Lung adenocarcinoma represents the major histological subtype of lung cancer, which in turn is the leading cause of cancer mortality worldwide (1). The heterogeneous nature of lung adenocarcinoma has long been observed in clinical practice. This has resulted in several revisions of the traditional TNM staging system, with additional architectural grading systems for lung adenocarcinoma, in an attempt to improve clinical risk stratification (2). While stage IIIB and IV diseases are generally considered surgically inoperable, patients with stage I disease are traditionally resected without adjuvant chemotherapy or radiation therapy as short-term and long-term risks for these postop therapies may exceed the benefit if the prognosis for long-term cure is favorable (3). Unfortunately, tumor relapse after surgery still remains the major cause of treatment failure in stage I diseases: The five-year survival rate after potential curative resection is 73% for stage IA and 58% for stage IB diseases (4). Therefore, adjuvant chemotherapy has been suggested for stage IB diseases with a tumor size greater than 4 cm based on retrospective reanalysis of the CALGB 9633 trial (3). A recent retrospective analysis on 25 267 stage IB cases further suggests the use of adjuvant chemotherapy in all stage IB patients (5). Despite these careful clinico-histo-pathological analyses, there are still many unmet needs. For example, a validated prognostic biomarker for high-risk stage I patients is lacking, and T-stage at this time appears to be the only available parameter. In addition, a predictive biomarker for tailored therapeutic regimen selection is warranted. Finally, as a tumor evolves during therapy, monitoring is necessary for therapeutic refinement. Gratefully, advances in genomics may help the field reach these once unachievable goals.

中文翻译：

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使多样性迈向精确

肺腺癌代表了肺癌的主要组织学亚型，这反过来又是全世界癌症死亡的主要原因（1）。长期以来，在临床实践中一直观察到肺腺癌的异质性。这导致了对传统TNM分期系统的几次修订，并增加了肺腺癌的体系结构分级系统，以期改善临床风险分层（2）。虽然通常认为IIIB和IV期手术不能手术，但传统上将I期患者切除而无辅助化学疗法或放射疗法，因为如果长期预后，这些术后治疗的短期和长期风险可能会超过获益治愈是有利的（3）。不幸，手术后肿瘤复发仍然是I期疾病治疗失败的主要原因：IA期潜在治愈性切除后的五年生存率为73％，IB期疾病为58％（4）。因此，根据对CALGB 9633试验的回顾性重新分析，已建议对肿瘤大小大于4 cm的IB期疾病进行辅助化疗（3）。最近对25267例IB期患者进行的回顾性分析进一步表明，所有IB期患者均应使用辅助化疗（5）。尽管进行了仔细的临床组织病理学分析，但仍存在许多未满足的需求。例如，缺乏针对I期高危患者的经过验证的预后生物标志物，此时的T期似乎是唯一可用的参数。此外，预测性生物标志物可用于量身定制的治疗方案选择。最后，随着肿瘤在治疗过程中的发展，监测对于改善治疗是必要的。值得庆幸的是，基因组学的进步可能有助于该领域实现这些曾经无法实现的目标。