About 30% of early-stage lung cancers will recur and metastasize after surgery! How to predict cancer recurrence, what experts say

There are two major difficulties in the treatment of cancer, one is the metastasis of cancer, and the other is the recurrence
of cancer.

There are many cancer patients who have successful surgeries, but end up dying of recurrence and metastasis
.
According to statistics, 70~80% of cancer patients die of recurrence and metastasis
.

Many patients ask:

Why does it recur after cutting the tumor?

Taking lung cancer, which ranks first in the world, as an example, the clinical cure rate of stage 1 lung cancer is only 59.
8%.

This means that even in the earliest stage of tumors, more than 30% of patients may relapse and progress!

Therefore, patients with early-stage tumors should not be taken lightly after surgery and chemotherapy
.

In fact, there are many reasons for cancer recurrence, such as living environment, physical state, etc.
, which boil down to the following 4 reasons:

1.
Incomplete
local treatment.
For example, at the time of the first operation, the resection margin is positive, that is, the tumor is not cut clean, or the lymph nodes that should be cleaned are not cleaned, resulting in rapid recurrence and metastasis
after surgery.

2.
Choice
of treatment.
Simple clinical treatment often causes damage to the patient's body, even if the tumor is controlled to a certain extent, but because the treatment causes the patient's immunity to decline, it also lays hidden dangers
for the recurrence and metastasis of the tumor.

3.
Lack of consolidation therapy
.
After conventional treatment, many patients think they can rest easy, but even during the recovery period, the rate of recurrence and metastasis is still high
.

4.
Other Reasons
.
The presence of cancer stem cells, late clinical staging of tumors and imbalances in the body's internal environment can cause cancer recurrence and metastasis
.

At present, surgery is still the preferred treatment for patients with non-small cell lung cancer (NSCLC), and a complete cure is possible
only after radical surgery.
However, postoperative recurrence and metastasis in NSCLC patients is a key factor affecting the prognosis of patients, and how to prevent postoperative recurrence is a very concerned issue
for both doctors and patients.

Due to the heterogeneity of NSCLC, including histological type, molecular characteristics, and driver genes, there are large differences
in patients with relapse.

In view of the lack of summary of the relevant content based on tumor molecular marker information and postoperative recurrence risk, the team of Dr.
He Jianxing of the Department of Thoracic Surgery of the First Affiliated Hospital of Guangzhou Medical University formulated a consensus on the prediction of postoperative recurrence of NSCLC based on molecular markers based on the recommendations of experts in relevant departments in China and clinical evidence, hoping to apply these emerging molecular marker information to accurately assess the risk after NSCLC resection.
It provides important theoretical support for formulating the best diagnosis and treatment strategy, and ultimately improves the prognosis and survival rate
of patients with early NSCLC.

The highlights are as follows:

Consensus 1:

Consensus 2:

Consensus 3:

The expression of multiple prognostic genes can be integrated for postoperative recurrence risk stratification in lung cancer patients.
It is recommended to detect mRNA expression of lung cancer 14 genes (BAG1, BRCA1, CDC6, CDK2AP1, ERBB3, FUT3, IL-11, LCK, RND3, SH3BGR, WNT3A, ESD, TBP, YAP1) in non-squamous NSCLC resected in stage IA-IIA R0, regardless of EGFR-positive or negative patients, Lung cancer 14 genetic testing identifies intermediate/high-risk patients (grade 1A)
who would benefit from adjuvant chemotherapy.

Consensus 4:

After radical resection in patients with early-stage NSCLC, a positive minimal residual disease (MRD) indicates a high risk of recurrence and requires closer follow-up management and consideration of more aggressive intervention strategies
.
However, MRD detection methods and evaluation standards need to be standardized, and their stability sensitivity needs to be improved
.
In the case of a negative MRD test, it is recommended to combine other molecular markers to comprehensively evaluate the risk of recurrence (grade 2A)
in NSCLC patients.

Consensus 5:

The prognostic prediction model based on clinicopathological risk factors also has important predictive value, and is independent of the prognostic value of molecular markers and driver genes (level 2A).

Patients with preinvasive lesions (AIS and MIA) and other patients with a good prognosis may not undergo corresponding molecular testing (grade 2A)
after surgery.

Early lung cancer is a malignant tumor
that can be cured by surgical treatment.
Although the overall prognosis for patients with early-stage NSCLC is better, approximately 30% of patients with early-stage NSCLC relapse
within 5 years of surgery.
This article summarizes the molecular markers closely related to recurrence and metastasis in patients after radical NSCLC resection, and provides a reference
for targeted interventions to reduce the occurrence of recurrence and metastasis events.

References:

Expert consensus on postoperative recurrence prediction of non-small cell lung cancer based on molecular markers

Source: Medical Elephant

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