patients with low-grade tumors had significantly greater median disease-free survival (DFS) (76.8 versus 13 months, p < 0.0001) and better overall survival (OS) (median OS not reached, p = 0.0003) than those with intermediate- and high-grade tumors. Tumor recurrence was 41.4% and 30.3% in mutant and wild-type patients. The 5-years survival rate was 54% and 71.2%. Multivariate analysis revealed that the new histological classification and the pathologic stage were independent predictors of both DFS and OS. EGFR mutation status had no prognostic implications.</p><p>Conclusion</p><p>Low grade tumors according to IASLC/ATS/ERS histological classification and the pathologic stage IA tumors of resected stage I lung adenocarcinomas independently predict better DFS and OS. EGFR mutations were frequently seen in histologically low- and intermediate-grade tumors but not a prognostic factor.</p></div

Overall survival of patients with stage I resected pulmonary adenocarcinoma.

<p>(A) Overall survival in relation to EGFR mutation status. (B) Overall survival in relation to tumor pathologic stage. (C) Overall survival in relation to histological classification.</p

Treatment modalities for recurrent disease.

<p>Treatment modalities for recurrent disease.</p

Cox proportional hazards model for analysis of overall survival.

<p>Cox proportional hazards model for analysis of overall survival.</p

Disease-free survival of patients with stage I resected pulmonary adenocarcinoma.

<p>(A, B) Disease-free survival in relation to EGFR mutation status. (C) Disease-free survival in relation to tumor pathologic stage. (D) Disease-free survival in relation to tumor histological classification.</p

Demographics of patients and tumor characteristics.

<p>Demographics of patients and tumor characteristics.</p

Comparison of Patients with Acute and Chronic Aspiration.

<p>^#Fisher’s exact tests.</p><p>Comparison of Patients with Acute and Chronic Aspiration.</p

Patient Characteristics.

<p>Patient Characteristics.</p

The multiple modalities of the flexible bronchoscopy included forceps, basket, loop, coagulation forceps, coagulation knife, and probe for cryotherapy.

<p>The multiple modalities of the flexible bronchoscopy included forceps, basket, loop, coagulation forceps, coagulation knife, and probe for cryotherapy.</p

Flexible Bronchoscopy with Multiple Modalities for Foreign Body Removal in Adults - Fig 2

<p><b>(A)</b> Atelectasis of the right lower lung. <b>(B)</b> Foreign body in the right intermediate bronchus. <b>(C)</b> Granulation tissue covered the foreign body. <b>(D)</b> Bony foreign body after removing the granulation tissue by cryotherapy and forceps. <b>(E)</b> A patent right intermediate bronchus is noted after foreign body removal. <b>(F)</b> The foreign body.</p