J Thorac Cardiovasc Surg 2008;135:633-634
© 2008 The American Association for Thoracic Surgery
Discussion
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Dr Virginia R. Litle
(New York, NY). Dr Reed, you have addressed a very important clinical question: Which patients with early-stage lung cancer may benefit from adjuvant therapy because they are at higher risk of recurrent disease. You have tried to keep it simple and straightforward and emphasize that. However, I have a few questions about the research design.
In this study you compared gene expression in the tumors versus the normal tissue. Often this may be better suited to identifying diagnostic markers rather than prognostic markers. You compared gene expression in the tumor cell lines with that in normal lymph nodes. This approach would typically identify potential markers for detection of lymph node metastases. It is not clear to me why this would identify markers that may be predictive of prognosis for poor outcome. Maybe you could clarify the logic of this approach.
Following up on that, in your table for recurrence analysis of single markers, the AUC was greater than 0.6 for CK19 only. For all the other markers, it was less than 0.6. How do we know identification of these markers might only be occurring by chance?
Dr Reed. The idea here was to try to simplify the process, as you noted, and the study actually started by looking at the ability to predict recurrence on lymph nodes gathered by very minimally invasive ways. After a series of studies, it became apparent that if the hypothesis was to predict the metastatic . . . [Full Text of this Article]
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Copyright © 2008 by The American Association for Thoracic Surgery.
