Abstract
BackgroundA novel fusion gene of echinoderm microtubule-associated protein-like 4 (EML4) and anaplastic lymphoma kinase (ALK) has been recently identified in non-small-cell lung cancers (NSCLCs). Patients with the EML4-ALK fusion gene demonstrate unique clinicopathological and physiological characteristics. Here we present a meta-analysis of large-scale studies to evaluate the clinicopathological characteristics of NSCLC patients harboring the EML4-ALK fusion gene.MethodsBoth English and Chinese databases were systematically used to search the materials of the clinicopathological characteristics of patients with NSCLC harboring the EML4-ALK fusion gene. Pooled relative risk (RR) estimates and the 95% confidence intervals (95% CI) were calculated with the fixed or random effect model. Publication bias and chi-square test were also calculated.Results27 retrospective studies were included in our meta-analysis. These studies included a total of 6950 patients. The incidence rate of EML4-ALK fusion in NSCLC patients was found to be 6.8% (472/6950). The correlation of the EML4-ALK fusion gene and clinicopathological characteristics of NSCLC patients demonstrated a significant difference in smoking status, histological types, stage, and ethnic characteristics. The positive rate of the EML4-ALK fusion gene expression in females were slightly higher than that in males, but not significantly (P = 0.52). In addition, the EML4-ALK fusion gene was mutually exclusive of the EGFR and KRAS mutation genes (P = 0.00).ConclusionOur pooled analysis revealed that the EML4-ALK fusion gene was observed predominantly in adenocarcinoma, non-smoking and NSCLC patients, especially those diagnosed in the advanced clinical stage of NSCLC. Additionally, the EML4-ALK fusion gene was exclusive of the EGFR and KRAS mutation genes. We surmise that IHC assay is a valuable tool for the prescreening of patients with ALK fusion gene in clinical practice, and FISH assay can be performed as a confirmation method. These insights might be helpful in guiding the appropriate molecular target therapy for NSCLC.
Highlights
Lung cancer is the most prevalent cancer and leading cause of cancer-related deaths worldwide [1]
The correlation of the echinoderm microtubule-associated protein-like 4 (EML4)-anaplastic lymphoma kinase (ALK) fusion gene and clinicopathological characteristics of non-small cell lung cancer (NSCLC) patients demonstrated a significant difference in smoking status, histological types, stage, and ethnic characteristics
Our pooled analysis revealed that the EML4-ALK fusion gene was observed predominantly in adenocarcinoma, non-smoking and NSCLC patients, especially those diagnosed in the advanced clinical stage of NSCLC
Summary
Lung cancer is the most prevalent cancer and leading cause of cancer-related deaths worldwide [1]. Despite improvements in therapeutic methodology, including surgery, chemotherapy and radiotherapy, the average prognosis of lung carcinoma still remains unsatisfactory and the five year survival rate is merely 15% [2]. Among those lung cancer patients, non-small cell lung cancer (NSCLC) accounted for approximately 80%-85% of lung cancer cases [3]. Increased attention has been garnered in the development and application of drugs that target specific molecules which expressed on NSCLC cells and great success has been reported in NSCLC patient study groups [5,6] These methods include signaling transduction and angiogenesis inhibitors, such as the epidermal growth factor receptor (EGFR) targeted drugs [7]. We present a meta-analysis of large-scale studies to evaluate the clinicopathological characteristics of NSCLC patients harboring the EML4-ALK fusion gene
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