Abstract: Objective To investigate the relationship between histological subtypes and the efficacy of epidermal growth factor receptor tyrosine kinase inhixitors（EGFR-TKIs） based on EGFR mutation. Methods Eighty-three cases of EGFR mutations-positive advanced lung adenocarcinoma received the EGFR-TKIs treatment form Jun 1，2009 to Dec 30，2012 from Fuzhou General Hospital of Nanjing Military Region and its relationship with the efficacy of EGFR-TKIs was reviewed. Reclassification was carried out based on 2011 Lung Adenocarcinoma Classification Standard. EGFR mutation was detected by RT-PCR.According to RECIST 1.1 standards， the efficacy was assessed. Results The total disease control rate （DCR） of 83 patients was 77.1%， including alveolar predominant type 82.9%，solid-predominant type 50%，like spikes type 92.9%，and papillary and micropapillary predominant type 66.6%.Median progression free survival of 83 patients was 16.0 months，including alveolar predominant type 17.0 months，solid predominant type 7.0 months，spikes predominant type 18.0 months，and papillary and micropapillary predominant type 12.0 months. Conclusion Spikes predominant who accepted EGFR-TKIs has a best DCR and PFS，but solid predominant is the worst.Pathological classification is help for predicitng EGFR-TKIs effect.