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Nancy R. Cook
P3.03 - Biology (Not CME Accredited Session) (ID 969)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Presentations: 1
- Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
P3.03-24 - Incorporation of a Molecular Prognostic Classifier Improves Conventional Non-Small Cell Lung Cancer Staging (ID 14531)
12:00 - 13:30 | Author(s): Nancy R. Cook
Despite significant advancements in the understanding of the molecular genetics of tumor biology, the 8th Edition of Non-Small Cell Lung Cancer (NSCLC) staging adopted in 2018 remains dependent upon tumor size, nodal spread, and metastasis. The survival of patients with early stage NSCLC remains poor and further improvement in staging is needed to better inform adjuvant therapy. In this study, we explored the integration of a clinically validated, molecular prognostic classifier into conventional staging.
A novel staging system, TNMB (“B” indicating Biology), that integrates a 14-gene molecular prognostic classifier with the 8th Edition, was developed using 332 patients with non-squamous NSCLC resected at the University of California, San Francisco (UCSF). TNMB was subsequently validated on a separate multi-institutional international cohort of 1,373 patients. Reclassification metrics were evaluated from adoption of TNMB and the 8th Edition. 4c3880bb027f159e801041b1021e88e8 Result
Adoption of TNMB improved prognostication of overall survival significantly more than adoption of the 8th Edition. TNMB resulted in Net Reclassification Improvement of 0.33 (95% CI 0.24-0.41), relative Integrated Discrimination Improvement of 22.1% (95% CI 8.8-35.3%), and Reclassification Calibration Statistic from 36 to 18 (P-Value 0.03 to 0.73). In contrast, the 8th Edition resulted in no change in Net Reclassification Improvement 0.03 (95% CI -0.00-0.06) or relative Integrated Discrimination Improvement -2.5% (95% CI -17.6-12.4%) and resulted in Reclassification Calibration Statistic from 134 to 22 (P-Value <0.01 to 0.27). 8eea62084ca7e541d918e823422bd82e Conclusion
Incorporation of a molecular prognostic classifier offers substantial improvement to conventional staging of NSCLC and may lead to a significant impact on clinical decision-making in early stage disease where identification of high risk patients is needed to guide adjuvant therapy. Our findings may encourage application of molecular prognostic classifiers into the refinement of conventional staging for other solid tumors.
Overall Survival of Non-Small Cell Lung Cancer Patients Following Surgical Resection by 7th Edition, 8th Edition, and TNMB Staging. TNMB had distinct separation of survival by stage and larger range of survival between early and late stages compared to conventional staging.
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