Nomogram Predicts Survival in Advanced EGFR-Mutant Lung Cancer on TKIs

A retrospective study of 250 patients with advanced EGFR-mutant lung adenocarcinoma has produced a nomogram that predicts overall survival and sorts patients into risk groups based on four variables: age, EGFR mutation subtype, serum CYFRA21-1 level, and the generation of tyrosine kinase inhibitor (TKI) used as first-line treatment. The work, published in BMC Pulmonary Medicine, addresses a practical gap in managing a cancer subtype in which targeted therapy extends survival but resistance inevitably develops.

The enrolled patients had stage IIIB to IV disease, carried EGFR mutations, received first-line TKIs, and underwent pretreatment contrast-enhanced thoracic CT between January 2015 and April 2024. There were 105 males and 145 females, with a mean age of 61 ± 11 years. Median overall survival in the cohort was 33 months (95% CI 25–37).

Multivariate Cox regression identified several factors tied to mortality risk. Patients with the exon 21-L858R mutation had a higher risk of death than those with exon 19-deletion mutations (HR = 1.541, P = 0.030). Age of 60 years or older (HR = 1.682, P = 0.003) and serum CYFRA21-1 of at least 4.5 ng/mL (HR = 1.767, P = 0.005) were each associated with relatively higher mortality risk. In contrast, treatment with third-generation EGFR-TKIs was associated with a decreased mortality risk compared with first- or second-generation drugs (HR = 0.476, P < 0.001).

From these variables the researchers built a nomogram predicting survival at 12, 24, 36, and 48 months. The time-dependent area under the curve values were 0.745, 0.717, 0.645, and 0.673 respectively, and the global Harrell’s concordance index (C-index) was 0.674. These are moderate discriminative figures: the model performed best in the first two years and less well at later time points.

Because the model was developed and evaluated in the same dataset, the team ran an internal validation using nonparametric bootstrapping with 1000 resamples. The corrected global C-index was 0.662, and the validated AUCs for 12-, 24-, 36-, and 48-month survival were 0.766, 0.714, 0.631, and 0.672.

The nomogram also stratified patients into risk groups.

Lung adenocarcinoma is the most common subtype of non-small cell lung cancer, and EGFR mutations occur frequently in Asian populations. First-line TKIs improve survival, but resistance is inevitable, leading to disease progression and death.

The authors conclude that the nomogram, incorporating age, EGFR genotype, serum CYFRA21-1 level, and EGFR-TKI generation, can predict overall survival and facilitate risk stratification in patients with advanced EGFR-mutated lung adenocarcinoma receiving first-line TKIs.

Subject of Research: A predictive nomogram for overall survival and risk stratification in advanced EGFR-mutant lung adenocarcinoma treated with first-line tyrosine kinase inhibitors.

Article Title: Overall survival prediction and risk stratification for advanced EGFR-mutant lung adenocarcinoma patients treated with first-line tyrosine kinase inhibitors

Article References: Tang, W., Feng, J., Kang, Y., Zhang, Z., Yin, Y., Zhong, J., Luo, S., & Zhong, J. (2026). Overall survival prediction and risk stratification for advanced EGFR-mutant lung adenocarcinoma patients treated with first-line tyrosine kinase inhibitors. BMC Pulmonary Medicine. https://doi.org/10.1186/s12890-026-04853-4

Image Credits: AI Generated

DOI: 10.1186/s12890-026-04853-4

Keywords: lung adenocarcinoma, EGFR mutation, tyrosine kinase inhibitors, overall survival, nomogram, risk stratification, CYFRA21-1, Cox regression, retrospective study, non-small cell lung cancer, Overall, survival