Highlights
- •Resected atypical and classical EGFR-mutated lung adenocarcinoma have similar DFS.
- •L861Q mutation is associated with the poorest DFS among atypical EGFR mutations.
- •Adjuvant chemotherapy couldn't benefit atypical EGFR-mutated lung adenocarcinoma.
Abstract
Introduction
This study evaluated the clinicopathologic characteristics and prognostic impact of
atypical epidermal growth factor receptor (EGFR) mutations in patients with completely
resected lung adenocarcinoma (LUAD) and investigate whether adjuvant chemotherapy
could benefit the survival outcomes for these subjects.
Material and methods
We retrospectively reviewed resected LUAD samples from 8437 patients and identified
5358 EGFR-mutated (EGFRm) cases. Of these, 4847 had classical mutations, while 511
had atypical mutations. For further survival analysis, propensity score matching,
Kaplan–Meier curve, and Cox regression analyses were conducted.
Results
Of the 511 patients with atypical EGFRm LUAD, 131 patients had compound mutations.
The frequency of exon 20 insertion (20-ins), G719X, L861Q, S768I, and de novo T790M
were 30.3%, 32.7%, 21.9%, 9.2%, and 11.4%, respectively. These patients included a
higher proportion of males than those with classical EGFRm LUAD. Between the 483 matched
pairs of the classical and atypical EGFRm patients, no significant difference emerged
in disease-free survival (DFS) (p = 0.476). Patients with the L861Q mutation had the poorest DFS among those with atypical
EGFRm LUAD (p = 0.005). Cox regression analyses revealed that the L861Q mutation was an independent
prognostic factor for DFS in 487 patients with solely atypical EGFRm LUAD. In addition,
adjuvant chemotherapy did not improve the DFS for those patients, whether in stage
IB (p = 0.638) or II-III (p = 0.505) of the disease.
Conclusion
The L861Q mutation is an independent prognostic factor for DFS in patients with atypical
EGFRm LUAD after complete resection who would not benefit from adjuvant chemotherapy
regardless of disease stage.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: October 30, 2022
Accepted:
September 29,
2022
Received in revised form:
September 23,
2022
Received:
May 20,
2022
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
