The postoperative survival of early-stage non-small-cell lung cancer (NSCLC) patients remains unsatisfactory. In this review, we examined the relevant literature to ascertain the prognostic effect of related indicators on early-stage NSCLC. The prognostic effects of the epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK), mesenchymal–epithelial transition (MET), C-ros oncogene 1 (ROS1), or tumour protein p53 (TP53) alterations in resected NSCLC remains debatable. Kirsten rat sarcoma viral oncogene homologue (KRAS) alterations indicate unfavourable outcomes in early-stage NSCLC. Meanwhile, adjuvant or neoadjuvant EGFR-targeted agents can substantially improve prognosis in early-stage NSCLC with EGFR alterations. Based on the summary of current studies, resected NSCLC patients with overexpression of programmed death-ligand 1 (PD-L1) had worsening survival. Conversely, PD-L1 or PD-1 inhibitors can substantially improve patient survival. Considering blood biomarkers, perioperative peripheral venous circulating tumour cells (CTCs) and pulmonary venous CTCs predicted unfavourable prognoses and led to distant metastases. Similarly, patients with detectable perioperative circulating tumour DNA (ctDNA) also had reduced survival. Moreover, patients with perioperatively elevated carcinoembryonic antigen (CEA) in the circulation predicted significantly worse survival outcomes. In the future, we will incorporate mutated genes, immune checkpoints, and blood-based biomarkers by applying artificial intelligence (AI) to construct prognostic models that predict patient survival accurately and guide individualised treatment.
早期非小细胞肺癌（NSCLC）患者的术后生存状况仍不理想。本文通过梳理相关文献，旨在明确各类指标对早期NSCLC的预后影响。在已切除的NSCLC中，表皮生长因子受体（EGFR）、间变性淋巴瘤激酶（ALK）、间质-上皮转化因子（MET）、C-ros原癌基因1（ROS1）及肿瘤蛋白p53（TP53）基因改变的预后价值尚存争议。而Kirsten大鼠肉瘤病毒癌基因同源物（KRAS）突变提示早期NSCLC预后不良。同时，针对EGFR突变的辅助或新辅助靶向治疗可显著改善此类早期NSCLC患者的预后。现有研究汇总表明，程序性死亡配体1（PD-L1）过表达的已切除NSCLC患者生存状况恶化，而PD-L1或PD-1抑制剂则能显著提升患者生存率。在血液生物标志物方面，围手术期外周静脉循环肿瘤细胞（CTCs）及肺静脉CTCs可预测不良预后并提示远处转移风险。同样，围手术期检测到循环肿瘤DNA（ctDNA）的患者生存期缩短。此外，围手术期循环癌胚抗原（CEA）水平升高也预示着显著恶化的生存结局。未来我们将整合突变基因、免疫检查点及血液生物标志物，通过人工智能技术构建能够精准预测患者生存、指导个体化治疗的预后模型。
A Review of Biomarkers and Their Clinical Impact in Resected Early-Stage Non-Small-Cell Lung Cancer
肿瘤(癌症)患者之家