Objectives

The ADAURA demonstrated the efficacy of osimertinib as adjuvant therapy in patients with resected stage IB-IIIA adenocarcinoma harboring epidermal growth factor receptor (EGFR) mutations. However, it is controversial whether adjuvant therapy should be applied to all these patients because of their heterogeneities. This study aimed to examine the influence of GGO and EGFR mutations on the prognosis and to identify optimal targets for the development of perioperative therapy.

Material and methods

Among the patients who underwent complete resection between 2003 and 2014 and had pathological stage IA3-IIA adenocarcinoma, 505 consecutive patients were examined for EGFR mutation status. The prognosis was analyzed among the clinicopathological factors including EGFR status and presence or absence of GGO.

Results

Of the 489 patients, 193 (39.5%) showed EGFR mutations. The recurrence-free survival (RFS) and overall survival (OS) of the EGFR mutant were slightly better than those of the EGFR wild type. There was no difference in RFS and OS between EGFR mutant and wild type in patients with GGO; however, EGFR mutant showed better OS than EGFR wild type in patients without GGO. The presence of GGO was a strong independent prognostic predictor in OS and RFS, but EGFR mutations was not predictors. In patients without GGO, EGFR mutants showed slightly higher recurrence, especially with a hazard ratio of 1.427 in stage IB.

Conclusions

Adenocarcinoma with GGO show a very good prognosis, so may not require adjuvant therapy. It will be necessary to further develop perioperative therapy in patients with poor prognosis.

中文翻译：

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表皮生长因子受体突变和放射磨玻璃样外观对早期肺腺癌患者预后的影响

目标

ADAURA 证明了奥希替尼作为辅助治疗对具有表皮生长因子受体 (EGFR) 突变的已切除 IB-IIIA 期腺癌患者的疗效。然而，由于这些患者的异质性，是否应该对所有这些患者进行辅助治疗存在争议。本研究旨在检查 GGO 和 EGFR 突变对预后的影响，并确定围手术期治疗发展的最佳靶点。

材料与方法

在 2003 年至 2014 年间接受完全切除且病理分期为 IA3-IIA 腺癌的患者中，连续检查了 505 名患者的 EGFR 突变状态。在包括EGFR状态和是否存在GGO在内的临床病理因素中分析预后。

结果

在 489 名患者中，193 名（39.5%）显示 EGFR 突变。EGFR突变体的无复发生存期（RFS）和总生存期（OS）略好于EGFR野生型。EGFR突变型和野生型GGO患者的RFS和OS无差异；然而，在没有 GGO 的患者中，EGFR 突变体显示出比 EGFR 野生型更好的 OS。GGO 的存在是 OS 和 RFS 中一个强有力的独立预后预测因子，但 EGFR 突变不是预测因子。在没有 GGO 的患者中，EGFR 突变体的复发率略高，尤其是 IB 期的风险比为 1.427。

结论

伴有 GGO 的腺癌预后非常好，因此可能不需要辅助治疗。有必要进一步发展预后不良患者的围手术期治疗。