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- Title
Prognostic molecular assay might improve identification of patients at risk for recurrence in early-stage non-small-cell lung cancer.
- Authors
Woodard, Gavitt A; Gubens, Matthew A; Jahan, Thierry M; Jones, Kirk D; Kukreja, Jasleen; Theodore, Pierre R; Cardozo, Shayne; Jew, Gregory; Clary-Macy, Carolyn; Jablons, David M; Mann, Michael J
- Abstract
INTRODUCTION: Adjuvant chemotherapy improves survival for some patients with NSCLC and is recommended in NCCN guidelines for stage Ib to IIa patients with certain 'high-risk' characteristics. An internationally validated, 14-gene expression assay has been shown to better stratify mortality risk in nonsquamous NSCLC than either conventional staging or these high risk clinicopathologic features. PATIENTS AND METHODS: A blinded chart review of 52 patients with prospective molecular risk stratification using the 14-gene test compared recurrence outcomes with a mean follow-up of 15.2 ± 11.7 months of patients with high- or low-risk determined according to either NCCN criteria or the molecular assay. RESULTS: Molecular risk assessment was discordant from NCCN criteria in 14 of 23 patients in stages Ib and IIa (61%). Recurrence was not observed among any of 31 molecular intermediate- or low-risk patients, including 10 NCCN high-risk patients, whereas 2 of 6 recurrences (33%) occurred among NCCN low-risk patients. Recurrences in stages I or IIa were seen in 2 of 18 NCCN high-risk patients (11%; both were stage IIa and both received a high-risk molecular designation), and in 4 of 18 patients (22%) with a high-risk molecular score, including 1 stage Ia and 1 stage Ib patient. CONCLUSION: This small cohort study suggests that a 14-gene prognostic assay more accurately stratifies risk among early-stage NSCLC patients than current NCCN criteria. NCCN guidelines already advocate risk stratification within tumor, node, metastases stages. This molecular assay has clinical utility in better identifying high-risk patients and might improve NCCN adjuvant chemotherapy recommendations.
- Publication
Clinical Lung Cancer, 2014, Vol 15, Issue 6, p426
- ISSN
1525-7304
- Publication type
Journal Article
- DOI
10.1016/j.cllc.2014.07.004