Author of

• 16637

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  P1.03 - Poster Session with Presenters Present (ID 455)

  • Event: WCLC 2016
  • Type: Poster Presenters Present
  • Track: Radiology/Staging/Screening
  • Presentations: 1
  • Moderators:
  • Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)

  • 16703

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    P1.03-066 - Incorporation of a Molecular Prognostic Classifier Improves Conventional Non-Small Cell Lung Cancer TNM Staging (ID 5831)

    14:30 - 14:30  |  Author(s): N.R. Cook
    • Abstract

    Background:
    Tumor size, nodal spread, and distant metastases form the basis of current non-small cell lung cancer staging. Despite undergoing a major revision in 2009, the poor outcomes of early-stage lung cancer patients relative to other solid tumors such as breast and colorectal cancer suggests that further improvement to our ability to stage non-small cell lung cancers is needed. In this study, we demonstrate the benefit of integrating a clinically validated molecular prognostic signature into conventional TNM staging.
    
    Methods:
    A new staging system integrating a 14-gene molecular prognostic classifier with TNM descriptors was developed using 332 patients with stage I-IIIB non-squamous, non-small cell lung cancer resected at the University of California, San Francisco. This staging system was subsequently validated on a separate multi-institutional international cohort of 1379 patients with stage I-IIIB disease. Reclassification measures were used to assess for improvements in calibration and discrimination beyond conventional TNM staging.
    
    Results:
    In the validation cohort, 78.2% of patients were reclassified using the new staging system. 73% of these patients were reclassified more accurately. The new staging system demonstrated improved measures of model fit including the modified Nagelkerke’s R[2] statistic as well as the c-index. In addition, incorporation of the molecular classifier resulted in a Net Reclassification Improvement of 16.6% (95%CI 7.9-25.2%) and a relative Integrated Discrimination Improvement of 27.9% (95%CI 6.4-49.4%). Kaplan-Meier analysis of overall survival after surgical resection demonstrated superior survival curve separation with the addition of the molecular classifier. Figure 1. Kaplan-Meier analysis of overall survival from time of surgical resection (A: TNM staging, B: TNMB staging). Figure 1
    
    
    
    Conclusion:
    Incorporation of a molecular classifier of tumor biology offers substantial improvements to conventional TNM staging and encourages application of molecular prognostic classifiers into the refinement of TNM staging systems for other solid tumors.