The role of EGFR mutations in predicting recurrence in early and locally advanced lung adenocarcinoma following definitive therapy

Abstract

// Carlos Galvez 2 , Saya Jacob 1 , Brian S. Finkelman 4 , Jeffrey Zhao 6 , Kyle Tegtmeyer 6 , Young Kwang Chae 2 , 3 , Nisha Mohindra 2 , 3 , Ravi Salgia 5 , Borko Jovanovic 6 , Amir Behdad 4 and Victoria Villaflor 2 , 3 1 Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA 2 Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA 3 Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA 4 Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA 5 City of Hope Comprehensive Cancer Center, Los Angeles, CA, USA 6 Northwestern University, Chicago, IL, USA Correspondence to: Victoria Villaflor, email: [email protected] Keywords: non-small cell lung cancer; lung adenocarcinoma; EGFR; early; recurrence Received: March 16, 2020     Accepted: April 27, 2020     Published: May 26, 2020 ABSTRACT Introduction: Roughly one third of new non-small cell lung cancer (NSCLC) is diagnosed at early stages. While lobectomy can improve mortality in this group, about 30–55% of patients will experience disease recurrence. Increased investigation into the factors affecting recurrence, particularly tumor molecular genetics such as EGFR mutations, is needed. Materials and Methods: We conducted a single-center retrospective study of 282 patients with early or locally advanced lung adenocarcinoma, with or without EGFR mutations, who underwent definitive therapy. We then assessed recurrence, stage at recurrence, time to recurrence and progression-free survival (PFS). Results: We identified 142 patients with EGFR -mutated and 140 EGFR -wildtype lung adenocarcinoma. Overall progression between groups was equivalent at ~40% at 5 years; no difference in PFS was observed at any time-point. However, among those who recurred, EGFR -mutated lung cancer had increased rates of metastatic recurrence compared to EGFR -wildtype disease (97% vs 68%, p = 0.007). Conclusions: EGFR -mutated disease may be associated with a higher risk of metastatic recurrence. Molecular testing may be a promising tool for risk stratification and surveillance following definitive management for early stage disease. Future prospective, multi-center cohort studies are needed to confirm these findings and improve our understanding of how EGFR mutation contributes to prognosis and clinical outcomes.

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