ArticleBMC cancer2025
Characterization of clinical risk factors for enhanced molecular residual disease monitoring in resected early-stage non-small cell lung cancer.
Article in BMC cancer, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundLung cancer is a leading cause of cancer mortality, with non-small cell lung cancer (NSCLC) accounting for the majority of cases. Standard treatment for early-stage NSCLC involves surgical resection, often complemented by adjuvant therapies. This study explores the dynamics of molecular residual disease (MRD) in early-stage NSCLC, emphasizing the prognostic value of baseline clinical characteristics.
methodsWe conducted a prospective study enrolling 78 patients with operable stage I-IIIA NSCLC. Serial blood samples were collected at various postoperative intervals to evaluate MRD via circulating tumor DNA (ctDNA) analysis. Clinical variables, such as tumor stage, driver mutations, carcinoembryonic antigen (CEA) levels, and histopathological characteristics, were assessed for their predictive capabilities for MRD positivity and disease relapse.
resultsAmong the 78 patients, 60.3% were diagnosed at stage IA, with a longitudinal MRD positivity rate of 20.5% (16/78). MRD-positive patients demonstrated shorter disease-free survival (DFS) compared to MRD-negative patients (hazard ratio = 171.4, P < 0.001). All nine patients with radiological relapse were MRD-positive, with a median lead time from MRD detection to relapse of 242.0 days. MRD + /DFS events were significantly associated with advanced clinical staging, absence of driver mutations, and elevated baseline CEA levels. A clinical risk factor (CRF) scoring system including the three factors effectively stratified patients by relapse risk, identifying those who could benefit from intensified postoperative treatment. The MRD + /DFS event rate was 36.3% for the CRF-high group compared to 0.0% for the CRF-low group (P < 0.001). The CRF score also stratified the patients by event-free survival, where CRF-low patients showed more favorable outcome compared to CRF-high patients (hazard ratio = 9.0, P < 0.001).
conclusionsOur findings highlight the interplay between clinical risk factors and MRD dynamics in early-stage NSCLC, offering insights for risk stratification and personalized treatment approaches. The CRF score may help clinicians tailor adjuvant therapies, ultimately improving outcomes for high-risk patients.
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