Comparative analyses of overall survival in patients with anaplastic lymphoma kinase-positive and matched wild-type advanced nonsmall cell lung cancer
Comparative analyses of overall survival in patients with anaplastic lymphoma kinase-positive and matched wild-type advanced nonsmall cell lung cancer
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DOI：
10.1002/cncr.26668
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发表时间：
2012-07-15
期刊：
影响因子：
6.2
通讯作者：
Bang, Yung-Jue
中科院分区：
文献类型：
--
作者：
Lee, June Koo;Park, Heae Surng;Bang, Yung-Jue
背景：这项研究的目的是调查晚期ALK阳性非小细胞肺癌(NSCLC)患者的总生存率(OS)，并与ALK野生型(WT)患者的匹配病例队列进行比较。方法：收集2003-2009年间首尔国立大学医院NSCLC数据库中1166例IIIB/IV期非鳞状细胞肺癌患者的资料。应用ALK荧光原位杂交(FISH)技术对262例表皮生长因子受体(EGFR)阳性患者和既往EGFR酪氨酸激酶抑制剂(TKI)治疗无效患者进行分析。比较ALK阳性患者、EGFR突变阳性患者和ALK-WT/EGFR-WT患者的总生存率(OS)。分析一线化疗和EGFR TKI后的无进展生存率(PFS)。结果：根据FISH分析，23例患者ALK阳性，在随访期间未接受ALK抑制剂治疗。ALK阳性患者、EGFR突变阳性患者和WT/WT患者的中位OS分别为12.2个月、29.6个月和19.3个月(VS EGFR突变阳性患者，P=.001；VS WT/WT，P=.127)。3组一线化疗后PFS差异无统计学意义。然而，接受EGFR TKIs治疗的患者在ALK阳性患者中的PFS比其他两组患者短(VS EGFR突变阳性患者，P<；.001；vs WT/WT，P<；.021)。结论：在前ALK抑制剂时代，ALK阳性患者的生存时间最短，尽管这与WT/WT患者在统计学上没有区别。尽管他们对以铂为基础的化疗的反应与对照组没有不同，但ALK阳性患者对EGFR TKI治疗的抵抗力甚至比WT/WT患者更高。癌症2012年；35793586。(C)2011年美国癌症协会。
BACKGROUND: The purpose of this study was to investigate the overall survival (OS) of patients with advanced ALK-positive nonsmall cell lung cancer (NSCLC) who were managed in the pre-ALK inhibitor era and to compare their survival with that of a matched case cohort of ALK wild-type (WT) patients. METHODS: Data from 1166 patients who had stage IIIB/IV NSCLC with nonsquamous histology were collected from the NSCLC database of Seoul National University Hospital between 2003 and 2009. ALK fluorescence in situ hybridization (FISH) was used to analyze 262 patients who either had the WT epidermal growth factor receptor (EGFR) or were nonresponders to previous EGFR tyrosine kinase inhibitor (TKI) therapy. Overall survival (OS) was compared between 3 groups: 1) ALK-positive patients, 2) EGFR mutation-positive patients, and 3) ALK-WT/EGFR-WT patients. Progression-free survival (PFS) after first-line chemotherapy and EGFR TKIs also was analyzed. RESULTS: Twenty-three patients were ALK-positive according to FISH analysis and did not receive ALK inhibitors during follow-up. The median OS for ALK-positive patients, EGFR mutation-positive patients, and WT/WT patients was 12.2 months, 29.6 months, and 19.3 months, respectively (vs EGFR mutation-positive patients, P = .001; vs WT/WT, P = .127). The PFS after first-line chemotherapy for the 3 groups was not different. However, the PFS for patients who received EGFR TKIs was shorter in ALK-positive patients compared with the other 2 groups (vs EGFR mutation-positive patients, P < .001; vs WT/WT, P < .021). CONCLUSIONS: In the pre-ALK inhibitor era, ALK-positive patients experienced the shortest survival, although it did not differ statistically from that of WT/WT patients. Although their responses to platinum-based chemotherapy were not different from comparator groups, ALK-positive patients were even more resistant to EGFR TKI treatment than WT/WT patients. Cancer 2012;35793586. (C) 2011 American Cancer Society.