Abstract: Objective To study and compare the clinical application between surgical treatment and non-surgical treatment in T790M-positive lung adenocarcinoma patients with long bone metastases in extremities. Methods Thirty-six patients with T790M-positive lung adenocarcinoma with long bone metastases who were admitted to Dongfang Hospital of Dongfang City，the Third People's Hospital of Hainan Province，Hainan General Hospital and the First Affiliated Hospital of Hainan Medical College from July 2016 to December 2018 were enrolled. They were divided into the surgical treatment group（n=17） and the non-surgical treatment group（n=19） based on treatment methods. The patients in the surgical treatment group underwent tumor resection and limb functional reconstruction，The non-surgical treatment group received minimally invasive treatment（including interventional therapy） or radiotherapy. The clinical efficacy was compared between the two groups. Results The visual analogue scale（VAS） score reduction rates，the Ennecking score increasing rates，the Kanofsky score increasing rates of patients in surgical treatment group were higher than those in non-surgical treatment group respectively（88.2% vs 52.6%，χ²=5.360，P=0.021；82.4% vs 47.4%，χ²=4.760，P=0.029；70.6% vs 36.8%，χ²=4.100，P=0.043）. There was no significant difference in the response rate and the disease control rate of both groups after treatment（52.9% vs 47.4%，χ2=0.111，P=0.738；76.5% vs 78.9%，χ²=0.032，P=0.858）. The median survival of patients of the surgical treatment group was higher than non-surgical treatment group，the differences was statistically significant （12.0 months vs 9.0 months，χ²=5.009，P=0.024）. Conclusion Surgical treatment can significantly reduce pain，improve limb function and the median survival of T790M-positive lung adenocarcinoma patients with long bone metastases in extremities.

Key words: Lung adenocarcinoma, Osimertinib, T790M, Bone metastasis, Surgical treatment