Epidermal Growth Factor Receptor Mutation in Resectable Lung Cancer: Association With Survival Outcomes

<h2>Abstract</h2><h3>Background</h3> Case series suggest comparable long-term survival between patients with epidermal growth factor receptor–mutant (EGFRmu) and wild-type (EGFRwt) lung cancer after surgery. We aimed to analyze our experience with stage I-III adenocarcinoma patients who underwent surgery, hypothesizing similar long-term survival. <h3>Methods</h3> From 2733 lobectomies (2013-2023), 578 adenocarcinoma patients underwent complete mutational analysis. Exclusions were stage IV disease and inadequate EGFR testing. Of 112 EGFRmu and 466 EGFRwt patients, baseline characteristics were compared, and survival trends and prognostic factors were analyzed. <h3>Results</h3> EGFRmu patients were more often female (<i>P</i> < .001), never-smokers (<i>P</i> < .001), and had stage I disease (<i>P</i> < .001). EGFRmu patients had better 5- and 10-year survival (55% vs 25%, <i>P</i> < .001), which may reflect baseline differences. Multivariable analysis identified tumor stage, age, male sex, and EGFRwt as predictors of mortality. Three-year disease-free survival was higher in EGFRmu patients compared with those with EGFRwt (75% vs 58%, <i>P</i> = .003). In multivariable analysis, EGFRwt status was not predictive of 5-year mortality in the absence of metastatic recurrence (hazard ratio, 1.05; 95% CI, 0.44-2.51; <i>P</i> = .92), but was significantly associated with increased risk of death following metastatic recurrence (hazard ratio, 1.77; 95% CI, 1.01-3.11; <i>P</i> = .048). <h3>Conclusions</h3> EGFRmu patients have distinct clinical characteristics and potentially better long-term survival, suggesting a need for tailored strategies in screening, research, and treatment.