A large, single-center, real-world study of clinicopathological characteristics and treatment in advanced ALK-positive non-small-cell lung cancer.
A large, single-center, real-world study of clinicopathological characteristics and treatment in advanced ALK-positive non-small-cell lung cancer.
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关于晚期 ALK 阳性非小细胞肺癌临床病理特征和治疗的大型、单中心、真实世界研究
DOI：
10.1002/cam4.1059
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发表时间：
2017-05
期刊：
影响因子：
4
通讯作者：
Zhang L
中科院分区：
文献类型：
--
作者：
Chen G;Chen X;Zhang Y;Yan F;Fang W;Yang Y;Hong S;Miao S;Wu M;Huang X;Luo Y;Zhou C;Gong R;Huang Y;Zhou N;Zhao H;Zhang L
克唑替尼在伴有间变性淋巴瘤激酶（ALK）重排的晚期非小细胞肺癌（NSCLC）患者中取得了惊人的成功。然而，没有真实的世界研究描述中国此类患者的临床病理学特征和治疗。从中山大学肿瘤防治中心连续收集患者。采用卡方检验探讨ALK融合状态与转移部位的关系。Kaplan-Meier方法和多变量分析用于估计无进展生存期（PFS）。共入组了291例晚期NSCLC患者（ALK（+），N = 97; ALK和表皮生长因子受体（EGFR）（-），N = 194）。基线时ALK阳性患者的脑转移发生率显著高于双阴性患者（26.5% vs. 16.5%，P = 0.038）和治疗期间（25.8% vs. 11.9%，P = 0.003），但胸腔积液相反（6.2% vs. 26.9%，基线时P < 0.001;治疗期间3.1% vs. 10.3%，P = 0.031）。53.6%的ALK阳性患者使用克唑替尼，而其他患者仅接受化疗（37.1%）或支持性治疗（9.3%）。在ALK阳性患者中，与化疗相比，克唑替尼的使用延长了PFS（中位PFS 17.6 m vs. 4.8 m，P < 0.001）。ALK阳性NSCLC比双阴性NSCLC有更多的脑转移和更少的胸腔积液。克唑替尼在晚期ALK阳性NSCLC中的任何线的PFS均优于化疗。然而，一半晚期ALK阳性患者从未接受过克唑替尼治疗，这是严峻的，需要改善。
Crizotinib has achieved astonishing success in advanced non‐small‐cell lung cancer (NSCLC) patients harboring anaplastic lymphoma kinase (ALK) rearrangement. However, no real‐world studies described the clinicopathological characteristics and treatment of such patients in China. Patients were consecutively collected from Sun Yat‐sen University Cancer Center. Chi‐square test was applied to explore the relationship between ALK fusion status and metastasis sites. Kaplan–Meier methods and multivariable analyses were used to estimate progression‐free survival (PFS). A total of 291 advanced NSCLC patients (ALK (+), N = 97; both ALK & epidermal growth factor receptor (EGFR) (‐), N = 194) were enrolled. The occurrence of brain metastasis in ALK‐positive patients was significantly higher than double‐negative ones both at baseline (26.5% vs. 16.5%, P = 0.038) and during treatment (25.8% vs. 11.9%, P = 0.003), but opposite for pleural effusion (6.2% vs. 26.9%, P < 0.001 at baseline; 3.1% vs. 10.3%, P = 0.031 during treatment). ALK‐positive patients of 53.6% used crizotinib, whereas others only received chemotherapy (37.1%) or supportive care (9.3%). Usage of crizotinib prolonged PFS compared with chemotherapy in ALK‐positive patients (median PFS 17.6 m vs. 4.8 m, P < 0.001). ALK‐positive NSCLC had more brain metastasis and less pleural effusion than double‐negative ones. Crizotinib showed better PFS than chemotherapy in advanced ALK‐positive NSCLC at any line. However, half advanced ALK‐positive patients never received crizotinib, which was grim and need improving.