Abstract
BACKGROUND: The efficacy of neoadjuvant chemoimmunotherapy (NCI) in resectable epidermal growth factor receptor-mutant (EGFR-mutant) lung adenocarcinoma (LUAD) remains controversial. This study aimed to compare the clinical efficacy, survival outcomes, and recurrence patterns between EGFR-wildtype and EGFR-mutant clinically stage I-III LUAD patients following NCI. METHODS: This retrospective study enrolled 97 patients (65 in the EGFR-wildtype group and 32 in the EGFR-mutant group). After balancing baseline characteristics via propensity score matching (PSM) with a 2:1 ratio, perioperative outcomes, pathological response rates, survival rates, and recurrence patterns were compared between the two groups. RESULTS: Post-PSM (EGFR-wildtype: n=50; EGFR-mutant: n=30), the EGFR-mutant group exhibited numerically similar rates of pathological complete response (pCR) (3.3% vs. 16.0%, P=0.17) and major pathological response (MPR) (13.3% vs. 14.0%, P>0.99) compared to the EGFR-wildtype group. No significant differences were observed in 3-year overall survival (OS) [hazard ratio (HR) =0.86, P=0.86] or recurrence-free survival (RFS) (HR =0.88, P=0.73) between EGFR-mutant and wildtype groups. However, EGFR-mutant patients exhibited higher locoregional recurrence (LR) rates (16.7% vs. 2.0%, P=0.049) and reduced node (N)-stage downstaging (64.0% vs. 36.7%, P=0.02). Perioperative outcomes, including operative time, blood loss, and complications, were comparable. CONCLUSIONS: EGFR mutation status may not independently predict survival outcomes after NCI, it could influence recurrence patterns, suggesting a need for enhanced local control strategies.