One of the toughest issues facing patients who have surgery for very early-stage lung cancer is uncertainty: Despite complete removal of their small lung tumors and no evidence of metastasis, at least one quarter of patients harbor tiny, undetectable clumps of cancer cells that have already spread outside their lungs and will kill them within a few years.
Doctors have no way of telling which cancers will recur, and, as a result, none of these patients receives chemotherapy that might otherwise reduce their chance of dying from the disease.
A new molecular test developed by doctors at the University of California, San Francisco (UCSF) may give doctors the ability to better predict post-operative early-stage lung cancer mortality. This week in the Journal of American Medical Association (JAMA), the team reports that the test effectively identifies patients with a high likelihood of recurrence even of this very early form of cancer, which is called “T1a node-negative non-squamous, non-small cell lung cancer.”
The retrospective study involved analyzing tumors from 1,439 patients in the United States and China who underwent surgery during the last 15 years. These patients belonged to either the Kaiser Permanente Northern California System or had gone to one of three hospitals in mainland China that participate in the China Clinical Trials Consortium.
The study showed that the scientists could accurately stratify patients even with the earliest stage of lung cancer into groups at low-, intermediate- or high-risk of death based solely on the activity of 14 different genes found in their tumors. The prognostic information obtained from this molecular analysis of an individual tumor’s biology significantly surpassed the information that could be obtained from any conventional prognostic criteria derived either from microscopic examination of the tumors, or from the patients’ clinical situations.
“This group of patients with very early disease is expected to increase as screening for lung cancer is more widely implemented,” said UCSF thoracic surgeon Michael Mann, MD. A number of hospitals around the country, including UCSF Medical Center, have implemented lung cancer screening programs in the last two years.
More Hope for Lung Cancer Survival
Published guidelines currently recommend chemotherapy for stage I lung cancer patients who are thought to be at very high risk of recurrence. These guidelines, however, provide no criteria to aid in the identification of high-risk patients with T1a node-negative disease.
The UCSF team and their colleagues previously demonstrated that the new assay better identifies high-risk stage I patients than the published criteria. It remained uncertain, however, if high-risk patients could also be identified from among the growing number of patients with the earliest, T1a node-negative cancers. The new report now confirms that the test can successfully identify patients even in this group who have a 50 percent chance of death, and for whom further intervention might also need to be considered.
Read more at UCSF.edu