{
  "abstract": "Rare epidermal growth factor receptor (EGFR) mutations are heterogeneous, and their significance after complete resection of stage I lung adenocarcinoma (LUAD) remains unclear. We evaluated the mutation spectrum, clinicopathological correlates, postoperative recurrence patterns, and survival outcomes of a study-defined primary rare EGFR mutation cohort after predefined exclusion of isolated T790M, exon 20 insertion-only disease, and major driver co-alterations. Consecutive patients who underwent R0 resection for pathological stage I LUAD with postoperative EGFR testing at West China Hospital between 2011 and 2024 were retrospectively identified. Rare mutation subtypes, compound mutation patterns, recurrence-free survival (RFS), and overall survival (OS) were assessed. Prognostic factors were evaluated using Cox regression, and outcomes were compared with classical EGFR mutations using 1:2 propensity score matching (PSM). Among 1,357 EGFR-positive stage I LUADs, 176 patients formed the primary rare-mutation cohort. The most frequent rare mutation groups were G719X (n=104), L861Q (n=71), and S768I (n=24), with distinct compound mutation patterns. Five-year OS and RFS were 95.8% and 93.5%, respectively. A micropapillary component was associated with shorter RFS in the primary multivariable model [hazard ratio (HR) =4.062, 95% confidence interval (CI): 1.134-14.544; P=0.03]. The unweighted number of pathological high-risk features was associated with RFS (global log-rank P=0.039), whereas adjuvant systemic therapy among stage IB patients and compound rare mutation status were not significantly associated with RFS. After PSM under comparable observed postoperative management, the rare-mutation group had similar OS and a lower recurrence risk than the classical-mutation group. After exclusion of isolated T790M and exon 20 insertion-only disease, completely resected stage I LUAD with rare EGFR mutations showed favorable long-term outcomes. Compared with classical mutations, rare mutations were associated with lower recurrence risk and similar OS after treatment-balanced matching. Pathological features, particularly a micropapillary component, may help identify patients at higher risk of recurrence.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Thoracic Surgery and Institute of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, China."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 11,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Lajie Man"
    },
    {
      "affs": [
        0
      ],
      "name": "Liang Xia"
    },
    {
      "affs": [
        0
      ],
      "name": "Chuan Li"
    },
    {
      "affs": [
        0
      ],
      "name": "Xiaohu Hao"
    },
    {
      "affs": [
        0
      ],
      "name": "Xiaolong Zhang"
    },
    {
      "affs": [
        0
      ],
      "name": "Ruichen Cui"
    },
    {
      "affs": [
        0
      ],
      "name": "Chenglin Guo"
    },
    {
      "affs": [
        0
      ],
      "name": "Yafei Xie"
    },
    {
      "affs": [
        0
      ],
      "name": "Jiahan Cheng"
    },
    {
      "affs": [
        0
      ],
      "name": "Chengwu Liu"
    },
    {
      "affs": [
        0
      ],
      "name": "Lunxu Liu",
      "orcid": "0000-0003-3964-5378"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/11k9xzg5kfrrm.bib",
  "cited_by": 0,
  "doi": "10.21037/tlcr-2026-0953",
  "fulltext_url": "https://europepmc.org/articles/PMC13743438",
  "id": "11k9xzg5kfrrm",
  "issns": [
    "2218-6751",
    "2226-4477"
  ],
  "landing_url": "https://europepmc.org/article/MED/42999644",
  "language": "eng",
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2740|Lung Cancer Treatments and Mutations"
    ]
  ],
  "openalex": "W7223853593",
  "pdf_url": "https://europepmc.org/articles/PMC13743438?pdf=render",
  "pmcid": "PMC13743438",
  "pmid": "42999644",
  "published": "2026-10-15",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/11k9xzg5kfrrm.ris",
  "sources": [
    {
      "first_seen": "2026-11-09T15:20:41Z",
      "native_id": "MED:42999644",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42999644"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "journal-openalex:2730|Lung Cancer Research Studies",
      "subfield": "oncology"
    }
  ],
  "title": "Rare epidermal growth factor receptor (EGFR) mutations in completely resected stage I lung adenocarcinoma: a real-world study of mutation spectrum, clinicopathological features, and prognosis.",
  "title_text": "Rare epidermal growth factor receptor (EGFR) mutations in completely resected stage I lung adenocarcinoma: a real-world study of mutation spectrum, clinicopathological features, and prognosis.",
  "type": "peer-reviewed",
  "updated_at": "2026-11-09T15:20:41Z",
  "url": "https://research.draconitic.com/paper/11k9xzg5kfrrm",
  "venue": "Translational lung cancer research",
  "versions": []
}