Strauss G M, Kwiatkowski D J, Harpole D H, Lynch T J, Skarin A T, Sugarbaker D J
Division of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02115, USA.
J Clin Oncol. 1995 May;13(5):1265-79. doi: 10.1200/JCO.1995.13.5.1265.
Although standard treatment of stage I non-small-cell lung cancer (NSCLC) consists of surgical resection alone, approximately 50% of clinical stage I and 30% to 40% of pathologic stage I patients have disease recurrence and die following curative resection. A large number of traditional pathologic and newer molecular markers have been identified, which appear to have important prognostic significance in this population. This review attempts to summarize these data comprehensively.
Criteria for study selection were English-language reports, identified using Medline and Cancerline, through the fall of 1994. Abstracts from the American Society of Clinical Oncology (ASCO) and the International Association for the Study of Lung Cancer (IASLG) were also reviewed.
Molecular markers are classified as molecular genetic markers, differentiation markers, proliferation markers, and markers of metastatic propensity. A number of these markers have been reported to be highly predictive of outcome in stage I NSCLC, and several reports conclude that a specific biomarker may be, aside from clinical stage, the most powerful determinant of prognosis in NSCLC. However, little has been done to clarify the relationships between these newer biologic markers, classic clinicopathologic variables, and clinical outcome.
At present, a firm conclusion regarding which biomarkers are most important in predicting outcome is not possible, and a model that reliably integrates all independent prognostic variables cannot be developed. A prospective trial is mandatory to address this issue, and a study design is suggested that would facilitate the development of a prognostic index, while simultaneously asking a therapeutic question. The development of a prognostic index would facilitate future trials in which only high-risk stage I patients could be targeted for investigation of postresection adjuvant treatment strategies.
虽然Ⅰ期非小细胞肺癌（NSCLC）的标准治疗仅包括手术切除，但约50%的临床Ⅰ期和30%至40%的病理Ⅰ期患者在根治性切除后会出现疾病复发并死亡。已确定了大量传统病理标志物和更新的分子标志物，它们在这一人群中似乎具有重要的预后意义。本综述试图全面总结这些数据。
研究选择标准为1994年秋季前使用Medline和Cancerline检索到的英文报告。还查阅了美国临床肿瘤学会（ASCO）和国际肺癌研究协会（IASLG）的摘要。
分子标志物分为分子遗传标志物、分化标志物、增殖标志物和转移倾向标志物。据报道，其中一些标志物对Ⅰ期NSCLC的预后具有高度预测性，一些报告得出结论，除临床分期外，特定的生物标志物可能是NSCLC预后最有力的决定因素。然而，在阐明这些更新的生物标志物、经典临床病理变量与临床结局之间的关系方面，几乎没有做什么工作。
目前，关于哪些生物标志物在预测结局方面最重要，还无法得出确凿结论，也无法建立一个可靠整合所有独立预后变量的模型。必须进行一项前瞻性试验来解决这个问题，建议采用一种研究设计，这将有助于制定预后指数，同时提出一个治疗问题。预后指数的制定将有助于未来的试验，在这些试验中，只有高危Ⅰ期患者可作为研究切除后辅助治疗策略的目标人群。
