title: Prediction of distant recurrence in resected stage I and II lung adenocarcinoma.
abstract: Optimal procedures for adjuvant treatment and post-surgical surveillance of resected non-small-cell lung cancer remain under discussion. Pathological features are the main determinant of follow-up therapy but have limited ability to identify patients at risk of recurrence. Increasingly, molecular markers are incorporated into clinical decision-making, including measures of tumor growth. The CCP score is a quantitative, molecular measure of proliferation derived from the RNA expression of 31 cell cycle genes and a component of the molecular prognostic score (mPS). The mPS score is a linear combination of CCP score and pathological stage. CCP score and mPS are independent predictors of survival in resected lung adenocarcinoma.
  
  
  
  CCP scores were determined by RT-qPCR for 318 patients diagnosed with stage I-II lung adenocarcinoma. Association of mPS and CCP score with distant recurrence and lung-cancer specific survival was assessed in Cox proportional hazards regression models adjusted for age, gender, tumor size, pathological stage and pleural invasion. Distant recurrence-free survival and lung-cancer specific survival by mPS risk group were calculated by Kaplan-Meier survival analysis.
  
  
  
  CCP scores were obtained for 205 stage I and 84 stage II patients. CCP score and mPS were independent markers of distant recurrence (CCP: HR 1.62, 95%CI 1.15-2.29, p=0.0055; mPS: HR 2.22, 95%CI 1.11-4.44, p=0.023). Patients with low mPS tumors were at significantly reduced risk of distant recurrence (log-rank p=4.2×10-5). Among stage I patients, stratification by mPS identified a patient group with increased risk of distant recurrence (36%, 95%CI 28-46%, log-rank p=0.0011) CONCLUSIONS: The molecular prognostic score stratifies early-stage, resected lung cancer patients for risk of distant recurrence and could be useful to inform treatment and surveillance decisions.
authors: Department of Medical and Surgical Sciences for Children and Adults, Operative Unit of Thoracic Surgery, University of Modena and Reggio Emilia, Via Largo del Pozzo 71- 41124, Modena, Italy. Electronic address: beatrice.aramini@gmail.com.
authors: Beatrice
authors: B
authors: Aramini
authors: Department of Medical and Surgical Sciences for Children and Adults, Operative Unit of Thoracic Surgery, University of Modena and Reggio Emilia, Via Largo del Pozzo 71- 41124, Modena, Italy.
authors: Christian
authors: C
authors: Casali
authors: Department of Medical and Surgical Sciences for Children and Adults, Operative Unit of Thoracic Surgery, University of Modena and Reggio Emilia, Via Largo del Pozzo 71- 41124, Modena, Italy.
authors: Alessandro
authors: A
authors: Stefani
authors: Department of Diagnostic and Clinical Medicine and Public Health, Operative Unit of Pathologic Anatomy, University of Modena and Reggio Emilia, Via Largo del Pozzo 71- 41124, Modena, Italy.
authors: Stefania
authors: S
authors: Bettelli
authors: Myriad Genetics Inc., Salt Lake City, 84108 UT, USA.
authors: Susanne
authors: S
authors: Wagner
authors: Myriad Genetics Inc., Salt Lake City, 84108 UT, USA.
authors: Zaina
authors: Z
authors: Sangale
authors: Myriad Genetics Inc., Salt Lake City, 84108 UT, USA.
authors: Elisha
authors: E
authors: Hughes
authors: Myriad Genetics Inc., Salt Lake City, 84108 UT, USA.
authors: Jerry S
authors: JS
authors: Lanchbury
authors: Department of Diagnostic and Clinical Medicine and Public Health, Operative Unit of Pathologic Anatomy, University of Modena and Reggio Emilia, Via Largo del Pozzo 71- 41124, Modena, Italy.
authors: Antonino
authors: A
authors: Maiorana
authors: Department of Medical and Surgical Sciences for Children and Adults, Operative Unit of Thoracic Surgery, University of Modena and Reggio Emilia, Via Largo del Pozzo 71- 41124, Modena, Italy.
authors: Uliano
authors: U
authors: Morandi
mesh_terms: D000230:Adenocarcinoma / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D000077192:Adenocarcinoma of Lung; D000368:Aged; D015415:Biomarkers; D002289:Carcinoma, Non-Small-Cell Lung / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D000066491:Clinical Decision-Making; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000378:metabolism / Q000473:pathology*; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D012306:Risk
chemical_list: D015415:Biomarkers
keywords: Biomarkers; Lung adenocarcinoma; Post-surgical treatment; Prognosis; Surveillance