Prognostic and predictive factors in resected non-small-cell lung cancer

Abstract

Tumor staging is at present the most important prognostic factor for survival in resected non-small cell lung cancer (NSCLC). Recent studies in prognostic and predictive factors have focused on identifying molecular markers. This paper review current known molecular markers as a prognostic and predictive value. The biomarkers included nucleotide excision repair system (ERCC1, RRM1, BRCA1), cell cycle regulators and apoptosis (p53, p27, bcl-2, KRAS), tumor proliferation (Ki-67), angiogenesis (VEGF, microvessel density), molecular imaging ((18)F-FDG-PET), AKT/mTOR signaling pathway (AKT, mTOR) and EGFR mutation. Recent study has demonstrated that overexpression of nucleotide excision repair protein is predictive of the resistance of NSCLC to gemcitabine and platinum. Overexpression of p53 and p27 is also a predictive marker for predicting poor outcome after adjuvant chemotherapy. A meta-analysis indicated that VEGF, Ki-67 and (18)F-FDG uptake can be a prognostic factor. Although phospho-Akt and mTOR overexpression are associated with poor outcome, the prognostic significance is still controversial. EGFR mutation is described as being associated with a favorable prognostic factor in resected NSCLC, but it is not an independent factor. Search for new prognostic/predictive markers remains an important task for lung cancer diagnosis and treatment.