- 作者：Hyo Jae Kang ; Hyo-Jeong Lim ; Jong Sun Park ; Young-Jae Cho ; Ho-Il Yoon ; Jin-Haeng Chung ; Jae Ho Lee ; Choon-Taek Lee
- 关键词：Lung adenocarcinoma ; EML4-ALK ; EGFR ; Bronchoscopy
- 刊名：Respiratory Medicine
- 出版年：February, 2014
- 年：2014
- 卷：108
- 期：2
- 页码：388-394
- 全文大小：649 K
Summary
Background
The discovery of the chromosomal fusion product of anaplastic lymphoma kinase (ALK) with echinoderm microtubule-associated protein-like 4 (EML4) (EML4-ALK) has changed the treatment paradigm of lung cancer. In this study, we analysed the clinical characteristics, including bronchoscopic findings, of patients with EML4-ALK-positive adenocarcinoma and compared them with those of EGFR mutation-positive patients.Materials and methods
In this retrospective cohort study, the clinical characteristics and bronchoscopic findings of patients with ALK fusion-positive lung cancers were compared to patients with EGFR-mutant lung cancers.
Results
Among the 440 patients with adenocarcinoma of lung screened for this study, 46 (10.4%) harboured the EML4-ALK fusion, 90 (20.4%) harboured an activating EGFR mutation, and all had adenocarcinoma. In univariate analysis, ALK-positive patients were significantly younger than EGFR-positive patients (p聽=聽0.004) and were more commonly male (p聽=聽0.021). An initial status of stage IV metastatic cancer was more frequently noted in EML4-ALK-positive patients (p聽=聽0.012), with initial brain metastasis frequently observed (p聽=聽0.007). Compared with EGFR-positive patients, EML4-ALK-positive patients were significantly more likely to have positive bronchoscopic findings, which suggested a more centralized origin (p聽=聽0.001). EML4-ALK patients also had significantly more positive bronchoscopic findings and were more commonly male in multivariate analysis.
Conclusions
The EML4-ALK fusion defines a new molecular subset of NSCLC that has distinct clinical and bronchoscopic findings suggesting more proximal origin when compared to tumours harbouring EGFR mutations.