{
  "abstract": "Adjuvant epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) therapy improves prognosis in patients with resected EGFR-mutated non-small cell lung cancer. However, evidence supporting its use in stage I disease with pathological high-risk features remains limited. We evaluated the association between adjuvant EGFR-TKI therapy and survival outcomes in patients with completely resected stage I invasive lung adenocarcinoma (LUAD) (≤3 cm), sensitizing EGFR mutations, and pathological high-risk features. This retrospective cohort study included patients who underwent complete resection for stage I invasive LUAD (≤3 cm) between January 2011 and May 2024. Eligible patients had an EGFR exon 19 deletion or exon 21 L858R mutation and at least one pathological high-risk feature, including lymphovascular invasion, visceral pleural invasion, spread through air spaces, high-grade histologic patterns (micropapillary, solid, and complex glandular patterns), or poor differentiation. The study outcomes were relapse-free survival (RFS) and overall survival (OS). The primary analysis used a 90-day landmark design, with baseline differences addressed using stabilized inverse probability of treatment weighting (IPTW). Survival distributions were estimated using the Kaplan-Meier method and compared using the log-rank test. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Simon-Makuch curves and time-dependent Cox regression analysis were additionally used to account for changes in treatment exposure over time. A 120-day landmark analysis was performed as a sensitivity analysis. Among 357 eligible patients, 354 remained alive and relapse-free at the 90-day landmark. Of these, 104 had initiated adjuvant EGFR-TKI therapy by the landmark, whereas 250 had not. In the unweighted landmark analysis, adjuvant EGFR-TKI therapy was associated with improved RFS (P=0.004; HR =0.27, 95% CI: 0.13-0.56). This association remained significant after IPTW adjustment (P=0.009; HR =0.28, 95% CI: 0.11-0.68). No significant difference in OS was observed in either the unweighted analysis (P=0.91; HR =0.93, 95% CI: 0.33-2.63) or the IPTW-weighted analysis (P=0.38; HR =1.34, 95% CI: 0.50-3.61). In the time-dependent analysis, EGFR-TKI exposure was associated with a lower hazard of relapse (P<0.001; HR =0.27, 95% CI: 0.14-0.52) but not with OS (P=0.49; HR =1.14, 95% CI: 0.41-3.19). The 120-day landmark sensitivity analysis yielded consistent results. In patients with completely resected stage I invasive LUAD (≤3 cm), sensitizing EGFR mutations, and pathological high-risk features, adjuvant EGFR-TKI therapy was associated with improved RFS, whereas no significant association with OS was observed.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 12,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Jie Cao"
    },
    {
      "affs": [
        0
      ],
      "name": "Zhaokang Huang"
    },
    {
      "affs": [
        0
      ],
      "name": "Fang Qiu"
    },
    {
      "affs": [
        0
      ],
      "name": "Nan Chen"
    },
    {
      "affs": [
        0
      ],
      "name": "Zhiyu Peng"
    },
    {
      "affs": [
        0
      ],
      "name": "Zetao Liu"
    },
    {
      "affs": [
        0
      ],
      "name": "Xizhou Liao"
    },
    {
      "affs": [
        0
      ],
      "name": "Xiaorong Zong"
    },
    {
      "affs": [
        0
      ],
      "name": "Peidi Li"
    },
    {
      "affs": [
        0
      ],
      "name": "Chenglin Guo"
    },
    {
      "affs": [
        0
      ],
      "name": "Jiandong Mei"
    },
    {
      "affs": [
        0
      ],
      "name": "Lunxu Liu"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/1cm0a0xx893e4.bib",
  "cited_by": 0,
  "doi": "10.21037/tlcr-2026-0951",
  "fulltext_url": "https://europepmc.org/articles/PMC13743449",
  "id": "1cm0a0xx893e4",
  "issns": [
    "2218-6751",
    "2226-4477"
  ],
  "landing_url": "https://europepmc.org/article/MED/42999658",
  "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": "W7221193562",
  "pdf_url": "https://europepmc.org/articles/PMC13743449?pdf=render",
  "pmcid": "PMC13743449",
  "pmid": "42999658",
  "published": "2026-09-24",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/1cm0a0xx893e4.ris",
  "sources": [
    {
      "first_seen": "2026-11-09T15:20:41Z",
      "native_id": "MED:42999658",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42999658"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "journal-openalex:2730|Lung Cancer Research Studies",
      "subfield": "oncology"
    }
  ],
  "title": "Association between adjuvant EGFR-TKI therapy and survival outcomes in completely resected stage I invasive lung adenocarcinoma (≤3 cm) with sensitizing EGFR mutations and pathological high-risk features.",
  "title_text": "Association between adjuvant EGFR-TKI therapy and survival outcomes in completely resected stage I invasive lung adenocarcinoma (≤3 cm) with sensitizing EGFR mutations and pathological high-risk features.",
  "type": "peer-reviewed",
  "updated_at": "2026-11-09T15:20:41Z",
  "url": "https://research.draconitic.com/paper/1cm0a0xx893e4",
  "venue": "Translational lung cancer research",
  "versions": []
}