Objective:A meta-analysis was performed to augment the insuffcient data on the impact of mutative EGFR downstream phosphatidylinositol-3-kinase (PI3K) and mitogen-activated protein kinase (MAPK) pathways on the clinical effciency of epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) treatment of non-small cell lung cancer (NSCLC) patients. Methods:Network databases were explored in April, 2015. Papers that investigated the clinical outcomes of NSCLC patients treated with EGFR-TKIs according to the status of K-ras and/or PIK3CA gene mutation were included. A quantitative meta-analysis was conducted using standard statistical methods. Odds ratios (ORs) for objective response rate (ORR) and hazard ratios (HRs) for progression-free survival (PFS) and overall survival (OS) were calculated. Results:Mutation in K-ras signiifcantly predicted poor ORR [OR=0.22;95%conifdence interval (CI), 0.13-0.35], shorter PFS (HR=1.56;95%CI, 1.27-1.92), and shorter OS (HR=1.59;95%CI, 1.33-1.91) in NSCLC patients treated with EGFR-TKIs. Mutant PIK3CA signiifcantly predicted shorter OS (HR=1.83;95%CI, 1.05-3.20), showed poor ORR (OR=0.70;95%CI, 0.22-2.18), and shorter PFS (HR=1.79;95%CI, 0.91-3.53) in NSCLC patients treated with EGFR-TKIs. Conclusion:K-ras mutation adversely affected the clinical response and survival of NSCLC patients treated with EGFR-TKIs. PIK3CA mutation showed similar trends. In addition to EGFR, adding K-ras and PIK3CA as routine gene biomarkers in clinical genetic analysis is valuable to optimize the effectiveness of EGFR-TKI regimens and identify optimal patients who will beneift from EGFR-TKI treatment.