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Objectives  Liver metastases appear in 20–30% of patients diagnosed with non-small cell lung cancer (NSCLC) and represent a poor prognosis feature of NSCLC and a possibly more treatment-resistant condition. Potential clinical outcome differences in NSCLC patients with liver metastases harboring molecular alterations in  EGFR ,  KRAS  and  EML4 - ALK  genes are still to be determined. This study aims to evaluate the incidence of liver metastasis in a single population and look for potential correlations between  EGFR  mutations, liver infiltration and clinical outcomes.    Methods  A total of 236 consecutive stage IV NSCLC patients treated at the Clínica Universidad de Navarra were analyzed.    Results  At onset, liver metastases were present in 16.9% of patients conferring them a shorter overall survival (OS) compared to those with different metastatic locations excluding liver infiltration (10 vs. 21 months; p = 0.001). Patients with  EGFR  wild-type tumors receiving standard chemotherapy and showing no liver involvement presented a superior median OS compared to those with liver metastases (23 vs. 13 months; p = 0.001). Conversely, patients with  EGFR -mutated tumors treated with EGFR tyrosin-kinase inhibitors (TKI’s) presented no significant differences in OS regardless of liver involvement (median OS not reached vs. 25 months; p = 0.81).    Conclusion  Overall, liver metastases at onset negatively impact OS of NSCLC patients. EGFR TKIs however, may reverse the effects of an initial negative prognosis of liver metastasis in first-line treatment of  EGFR  mutated NSCLC patients.    Electronic supplementary material  The online version of this article (doi:10.1186/s12967-015-0622-x) contains supplementary material, which is available to authorized users.

journal of translational medicine

Impact of epidermal growth factor receptor (EGFR) activating mutations and their targeted treatment in the prognosis of stage IV non-small cell lung cancer (NSCLC) patients harboring liver metastasis