title: A genomic strategy to refine prognosis in early-stage non-small-cell lung cancer.
abstract: BACKGROUND
  Clinical trials have indicated a benefit of adjuvant chemotherapy for patients with stage IB, II, or IIIA--but not stage IA--non-small-cell lung cancer (NSCLC). This classification scheme is probably an imprecise predictor of the prognosis of an individual patient. Indeed, approximately 25 percent of patients with stage IA disease have a recurrence after surgery, suggesting the need to identify patients in this subgroup for more effective therapy.
  
  
  METHODS
  We identified gene-expression profiles that predicted the risk of recurrence in a cohort of 89 patients with early-stage NSCLC (the lung metagene model). We evaluated the predictor in two independent groups of 25 patients from the American College of Surgeons Oncology Group (ACOSOG) Z0030 study and 84 patients from the Cancer and Leukemia Group B (CALGB) 9761 study.
  
  
  RESULTS
  The lung metagene model predicted recurrence for individual patients significantly better than did clinical prognostic factors and was consistent across all early stages of NSCLC. Applied to the cohorts from the ACOSOG Z0030 trial and the CALGB 9761 trial, the lung metagene model had an overall predictive accuracy of 72 percent and 79 percent, respectively. The predictor also identified a subgroup of patients with stage IA disease who were at high risk for recurrence and who might be best treated by adjuvant chemotherapy.
  
  
  CONCLUSIONS
  The lung metagene model provides a potential mechanism to refine the estimation of a patient's risk of disease recurrence and, in principle, to alter decisions regarding the use of adjuvant chemotherapy in early-stage NSCLC.
authors.affiliation: Institute for Genome Sciences and Policy, Duke University, Durham, NC 27708, USA.
authors.forename: Anil
authors.initials: A
authors.lastname: Potti
authors.forename: Sayan
authors.initials: S
authors.lastname: Mukherjee
authors.forename: Rebecca
authors.initials: R
authors.lastname: Petersen
authors.forename: Holly K
authors.initials: HK
authors.lastname: Dressman
authors.forename: Andrea
authors.initials: A
authors.lastname: Bild
authors.forename: Jason
authors.initials: J
authors.lastname: Koontz
authors.forename: Robert
authors.initials: R
authors.lastname: Kratzke
authors.forename: Mark A
authors.initials: MA
authors.lastname: Watson
authors.forename: Michael
authors.initials: M
authors.lastname: Kelley
authors.forename: Geoffrey S
authors.initials: GS
authors.lastname: Ginsburg
authors.forename: Mike
authors.initials: M
authors.lastname: West
authors.forename: David H
authors.initials: DH
authors.lastname: Harpole
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Nevins
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002289:Carcinoma, Non-Small-Cell Lung / Q000235:genetics* / Q000401:mortality / Q000473:pathology; D005260:Female; D015870:Gene Expression; D020869:Gene Expression Profiling; D006801:Humans; D008175:Lung Neoplasms / Q000235:genetics* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D008957:Models, Genetic; D005810:Multigene Family; D009364:Neoplasm Recurrence, Local / Q000235:genetics*; D009367:Neoplasm Staging; D011379:Prognosis; D012334:RNA, Neoplasm / Q000032:analysis; D012306:Risk; D016019:Survival Analysis
chemical_list: D012334:RNA, Neoplasm