Abstract
IntroductionThis 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.MethodsA 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.ResultsForty-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).ConclusionThe 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.
Highlights
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
Patients with echinoderm microtubule-associated protein-like 4 gene and anaplastic lymphoma kinase gene (EML4-ALK) fusion is another important subset of non-small-cell lung cancer (NSCLC)
This is caused by a small inversion of chromosome 2p and the hydrophobic echinoderm microtubule-associated protein-like protein (HELP) domain, and a portion of the WD-repeat region becomes fused to the intracellular juxtamembrane region of ALK [5]
Summary
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. Patients with echinoderm microtubule-associated protein-like 4 gene and anaplastic lymphoma kinase gene (EML4-ALK) fusion is another important subset of NSCLC. This is caused by a small inversion of chromosome 2p (the N-terminal half of EML4 encompassing the basic region) and the hydrophobic echinoderm microtubule-associated protein-like protein (HELP) domain, and a portion of the WD-repeat region becomes fused to the intracellular juxtamembrane region of ALK [5]. Researchers have identified other ALK fusion partners in addition to EML4, including TRK-fused gene (TFG) [9], kinesin family member 5B (KIF5B) [10], kinesin light chain 1 (KLC1) [11], huntingtin-interacting protein 1 (HIP1) [12], translocated promoter region (TPR) [13], and SEC31A [14]
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