Sublobar resection combined with furmonertinib in peripheral solid EGFR-mutated stage IA3 lung adenocarcinoma...

The optimal management strategy for peripheral solid epidermal pathological stage IA3 lung adenocarcinoma (LUAD) complicated by pulmonary dysfunction remains uncertain. Although lobectomy is traditionally regarded as the standard treatment, many patients with impaired pulmonary reserve are unable to tolerate standard resection and instead undergo sublobar resection (SR). However, SR may be associated with a higher risk of locoregional recurrence due to inadequate margins and limited lymph node assessment. Evidence supporting the use of adjuvant epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) in the treatment of resected early-stage non-small cell lung cancer (NSCLC) has grown substantially; however, research specific to stage IA3 disease-particularly in patients with both solid-type tumors and pulmonary dysfunction-is limited. Thus, determining whether SR combined with EGFR-TKIs can achieve oncologic outcomes comparable to those of lobectomy while maintaining acceptable safety profiles is of significant clinical relevance. This study aimed to evaluate the prognostic value and perioperative safety of SR combined with furmonertinib in the treatment of patients of peripheral solid EGFR-mutated stage IA3 LUAD with pulmonary dysfunction.

Patients of peripheral solid pathological stage IA3 LUAD from three thoracic tumor center were screened and enrolled in the study from January 2018 to July 2020. Based on treatment, the enrolled patients were divided into the following three groups: lobectomy group (group A); SR combined with furmonertinib group (group B), and SR alone group (group C). A Cox regression model was established by univariate and multivariate analyses. The primary study endpoint was 3-year recurrence-free survival (RFS), and the secondary study endpoints were 5-year overall survival (OS), and the incidence rate of 90-day adverse events (AEs).

A total of 160 peripheral solid stage IA3 LUAD patients were enrolled in the study, of whom 105 (66.0%) were allocated to group A, 21 (13.0%) to group B, and 34 (21%) to group C. No statistically significant difference was found in the incidence of grade 1-2 AEs within 90 days among the three groups (χ²=0.149, P=0.92). The Cox regression model showed that the International Association for the Study of Lung Cancer (IASLC) grade and treatment modality were independent risk factors for recurrence or metastasis. Kaplan-Meier survival analysis demonstrated that 3-year RFS and 5-year OS did not differ significantly between group A and group B (P=0.06; P=0.09). However, both 3-year RFS and 5-year OS were significantly better in group A (P=0.045; P=0.046) and group B (P=0.004; P=0.006) compared with group C.

For peripheral solid stage IA3 LUAD with pulmonary dysfunction, SR combined with EGFR-TKI did not increase the incidence rate of grade 1-2 AEs, and the 3y-RFS and 5y-OS were superior to those SR alone. Better study designs are required to compare long term survival between SR + EGFR-TKI and lobectomy.