Blood-Based MRD Test Predicts Recurrence Risk After Lung Cancer Surgery

Assessing recurrence risk after surgery for early-stage non-small cell lung cancer remains challenging, complicating adjuvant therapy and surveillance decisions. Blood-based molecular residual disease (MRD) testing may refine risk assessment beyond standard clinical tools. Supporting this potential, new data presented at a global lung cancer meeting show that an MRD assay strongly predicts recurrence-free and overall survival after surgery.

Natera (Austin, TX, USA) reported new findings for its Signatera molecular residual disease (MRD) test at the International Association for the Study of Lung Cancer (IASLC) 2026 World Conference on Lung Cancer in Seoul, South Korea. The company and its collaborators presented four abstracts, including two oral presentations. Among them, a mini-oral presentation featured what the company called the largest MRD dataset ever presented in lung cancer.

Image: Signatera uses ctDNA analysis to identify residual tumor-derived genetic material after definitive treatment (image credit: Adobe Stock)

The analysis included 1,129 patients with resected stage 1–3 non-small cell lung cancer followed between 2016 and 2025. Investigators evaluated Signatera MRD detection shortly after surgery and during longitudinal surveillance. Findings were consistent across both primary surgical and perioperative cohorts, supporting the potential applicability of Signatera monitoring across these treatment settings.

Early postoperative Signatera status, assessed 7–90 days after surgery, strongly predicted recurrence-free survival. MRD-negative patients had a three-year recurrence-free survival rate 25 percentage points higher than MRD-positive patients. During surveillance, MRD positivity was associated with approximately fivefold higher risk of recurrence or death. The analysis also supported the assay’s prognostic value for overall survival.

“One of the pressing challenges in early-stage lung cancer is knowing which patients are truly at risk of recurrence and our standard clinical tools don't reliably give us that answer,” said Charu Aggarwal, M.D., M.P.H., FASCO, the Leslye Heisler Professor for Lung Cancer Excellence at the University of Pennsylvania’s Perelman School of Medicine and principal investigator of the study.

“This dataset showed, across more than 1,100 patients, that Signatera MRD status, in the early post-surgical window and throughout surveillance, is a powerful and consistent predictor of recurrence-free and overall survival. That kind of evidence, at this scale, can meaningfully change how we think about adjuvant treatment decisions in lung cancer,” added Dr. Aggarwal.

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