Adjuvant epidermal growth factor receptor tyrosine kinase inhibitor in resected stage N2 non-small cell lung cancer harboring EGFR mutation.

Authors

Yinyin Xue, Qiang Wu, Wen Li, Feng Xu, Yan Li, Qinghua Zhou

Published in

Translational lung cancer research. Volume 15. Issue 5. Pages 133. May 31, 2026. Epub Apr 24, 2026.

Abstract

Adjuvant therapy with epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) is effective and safe for patients with completely resected non-small cell lung cancer (NSCLC) with EGFR mutations, but certain issues remain unresolved. This retrospective study aimed to investigate the optimal adjuvant treatment regimen and duration of EGFR-TKI treatment, evaluate the efficacy of different generations of EGFR-TKIs, and identify prognostic factors for patients with stage N2 EGFR-mutant NSCLC.
From July 31, 2010, to July 31, 2022, clinicopathological data were collected from 190 patients with N2 EGFR-mutant NSCLC who underwent complete surgical resections. Patients received either postoperative adjuvant EGFR-TKI monotherapy or adjuvant combination therapy with EGFR-TKI (chemotherapy, radiotherapy, or radiochemotherapy prior to EGFR-TKI therapy). Overall survival (OS) and disease-free survival (DFS) were assessed.
The median follow-up of the 190 patients was 49 months, with a 4-year DFS rate being 41.3% and the 4-year OS rate being 80.2%. Among these patients, 127 (66.8%) received EGFR-TKI monotherapy, while 63 (33.2%) received combination therapy. Pathological tumor-node-metastasis (pTNM) stage (stage IIIA vs. stage IIIB; P=0.01) and generation of EGFR-TKI (third vs. first; P<0.001) were significantly associated with DFS benefit, but not with OS. The number of positive mediastinal lymph nodes (<3 vs. ≥3) correlated with both DFS (P=0.02) and OS (P=0.04) benefit. EGFR mutation status (exon 19 deletion vs. exon 21 L858R point mutation) was significantly associated with DFS (P=0.03) and OS (P=0.01). However, EGFR-TKI monotherapy and combination therapy demonstrated no significant differences in terms of DFS (P=0.73) or OS (P=0.13). Longer duration of EGFR-TKI treatment (>3 vs. ≤3 years) was associated with better DFS (P<0.001) and OS (P<0.001). Moreover, pTNM stage, generation of EGFR-TKI, and duration of EGFR-TKI treatment were identified as independent prognostic factors for DFS (all P<0.05), while duration of EGFR-TKI treatment was also an independent prognostic factor for OS (P<0.001).
Our study found that EGFR-TKI monotherapy and combination therapy demonstrated no significant differences in terms of DFS or OS in patients with completely resected stage N2 EGFR-mutant NSCLC. Adjuvant treatment with third-generation EGFR-TKIs and prolonged treatment duration may offer enhanced survival benefits.

PMID:
42299229
Bibliographic data and abstract were imported from PubMed on 16 Jun 2026.

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