Precision medicine in non-small cell lung cancer (NSCLC) is a rapidly evolving area, with the development of targeted therapies for advanced disease and concomitant molecular testing to inform clinical decision-making. In contrast, routine molecular testing in stage I–III disease has not been required, where standard of care comprises surgery with or without adjuvant or neoadjuvant chemotherapy, or concurrent chemoradiotherapy for unresectable stage III disease, without the integration of targeted therapy. However, the phase 3 ADAURA trial has recently shown that the epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI), osimertinib, reduces the risk of disease recurrence by 80% versus placebo in the adjuvant setting for patients with stage IB–IIIA EGFR mutation-positive NSCLC following complete tumor resection with or without adjuvant chemotherapy, according to physician and patient choice. Treatment with adjuvant osimertinib requires selection of patients based on the presence of an EGFR-TKI sensitizing mutation. Other targeted agents are currently being evaluated in the adjuvant and neoadjuvant settings. Approval of at least some of these other agents is highly likely in the coming years, bringing with it in parallel, a requirement for comprehensive molecular testing for stage I–III disease. In this review, we consider the implications of integrating molecular testing into practice when managing patients with stage I–III non-squamous NSCLC. We discuss best practices, approaches and challenges from pathology, surgical and oncology perspectives.

非小细胞肺癌 (NSCLC) 的精准医学是一个快速发展的领域，随着针对晚期疾病的靶向疗法的开发和伴随的分子检测的发展，为临床决策提供信息。相比之下，I-III 期疾病不需要常规分子检测，其中护理标准包括手术加或不加辅助或新辅助化疗，或对不可切除的 III 期疾病进行同步放化疗，而没有整合靶向治疗。然而，ADAURA 3 期试验最近表明，在 IB-IIIA 期患者的辅助治疗中，表皮生长因子受体 (EGFR) 酪氨酸激酶抑制剂 (TKI) 奥希替尼与安慰剂相比可将疾病复发风险降低 80%表皮生长因子受体根据医生和患者的选择，在有或没有辅助化疗的情况下完全切除肿瘤后的突变阳性 NSCLC。辅助奥希替尼治疗需要根据 EGFR-TKI 致敏突变的存在来选择患者。其他靶向药物目前正在辅助和新辅助环境中进行评估。在未来几年中，至少有一些其他药物极有可能获得批准，同时也需要对 I-III 期疾病进行全面的分子检测。在这篇综述中，我们考虑了在管理 I-III 期非鳞状 NSCLC 患者时将分子检测整合到实践中的意义。我们从病理学、外科和肿瘤学的角度讨论最佳实践、方法和挑战。