Analysis of Molecular Biomarkers in Resected Early-Stage Non-Small Cells Lung Cancer: A Narrative Review

Abstract

Next-generation sequencing has become a cornerstone in clinical oncology practice and is recommended for the appropriate use of tailored therapies in NSCLC. While NGS has already been standardised in advanced-stage NSCLC, its use is still uncommon in the early stages. The recent approval of Osimertinib for resected EGFR-mutated NSCLC in an adjuvant setting has launched the hypothesis that other targeted therapies used in metastatic patients can also lead to improved early-stage outcomes of NSCLC. The impact of molecular biomarkers on the prognosis of patients undergoing radical surgery for NSCLC is still unclear. Notably, the heterogeneous populations included in the studies that analysed surgical patients could be the main reason for these results. In this review, we report the most important studies that analysed the impact of principal molecular biomarkers on the survival outcomes of patients who underwent radical surgery for NSCLC.

Fluorescence-guided lung nodule identification during minimally invasive lung resections

“…Video-thoracoscopic and robotic approaches have demonstrated better perioperative outcomes compared with the open approach. Although controversies still remain with regard to intraoperative lymph node assessment, the long-term oncological outcomes seem to be similar to those of thoracotomy (5). Nonetheless, irrespective of whether surgical techniques are in tune with the rapid technological advancements of the last few decades, nodule detection is still restricted to a visual inspection of indirect signs, such as visceral pleura retraction, and manual palpation (6).…”

Perioperative outcomes of robotic lobectomy for early-stage non-small cell lung cancer in elderly patients

“…In the context of minimally invasive surgery, robotic surgery is outgrowing thanks to its ability to enhance surgical maneuverability and visualization (12). Nonetheless, robotic surgery is demonstrated to improve oncological outcomes with a complication and conversion rate comparable to video-assisted surgery (13). However, the perioperative results of roboticassisted lobectomy for early-stage lung cancer in patients older than 75 years have not been clearly assessed, and the best treatment strategy for NSCLC affecting the elderly is often omitted from guidelines and clinical trials leading to management ambiguities (9).…”