Radiologic Characteristics of Surgically Resected Non-Small Cell Lung Cancer With ALK Rearrangement or EGFR Mutations
Radiologic Characteristics of Surgically Resected Non-Small Cell Lung Cancer With ALK Rearrangement or EGFR Mutations
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DOI：
10.1016/j.athoracsur.2015.07.062
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发表时间：
2016-02-01
影响因子：
4.6
通讯作者：
Chung, Jin-Haeng
中科院分区：
文献类型：
--
作者：
Kim, Tae Jung;Lee, Choon-Taek;Chung, Jin-Haeng
背景放射基因组学特征可预测手术切除的非小细胞肺癌（NSCLC）患者的间变性淋巴瘤激酶（ALK）重排。采用荧光原位杂交技术对497例NSCLC患者进行ALK重排检测。其中，198例接受ALK和表皮生长因子受体（EGFR）突变筛查的患者入组。采用单因素和多因素分析研究了不同基因型的临床病理结果、手术后生存率、计算机断层扫描（CT）特征和最大标准化摄取值。采用受试者工作特征（ROC）曲线分析这些因素的预测价值。切除的NSCLC中ALK阳性的患病率为5.0%（25/497）。ALK重排患者在患者年龄方面存在显著差异（ALK与EGFR的p = 0.006，ALK与野生型[WT]/WT的p = 0.04），实体病变（ALK vs EGFR p = 0.0074），对比增强程度（ALK vs EGFR p = 0.0006）和病变边缘（ALK vs EGFR p = 0.0011，ALK vs WT/WT p = 0.0314）。多变量分析显示，年轻、实性病变、分叶状边缘和增强CT扫描的低密度是ALK阳性的独立预测因素（分别为p = 0.027、0.046、0.001、0.021）。预测模型的ROC曲线下面积为0.832，具有良好的区分度。与EGFR突变或WT/WT队列相比，ALK重排肺癌具有特征性临床和影像学特征。我们的研究结果表明，年轻，分叶状边缘，实性病变，增强CT扫描低密度是ALK重排肺癌的重要预测因子。(C)2016胸外科医师协会
Background. Radiogenomic features are predictive of anaplastic lymphoma kinase (ALK) rearrangement in surgically resected non-small cell lung cancer (NSCLC).Methods. ALK rearrangement was screened by fluorescent in situ hybridization in 497 patients with resected NSCLC. Of these, 198 patients screened for both ALK and epidermal growth factor receptor (EGFR) mutation were enrolled. Clinicopathologic findings, survival after surgical procedure, computed tomographic (CT) features, and maximum standardized uptake value according to different genotypes were investigated with univariate and multivariate analyses. A receiver operating characteristic (ROC) curve analysis was performed to quantify the predictive value of these factors.Results. The prevalence of ALK positivity in resected NSCLC was 5.0% (25 of 497). Patients with ALK rearrangement showed significant differences in terms of patient's age (p = 0.006 for ALK versus EGFR, and 0.04 for ALK versus wild type [WT]/WT, respectively), solid lesion (p = 0.0074 for ALK versus EGFR), degree of contrast enhancement (p = 0.0006 for ALK versus EGFR), and lesion margin (p = 0.0011 for ALK versus EGFR, and 0.0314 for ALK versus WT/WT, respectively) compared with EGFR mutant and WT/WT cohorts. Multivariate analysis revealed that young age, solid lesion, lobulated margin, and hypoattenuation at contrast-enhanced CT scan were independent predictors of ALK positivity (p = 0.027, 0.046, 0.001, 0.021, respectively). The area under the ROC curve of the predictive model was 0.832, which suggests good discrimination.Conclusions. ALK-rearranged lung cancer has characteristic clinical and imaging features compared with EGFR mutant or WT/WT cohorts. Our findings suggest that young age, lobulated margin, solid lesion, and hypoattenuation at contrast-enhanced CT scan are important predictors of ALK-rearranged lung cancer. (C) 2016 by The Society of Thoracic Surgeons