A genomic strategy to refine prognosis in early-stage non-small-cell lung cancer.

TLDR: The lung metagene model provides a potential mechanism to refine the estimation of a patient's risk of disease recurrence and, in principle, to alter decisions regarding the use of adjuvant chemotherapy in early-stage NSCLC.

Abstract: Background Clinical trials have indicated a benefit of adjuvant chemotherapy for patients with stage IB, II, or IIIA — but not stage IA — non–small-cell lung cancer (NSCLC). This classification scheme is probably an imprecise predictor of the prognosis of an individual patient. Indeed, approximately 25 percent of patients with stage IA disease have a recurrence after surgery, suggesting the need to identify patients in this subgroup for more effective therapy. Methods We identified gene-expression profiles that predicted the risk of recurrence in a cohort of 89 patients with early-stage NSCLC (the lung metagene model). We evaluated the predictor in two independent groups of 25 patients from the American College of Surgeons Oncology Group (ACOSOG) Z0030 study and 84 patients from the Cancer and Leukemia Group B (CALGB) 9761 study. Results The lung metagene model predicted recurrence for individual patients significantly better than did clinical prognostic factors and was consistent across all early stages ...