Biomarker Integration in the Perioperative Management of Early-Stage Non-Small-Cell Lung Cancer

The concept of personalized medicine has tremendous appeal-tailoring diagnosis and treatment to an individual, rather than a "one-size-fits-all" approach. The management of non-small-cell lung cancer (NSCLC) has rapidly evolved toward strategies increasingly guided by tumor biology and precision oncology. The safety and significant efficacy of biomarker-directed therapies in metastatic disease have fueled interest in applying precision oncology to early-stage, operable NSCLC. Advances in molecular profiling have revealed that a substantial proportion of resected NSCLC harbor actionable driver mutations, enabling the integration of targeted therapies into the perioperative setting. The success of adjuvant epidermal growth factor receptor and anaplastic lymphoma kinase inhibition established a framework for biomarker-driven therapy and highlights the importance of comprehensive molecular testing at diagnosis. In parallel, perioperative immune checkpoint inhibitor-based strategies have expanded treatment options for appropriately selected patients, further emphasizing the importance of molecular profiling. Significant implementation gaps remain, including incomplete molecular testing, delayed results, inadequate tissue sampling, fragmented workflows, and disparities in access. Beyond clinically actionable driver mutations, emerging research highlights radiogenomics and advances in the use of circulating tumor DNA for minimal residual disease detection, with important implications for early recurrence detection and patient prognostication, although these technologies differ in clinical maturity. Collectively, these developments emphasize the molecular heterogeneity underlying early-stage NSCLC and the expanding role of biomarkers in guiding clinical decision-making. Integrating genomic, radiographic, and biologic markers into clinical workflows will be essential to refine risk stratification, personalize perioperative treatment strategies, and ultimately improve long-term oncologic outcomes.