Tumor Differentiation and EGFR Mutation Associated with Disease-Free Survival in Stage IA Lung Adenocarcinoma Patients with Curative Surgery

Lu Yang; Chong Pang; Fei Xu; Guangjian Yang; Haiyan Xu; Changli Wang; Yan Wang

doi:10.2147/CMAR.S286503

Tumor Differentiation and EGFR Mutation Associated with Disease-Free Survival in Stage IA Lung Adenocarcinoma Patients with Curative Surgery

Cancer Manag Res. 2020 Dec 7:12:12549-12556. doi: 10.2147/CMAR.S286503. eCollection 2020.

Authors

Lu Yang^#¹, Chong Pang^#², Fei Xu¹, Guangjian Yang¹, Haiyan Xu³, Changli Wang², Yan Wang¹

Affiliations

¹ Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People's Republic of China.
² Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Lung Cancer Center, Tianjin, 300060, People's Republic of China.
³ Department of Comprehensive Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People's Republic of China.

^# Contributed equally.

Abstract

Background: Nearly 30% of stage IA non-small-cell lung cancer patients eventually die of recurrence or metastasis. This study aimed to predict stage IA lung adenocarcinoma (LADC) patients who underwent radical resection with a high risk of recurrence or metastasis.

Methods: Information on clinicopathological, genetic and therapeutic features and recurrence status was collected in this retrospective and two-center study. A nomogram based on multivariate analysis was established to predict disease-free survival. Further stratification was performed to identify populations with a high risk of relapse.

Results: A total of 1584 patients with pathological stage IA LADC who underwent radical surgery between 2011 and 2015 were enrolled from two medical institutions in this study. The nomogram including tumor differentiation and EGFR mutation had a higher C-index of 0.880 (95% CI 0.833-0.926) compared to 0.598 (95% CI 0.486-0.711) for the AJCC 8th TNM staging system. Furthermore, the C-index for the validation cohort was 0.798 (95% CI 0.738-0.857). In addition, the 3-year cumulative nonrecurrence rate in the high-risk group stratified by this model was 21.8% compared to 98.1% in the low-risk group.

Conclusion: This study proposed a new nomogram including tumor differentiation and EGFR mutation to predict recurrence or metastatic probability in stage IA LADC patients who underwent radical surgery. This nomogram could identify patients in the high-risk group and help guide adjuvant treatment in the future.

Keywords: disease-free survival; lung adenocarcinoma; nomogram; stage IA.

Grants and funding

This research was supported by the CAMS Innovation Fund for Medical Sciences (CIFMS; No.2019-12M-2-003).