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Title
Use of Molecular Risk Stratification of Early Stage Non-Small Cell Lung Cancer to Identify Increase Failure Despite Complete Surgical Resection

K. Adam Lee, Lindsey Silas.
Jupiter Medical Center, jupiter, FL, USA.

Background
Annually 40,000 patients are diagnosed early stage non-small cell lung cancer (NSCLC). 30-50% patients fail survival despite complete surgical resection. Early stage NSCLC patients who are not candidates for adjuvant treatment per current guidelines do harbor occult metastasis and have disease reoccurrence. The AJCC 8th Edition utilizes only clinicopathologic characteristics despite adoption of molecular biomarkers in management of NSCLC. Classified IA3 may miss size criteria at 3cm of IB but may biologically behave as IB, though stage drift to lower stage by National Comprehensive Cancer Network (NCCN) will not recommend adjuvant therapy. Our goal to further differentiate the subset of resected IA3 who may benefit adjuvant therapy. 14 gene quantitative polymerase chain reaction expression assay demonstrates ability to stratify risk IA,IB, and IIA non-squamous into low, intermediate, and high risk. Such results significantly impact physician treatment decisions in the new classification IA3.
METHODS
A review of 52 consecutive patients after complete resection of early stage NSCLC into a 14 gene molecular stratification test ,the Oncocyte (Irvine, CA) DetermaRx test.
RESULTS
Forty-one of fifty-two staged IA with ten at stage IA3(24%). 5 of 10 stage IA3 (50%) registered intermediate to high risk. Two possessed Kras G12C mutation and one EGFR.
Conclusion
Data suggests a 20-34% chance of reoccurrence for early stage. Molecular profiling of completely resected stage IA3 more accurately stratifies risk than current NCCN guidelines and should be considered in identifying increased risk patients who might improve with adjuvant chemotherapy recommendations.


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