The Prognostic and Mutational Characteristics of Multiple Early-stage LungCancers Manifesting as Subsolid Nodules

Introduction/Objective: To explore the prognostic and EGFR mutational characteristics of patients with multiple lung subsolid nodules (SSNs) after surgical resection. Methods: A retrospective analysis was performed on 250 patients with pathologically confirmed T1aN0M0 lung cancer, who were divided into single SSN (n = 126), multiple SSNs (n = 42), and single solid nodule (n = 82) groups. All patients underwent a single surgical resection and were followed up to assess recurrence-free survival (RFS) and overall survival (OS). EGFR mutation testing was performed in 131 patients. Results: The 5-year OS rates were 100% (single SSN group), 95.2% (multiple SSNs group), and 89.0% (solid nodule group) (single vs. multiple SSNs, P < 0.05; multiple SSNs vs. solid nodules, P = 0.226). The 5-year RFS rates were 99.2%, 88.1%, and 76.8%, respectively (single vs. multiple SSNs, P < 0.01; multiple SSNs vs. solid nodules, P = 0.111). EGFR mutation rates were 69.2%, 71.4%, and 42.1% in the three groups, respectively. Discussion: Patients with multiple subsolid nodules on CT had a slightly worse prognosis than those with a single subsolid nodule. It may be necessary to reconsider the rationale for simply classifying all multiple subsolid nodules as multiple primary lung cancers (MPLC). The high EGFR mutation rate in the multiple subsolid nodule group suggests that targeted therapy may be a potential treatment option for patients with multiple subsolid lesions. Conclusion: CT-detected multiple subsolid nodules are associated with a slightly poorer prognosis than single subsolid nodules, resist simplistic classification as multiple primary lung cancers, and exhibit a high EGFR mutation rate that supports targeted therapy as a treatment option.