Non-small cell lung cancer (NSCLC) is the most common cause of cancer death in BC and worldwide. In 2020, 29,300 Canadians were diagnosed with lung cancer and 21,000 died from it — more than colon, breast, and prostate cancers combined. Patients amenable to surgery have the best prospect of cure, but often cancer returns and is lethal. Only 5 percent of patients benefit from chemotherapy after surgery. Return of cancer is caused by changes in the tumour genes and immune system. It is possible to predict these changes to identify patients who would benefit from targeted gene and immune therapies, but testing for tumour genes and immune biomarkers is not done in Stage I-III NSCLC in BC. We will use novel tests to understand how the immune system and tumour genes predict cancer recurrence after surgery. This will be led by thoracic surgeon Dr. Anna McGuire. Tumour gene analysis will be done at the BC Cancer Genomic Lab and immune system analysis will be led by Drs. MacAulay and Guillaud at the BCCRC. Our results will reveal which features predict cancer recurrence so patients who can benefit from targeted gene or immune therapies can be identified. This is first step to implementing this testing for NSCLC patient in BC to improve survival.