Issues

The cover image is adapted from Fig. 1 in the article, “Lung Microbial and Host Genomic Signatures as Predictors of Prognosis in Early-Stage Adenocarcinoma,” by Tsay and colleagues. Risk of early-stage lung adenocarcinoma recurrence after surgical resection is significant, and post-recurrence median survival is approximately two years. Currently there are no commercially available biomarkers that predict recurrence. Tsay and colleagues sought to more completely characterize the microbial composition and transcriptome in tumor and tumor-adjacent unaffected lung tissues to determine whether these combined outputs may serve as meaningful predictors of early stage I lung adenocarcinoma recurrence. In 91 early-stage (Stage IA/IB) lung adenocarcinoma patients with extensive follow-up, the authors used 16s rRNA gene sequencing and host RNA-sequencing to map the microbial and host transcriptomic landscape in tumor and adjacent unaffected lung samples. Both microbiota and gene expression profiles from tumor-adjacent unaffected lung samples were predictive of recurrence risk and showed substantially increased performance over analogous tumor profiling. Figure 1 shows microbiota in tumor and unaffected lung associated with cancer recurrence. Overall, modeling suggested that a combined microbial/transcriptome approach using unaffected lung samples had the best biomarker performance (AUC = 0.83). This study suggests that lung adenocarcinoma recurrence is associated with distinct pathophysiological mechanisms of microbial–host interactions in the unaffected lung rather than those present in the resected tumor. For more information, see the article beginning on page 1433.