Worse disease-free, tumor-specific, and overall survival in surgically-resected lung adenocarcinoma patients with ALK rearrangement
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Qiongqiong Gao1,2,3,4, Pupu Li1,2,3,4, Xiangli Jiang1,2,3,4, Zhongli Zhan1,2,3,5, Qingna Yan1,2,3,5, Bo Zhang6 and Chun Huang1,2,3,4
1Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin 300060, P.R. China
2Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, P.R. China
3Tianjin’s Clinical Research Center for Cancer, Tianjin 300060, P.R. China
4Department of Thoracic Oncology, Tianjin Cancer Institute & Hospital, Tianjin 300060, P.R. China
5Department of Pathology, Tianjin Lung Cancer Center, Tianjin Cancer Institute & Hospital, Tianjin 300060, P.R. China
6Department of Ultrasound Diagnosis, Second Hospital of Tianjin Medical University, Tianjin 300060, P.R. China
Chun Huang, email: [email protected]
Keywords: anaplastic lymphoma kinase rearrangement, lung adenocarcinoma, surgical resection, clinicopathological characteristics, treatment outcome
Received: March 17, 2017 Accepted: August 26, 2017 Published: September 18, 2017
Introduction: This study determined the prevalence of anaplastic lymphoma kinase (ALK) rearrangement, and identified the associations of ALK rearrangement with clinicopathologic characteristics and treatment outcomes in patients with surgically-resected stage I-III lung adenocarcinoma.
Methods: A total of 534 surgically-resected lung adenocarcinoma patients were studied. The prevalence of ALK protein over-expression was determined by a fully-automated immunochemistry assay (with mouse monoclonal Ventana D5F3 antibody), and the associations of ALK rearrangement with clinicopathologic characteristics and treatment outcomes were analyzed.
Results: Forty-two (7.9%) of the 534 lung adenocarcinoma patients were ALK IHC-positive. ALK rearrangement was significantly associated with younger age (P = 0.011), high T-stage (P = 0.025), high pathologic stage (P = 0.002), solid predominant adenocarcinoma with mucin production (P = 0.006), invasive mucinous adenocarcinoma (P = 0.009), and receipt of adjuvant therapy after surgery (P = 0.036), but no significant associations were found between the ALK rearrangement and sex or smoking status. ALK IHC-positivity was significantly associated with a shorter disease-free survival, tumor-specific survival, and overall survival (P = 0.001, 0.026, and 0.007, respectively). Multivariate analysis showed that ALK IHC-positivity was an adverse prognostic factor for disease-free survival (HR, 1.80; 95% CI 1.18-2.77; P = 0.007), tumor-specific survival (HR, 2.59; 95% CI 1.35-4.97; P = 0.004), and overall survival (HR, 1.92; 95% CI 1.07-3.44; P = 0.030).
Conclusion: The clinical characteristics of patients with ALK-positive lung adenocarcinoma were similar to those of EGFR-mutated patients. ALK rearrangement was an adverse prognostic factor in surgically-resected lung adenocarcinoma patients.
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