MRD status combined with TNM staging optimizes postoperative prognostic stratification in non-small cell lung cancer: a meta-analysis and systematic review.

Objective: To investigate survival differences based on MRD status at different landmarks and tumor staging in patients with early-stage non-small cell lung cancer (NSCLC) following surgical resection.

Methods: Data from six studies including 867 early-stage NSCLC patients who underwent surgery were summarized. Patients were grouped according to MRD status at different detection time points and tumor staging. Survival differences among subgroups were evaluated using the Kaplan-Meier method, and statistical significance was determined through the log-rank test.

Result: MRD-negative patients exhibit significantly better RFS and OS compared to MRD-positive patients. Based on MRD status at 3-7 days and 30 days post-surgery, combined with TNM staging, we propose a novel four-category prognostic stratification system centered on post-surgery dual-detection timepoints. This stratification system outperforms the traditional TNM staging and is divided into four groups: Group A: Post-surgery dual-negative with Stage I disease; Group B: Post-surgery dual-negative with Stage II disease; Group C: Post-surgery dual-negative with Stage III disease or MRD-positive at 3-7 days but negative at 30 days post-surgery （positive-to-negative conversion)；Group D: Post-surgery dual-positive or MRD-negative at 3-7 days but positive at 30 days post-surgery (negative-to-positive conversion).The RFS outcomes are ranked as Group A > Group B > Group C > Group D. Notably, Group D has worse RFS than Stage III patients.