title: Prognostic Factors for Survival After Recurrence in Patients With Completely Resected Lung Adenocarcinoma: Important Roles of Epidermal Growth Factor Receptor Mutation Status and the Current Staging System.
abstract: Epidermal growth factor receptor (EGFR) status and pathological stage (p-stage) were shown to be essential prognostic factors for estimating survival after recurrence of lung adenocarcinoma. In patients with EGFR mutations, those with early p-stage tumors showed better survival after disease recurrence than those with advanced p-stage tumors. The EGFR mutation status and p-stage could also prompt the design of clinical trials on adjuvant therapy for patients after complete surgical resection.
  
  
  BACKGROUND
  The current staging system and epidermal growth factor receptor (EGFR) mutation status are key factors for predicting survival. However, the significance of these factors as predictors of survival after disease recurrence (PRS) has not been sufficiently elucidated. The objective of this study was to investigate the clinicopathological factors, particularly the EGFR mutation status and pathological stage (p-stage), which affect PRS in patients with completely resected lung adenocarcinoma.
  
  
  METHODS
  We retrospectively reviewed the data of 198 consecutive lung adenocarcinoma patients with disease recurrence who previously underwent complete surgical resection in our hospital.
  
  
  RESULTS
  Of the 198 patients, 117 were examined for EGFR mutations (mutants). Mutants were detected in 57 patients (28.7%). The patients with mutants had a significantly better 3-year PRS (3y-PRS) rate (68.6%) than those with an EGFR wild type (WT) status (51.7%) or an unknown (UN) status (27.0%). The 3y-PRS rates for p-stage I to II (p-I-II) and p-stage III (p-III) were 52.5% and 29.3%, respectively. Multivariate survival analysis showed that the EGFR mutation status and p-stage had significant associations with favorable PRS. The 3y-PRS rate for mutants/p-I-II (81.4%) was significantly better than that for mutants/p-III (48.0%). Conversely, there was no significant difference between mutants/p-III and WT/UN/p-I-II (3y-PRS: 40.7%) or between mutants/p-III and WT/UN/p-III (3y-PRS: 24.4%).
  
  
  CONCLUSIONS
  EGFR status and p-stage were shown to be essential prognostic factors for estimating PRS. In patients with mutants, those with early p-stage tumors showed better PRS than those with advanced p-stage tumors.
authors.affiliation: Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan. Electronic address: yjnkudo@gmail.com.
authors.forename: Yujin
authors.initials: Y
authors.lastname: Kudo
authors.affiliation: Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan.
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Shimada
authors.affiliation: Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan; Department of Chest Surgery, St Marianna University School of Medicine, Kanagawa, Japan.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Saji
authors.affiliation: Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan.
authors.forename: Yasufumi
authors.initials: Y
authors.lastname: Kato
authors.affiliation: Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Yoshida
authors.affiliation: Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Matsubayashi
authors.affiliation: Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan.
authors.forename: Seisuke
authors.initials: S
authors.lastname: Nagase
authors.affiliation: Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Kakihana
authors.affiliation: Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan.
authors.forename: Naohiro
authors.initials: N
authors.lastname: Kajiwara
authors.affiliation: Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan.
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Ohira
authors.affiliation: Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Toshitaka
authors.initials: T
authors.lastname: Nagao
authors.affiliation: Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan.
authors.forename: Norihiko
authors.initials: N
authors.lastname: Ikeda
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000401:mortality; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004252:DNA Mutational Analysis; D066246:ErbB Receptors / Q000235:genetics*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009154:Mutation / Q000235:genetics*; D009367:Neoplasm Staging; D011013:Pneumonectomy; D011237:Predictive Value of Tests; D011379:Prognosis; D012008:Recurrence; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: C512478:EGFR protein, human; D066246:ErbB Receptors
keywords: Brain metastasis; Epidermal growth factor receptor mutation; Non–small-cell lung cancer; Pathological stage; Postoperative recurrence survival