Photo Credit: Dr. Microbe

The following is a summary of “Differential Prognostic Value of Vascular Invasion in Resected Lung Adenocarcinomas According to Epidermal Growth Factor Receptor Mutational Status,” published in the November 2023 issue of Pulmonology by Lee, et al.

It’s not clear if all people with epidermal growth factor receptor (EGFR)-mutant cancer in stages IB to IIIA should get osimertinib as an extra treatment. For a study, researchers sought to look into how arterial invasion can be used to show different levels of risk based on EGFR mutational state. Patients with stage IB to IIIA lung cancer who had surgery at a tertiary care center between 2011 and 2016. Overall survival (OS) was the study’s goal. The modified log-rank test and multivariate Cox regression with clinicopathological factors as controls were used to examine the predictive value of vascular invasion. 

They did a sensitivity analysis that looked at ground-glass opacity on CT scans as an extra covariate, as well as subgroup studies based on the stage of the disease. There were 272 cases, with 146 being women aged 58 to 72 years. Of these, 128 had EGFR-mutant adenocarcinomas. There was a higher 5-year OS rate (P <.05) in EGFR-mutant lung adenocarcinomas that did not have vascular spread. It was 90.8% (95% CI: 84.0% to 98.1%). It was found that vascular invasion was a separate, bad predictor of outcome in EGFR-mutant lung adenocarcinomas (adjusted log-rank test, P =.02; adjusted hazard ratio, 3.01; 95% CI: 1.30–7.02; P =.01). 

EGFR wild-type adenocarcinomas, on the other hand, did not have a worse outcome when they had vascular invasion (adjusted log-rank test, P =.95; adjusted hazard ratio, 1.32; 95% CI: 0.74–2.34; P =.35). The sensitivity analysis and subset studies both came up with the same results. Patients with removed lung adenocarcinomas without vascular invasion and EGFR mutations had a very good outlook. Vascular invasion had a different predictive value depending on the EGFR mutational state.

Source: sciencedirect.com/science/article/abs/pii/S1525730423001389