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Stage I lung adenocarcinoma (LADC) has a 5-year overall survival (OS) of 68%, with stage IA1 reaching as high as 91% (1-3). Surgery is the conventional treatment and currently preferred local treatment that can achieve complete relief in early-stage non-small cell lung cancer (NSCLC) (4). However, the relapse of some early-stage NSCLC has brought attention to the post-operative management of resectable tumors (5). According to phase III trials, adjuvant chemotherapy after R0 resection may achieve an improvement of 5% in 5-year survival, but the result is limited among patients with NSCLC staged higher than IB. In stage IA patients, the use of adjuvant chemotherapy can be even detrimental (6). Moreover, the current clinical practice guideline does not recommend adjuvant chemotherapy in stage IA patients after R0 resection (7). With a low genetic testing rate in earlystage LADC, no evidence from phase III clinical trials has demonstrated that epidermal growth factor receptormutated (EGFRm) stage IA patients can benefit from adjuvant EGFR-tyrosine kinase inhibitors (TKIs). Without adjuvant therapy, 5–10% patients will suffer from early recurrence 2–3 years after their curative surgery (8). It remains unclear how to identify the high-risk cohort in stage IA patients. The evaluation on the prognosis of stage IA patients is mainly based on pathological findings: the size of invasive component, lymphatic or vascular invasion, or visceral pleural invasion (9,10). Because genetic testing is mainly performed in advanced stage NSCLC (11,12), the prognostic and predictive values of genomic profiling has not been widely recognized in early-stage NSCLC (13,14). However, it has been reported that advanced NSCLC patients harboring co-mutation of EGFR and TP53 have a poorer prognosis (15-17). Relapse in resected NSCLC patients is often reported as local or regional recurrence and metastasis. For these advanced stage recurrent patients, there still lacks high-level evidence as to whether these patients should be treated in the same way as advanced stage patients for the first-line treatment, or if they should iMDT Corner

journal of thoracic disease

First-line treatment selection with organoids of an EGFRm + TP53m stage IA1 patient with early metastatic recurrence after radical surgery and follow-up