In 2021 we can do better than size alone when selecting which early-stage non-small cell lung cancers (NSCLC) are most likely to benefit from systemic therapy. While tumor mutation burden, or more specifically a lack thereof, has been shown retrospectively to be associated with a survival benefit from chemo, this large prospective observational study of 426 patients with completely-resected NSCLC (75% stage I) points to  alterations in SMARCA4 and TP53 and, interestingly, the fraction of genome altered as independent predictors of local recurrence-free survival. | Jones, JAMA Surg 2021


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