Tumor Purity as a Prognostic and Predictive Biomarker of Postoperative Radiation Therapy Outcomes in Stage IIIA-N2 Non-Small Cell Lung Cancer: A Transcriptomic Analysis From the Lung ART Trial.
Wael Salem Zrafi, Víctor Albarrán-Artahona, Filippo Gustavo Dall'Olio et al.
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In 30 seconds
This transcriptomic analysis of the randomised Lung ART-IFCT 0503 trial examined tumor purity (TP) as a prognostic and potential predictive biomarker in 285 patients with resected stage IIIA-N2 non-small cell lung cancer; 144 received postoperative radiation therapy (PORT). Higher TP was associated with worse overall and disease-free survival. Median overall survival was 48.5 months with high TP versus 106.5 months with low TP (P < .001). An interaction between TP and PORT for overall survival suggested possible variation in PORT benefit by TP, but the authors consider this exploratory.
Key findings
- High TP was associated with shorter overall survival: 48.5 vs 106.5 months (P < .001).
- High TP was associated with shorter disease-free survival: 18.4 vs 48.0 months (P = .017).
- A TP × PORT interaction was observed for overall survival (P = .049); the interaction for disease-free survival was a trend (P = .07).
- TP inversely correlated with CD3⁺ and CD8⁺ T-cell infiltration (r = -0.52 and r = -0.45, respectively).
Why it matters
The findings suggest that tumor composition may carry prognostic information beyond standard clinical features and could help explain variation in outcomes after surgery. The observed interaction also raises the possibility that TP may identify differences in PORT benefit. However, the predictive result is exploratory, so TP should not be treated as an established basis for selecting postoperative radiation.
What to keep in mind
The potential predictive value of TP for PORT is exploratory and requires independent validation.