Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Feb;10(2):1165-1185.
doi: 10.21037/tlcr-20-750.

Molecular biomarkers in early stage lung cancer

María Rodríguez  1 , Daniel Ajona  2   3   4   5 , Luis M Seijo  6   7 , Julián Sanz  8 , Karmele Valencia  2   4   5 , Jesús Corral  9 , Miguel Mesa-Guzmán  10 , Rubén Pío  2   3   4   5 , Alfonso Calvo  2   3   4   11 , María D Lozano  3   4   11   12 , Javier J Zulueta  3   4   13 , Luis M Montuenga  2   3   4   11
Affiliations
Review

Molecular biomarkers in early stage lung cancer

María Rodríguez et al. Transl Lung Cancer Res. 2021 Feb.

Abstract

Low dose computed tomography (LDCT) screening, together with the recent advances in targeted and immunotherapies, have shown to improve non-small cell lung cancer (NSCLC) survival. Furthermore, screening has increased the number of early stage-detected tumors, allowing for surgical resection and multimodality treatments when needed. The need for improved sensitivity and specificity of NSCLC screening has led to increased interest in combining clinical and radiological data with molecular data. The development of biomarkers is poised to refine inclusion criteria for LDCT screening programs. Biomarkers may also be useful to better characterize the risk of indeterminate nodules found in the course of screening or to refine prognosis and help in the management of screening detected tumors. The clinical implications of these biomarkers are still being investigated and whether or not biomarkers will be included in further decision-making algorithms in the context of screening and early lung cancer management still needs to be determined. However, it seems clear that there is much room for improvement even in early stage lung cancer disease-free survival (DFS) rates; thus, biomarkers may be the key to refine risk-stratification and treatment of these patients. Clinicians' capacity to register, integrate, and analyze all the available data in both high risk individuals and early stage NSCLC patients will lead to a better understanding of the disease's mechanisms, and will have a direct impact in diagnosis, treatment, and follow up of these patients. In this review, we aim to summarize all the available data regarding the role of biomarkers in LDCT screening and early stage NSCLC from a multidisciplinary perspective. We have highlighted clinical implications, the need to combine risk stratification, clinical data, radiomics, molecular information and artificial intelligence in order to improve clinical decision-making, especially regarding early diagnostics and adjuvant therapy. We also discuss current and future perspectives for biomarker implementation in routine clinical practice.

Keywords: Early lung cancer; biomarkers; lung nodule; radiomics; screening.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/tlcr-20-750). The series “Implementation of CT-based screening of lung cancer” was commissioned by the editorial office without any funding or sponsorship. LMM serves as an unpaid editorial board member of Translational Lung Cancer Research from Sep 2019 to Sep 2021. DA reports other, during the conduct of the study. LMS reports personal fees from Sabartech, personal fees from Astra Zeneca, personal fees from Esteve, personal fees from Chiesi, outside the submitted work. RP has two patents licensed to Amadix: new lung cancer molecular markers, and in vitro method for the diagnosis of lung cancer. JJZ reports other from VisionGate, Inc., outside the submitted work. In addition, Dr. LMM has a patent: complement fragments for the diagnosis of lung cancer licensed. The authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
The role of molecular markers in the early lung cancer management cascade.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Al-Ayoubi AM, Flores RM. Management of CT screen-detected lung nodule: the thoracic surgeon perspective. Ann Transl Med 2016;4:156. 10.21037/atm.2016.03.49 - DOI - PMC - PubMed
    1. Henschke CI, Yankelevitz DF, Libby DM, et al. Survival of patients with stage I lung cancer detected on CT screening. N Engl J Med 2006;355:1763-71. 10.1056/NEJMoa060476 - DOI - PubMed
    1. de Koning HJ, van der Aalst CM, de Jong PA, et al. Reduced lung-cancer mortality with volume CT screening in a randomized trial. N Engl J Med 2020;382:503-13. 10.1056/NEJMoa1911793 - DOI - PubMed
    1. Pastorino U, Silva M, Sestini S, et al. Prolonged lung cancer screening reduced 10-year mortality in the MILD trial: new confirmation of lung cancer screening efficacy. Ann Oncol 2019;30:1162-9. 10.1093/annonc/mdz117 - DOI - PMC - PubMed
    1. Aberle DR, Adams AM, Berg CD, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 2011;365:395-409. 10.1056/NEJMoa1102873 - DOI - PMC - PubMed

LinkOut - more resources