Improved outcomes and staging in non-small-cell lung cancer guided by a molecular assay

Future Oncol. 2021 Dec;17(34):4785-4795. doi: 10.2217/fon-2021-0517. Epub 2021 Aug 26.


There remains a critical need for improved staging of non-small-cell lung cancer, as recurrence and mortality due to undetectable metastases at the time of surgery remain high even after complete resection of tumors currently categorized as 'early stage.' A 14-gene quantitative PCR-based expression profile has been extensively validated to better identify patients at high-risk of 5-year mortality after surgical resection than conventional staging - mortality that almost always results from previously undetectable metastases. Furthermore, prospective studies now suggest a predictive benefit in disease-free survival when the assay is used to guide adjuvant chemotherapy decisions in early-stage non-small-cell lung cancer patients.

Keywords: adjuvant therapy; molecular assay; molecular prognostic classifier; non-small-cell lung cancer; predictive; risk stratification; tumor genetic profile.

Plain language summary

Lay abstract There is a need for improvement in the way early-stage non-small-cell lung cancers are staged and treated because many patients with ‘early-stage’ disease suffer high rates of cancer recurrence after surgery. In recent years, a specialized test has been developed to allow better characterization of a tumor's risk of recurrence based on the genes being expressed by tumor cells. Use of this test, in conjunction with standard staging methods, is better able to identify patients at high risk of cancer recurrence after surgery. Evidence suggests that giving chemotherapy to patients at high risk of recurrence after surgery reduces recurrence rates and improves long-term patient survival.

Publication types

  • Validation Study

MeSH terms

  • Biomarkers, Tumor / genetics*
  • Carcinogenesis / genetics
  • Carcinoma, Non-Small-Cell Lung / diagnosis
  • Carcinoma, Non-Small-Cell Lung / genetics
  • Carcinoma, Non-Small-Cell Lung / mortality*
  • Carcinoma, Non-Small-Cell Lung / therapy
  • Chemotherapy, Adjuvant / statistics & numerical data
  • Clinical Decision-Making
  • Datasets as Topic
  • Disease-Free Survival
  • Gene Expression Profiling
  • Gene Expression Regulation, Neoplastic
  • Humans
  • Lung Neoplasms / diagnosis
  • Lung Neoplasms / genetics
  • Lung Neoplasms / mortality*
  • Lung Neoplasms / therapy
  • Molecular Diagnostic Techniques / methods*
  • Molecular Diagnostic Techniques / statistics & numerical data
  • Neoplasm Recurrence, Local / epidemiology*
  • Neoplasm Recurrence, Local / genetics
  • Neoplasm Recurrence, Local / prevention & control
  • Neoplasm Staging / methods
  • Pneumonectomy / statistics & numerical data
  • Prospective Studies
  • Real-Time Polymerase Chain Reaction
  • Risk Assessment / methods


  • Biomarkers, Tumor