The Genomic Evolution of Early‐Stage Non‐Small Cell Lung Cancer

ABSTRACT The widespread application of low‐dose computed tomography has significantly increased the detection of early‐stage non‐small cell lung cancer (NSCLC); however, therapeutic advances remain limited by an incomplete understanding of the genomic factors underlying tumor evolution. Here, we provide a comprehensive review of the genomic evolution of early‐stage NSCLC, with a particular focus on lung adenocarcinoma and squamous cell carcinoma. We summarize the genomic mechanisms driving pathological progression from pre‐invasive to invasive lesions as well as the molecular alterations associated with radiological progression. Furthermore, we discuss clonal evolution models, highlighting the distinct roles of clonal versus sub‐clonal mutations and the dynamic changes in the tumor microenvironment. Finally, we address the translational implications of these findings for developing novel biomarkers and screening strategies, and outline current methodological limitations and future directions in the field.