Purpose: Broad-based molecular testing with next-generation sequencing (NGS) is now the standard of care in advanced non-small cell lung cancer (NSCLC). Two approaches to molecular testing are (1) reflexive testing at pathologic NSCLC confirmation, often using an in-house molecular panel, and (2) send-out testing to private vendors, ordered by a clinician. This study explored the outcomes with reflex versus send-out testing. Methods: A retrospective chart review was conducted of patients diagnosed with de novo stage IV NSCLC in 2019 and 2020 at three hospitals in the same system, one academic hospital (Northwestern Memorial Hospital, or NMH) utilizing reflex, in-house NGS, and two community-based hospitals (Central DuPage Hospital, or CDH, and Delnor, or D) sending out tissue samples for testing. The outcomes assessed were the time from biopsy to results, biopsy to treatment, the incidence of first-line targetable mutations and the use of first-line targeted therapies, and overall survival. Results: In total, 191 patients met the inclusion criteria, 85 at NMH, 106 at CDH + D, and in total, 131 in 2019 and 60 in 2020. The time to results was significantly shorter with reflexive NGS when compared with send-out testing; the time to treatment was also shorter but not statistically significant. At CDH + D, the time to results was significantly shorter with a limited panel than with comprehensive testing, but the time to treatment was similar. NGS testing rates were 95% at NMH and 84.5% at CDH + D (p= 0.009), with 31.0% at NMH receiving 1L targeted therapies versus 20.8% at CDH + D (p= 0.08). In 2019, the median time from biopsy to treatment was 35 days at NMH and 38 days at CDH and Delnor; in 2020, time to treatment was 26 days and 37 days, respectively. Overall survival trended longer in 2020 relative to 2019 independent of site. Conclusion: Reflexive NGS testing is associated with a shorter time to actionable results and higher rates of first-line targetable mutations than send-out testing. In practices with send-out testing, limited panels had slightly faster turnaround times but no difference in time to treatment. If resources allow, reflexive NGS should be considered in healthcare systems for patients with NSCLC.
目的：基于下一代测序（NGS）的广泛分子检测现已成为晚期非小细胞肺癌（NSCLC）的标准诊疗手段。分子检测主要有两种方式：（1）在病理确诊NSCLC时进行反射性检测，通常使用院内分子检测组合；（2）由临床医生将样本送至外部商业检测机构进行检测。本研究旨在比较反射性检测与送外检测的临床结果差异。方法：回顾性分析了2019年至2020年间在同一医疗系统内三家医院确诊的初治IV期NSCLC患者病历资料，其中一家学术医院（西北纪念医院，NMH）采用院内反射性NGS检测，两家社区医院（中央杜佩奇医院，CDH和德尔诺医院，D）则将组织样本送外检测。评估指标包括：从活检到获取结果的时间、从活检到开始治疗的时间、一线可靶向突变的发生率、一线靶向治疗的应用情况以及总生存期。结果：共191例患者符合纳入标准，其中NMH 85例，CDH+D 106例；2019年131例，2020年60例。与送外检测相比，反射性NGS检测获取结果的时间显著缩短；开始治疗的时间也较短，但无统计学显著性。在CDH+D医院，有限检测组合比全面检测获取结果的时间显著缩短，但开始治疗的时间相近。NGS检测率在NMH为95%，在CDH+D为84.5%（p=0.009）；NMH患者接受一线靶向治疗的比例为31.0%，而CDH+D为20.8%（p=0.08）。2019年，从活检到开始治疗的中位时间在NMH为35天，在CDH和Delnor为38天；2020年则分别为26天和37天。无论检测地点如何，2020年的总生存期较2019年呈延长趋势。结论：与送外检测相比，反射性NGS检测能够更快获得可指导治疗的结果，且一线可靶向突变检出率更高。在采用送外检测的医疗机构中，有限检测组合的周转时间略快，但开始治疗的时间无差异。若资源允许，医疗系统应考虑对NSCLC患者采用反射性NGS检测。
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