Department of Pathology, West China Hospital of Sichuan University, Chengdu, 610041, China.
Department of Pathology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, China.
Hum Pathol. 2014 Jul;45(7):1414-22. doi: 10.1016/j.humpath.2014.02.015. Epub 2014 Mar 5.
Anaplastic lymphoma kinase (ALK) translocation-positive adenocarcinoma of the lung is a newly recognized molecular subgroup. Limited data on the clinicopathological features of this entity in the Chinese population are available. We performed immunohistochemical staining for the ALK protein and fluorescence in situ hybridization detection of the ALK translocation. We enrolled 793 Chinese patients with lung adenocarcinoma and identified 54 ALK translocation-positive patients (6.8%) in the group. Compared with the entire group of patients, ALK translocation-positive patients were younger (P < .01) and more likely to be nonsmokers (P = .017), but presented with a higher percentage of advanced-stage disease (P = .022) and lymph node metastases (P = .006). ALK translocation-positive patients more commonly exhibited poorly differentiated tumor histology and a predominantly solid tumor growth pattern relative to the ALK translocation-negative patients. Morphologically, ALK translocation was associated with extracellular mucus secretion, a mucinous cribriform structure, and signet ring cell (SRC) components. ALK translocation was present in 42.5% and 34.0% of adenocarcinomas with SRC components or wild-type EGFR, respectively. ALK translocation, occurring at a frequency of 6.8% in Chinese patients, defines a unique molecular subgroup of lung tumors. Fluorescence in situ hybridization should be performed in each case of lung adenocarcinoma with SRC components or wild-type EGFR to identify ALK translocation-positive patients.
间变性淋巴瘤激酶（ALK）阳性肺腺癌是一个新确认的分子亚型。目前在中国人群中，有关该实体的临床病理特征的资料有限。我们对 ALK 蛋白进行了免疫组织化学染色，并用荧光原位杂交法检测 ALK 易位。我们共纳入了 793 例中国肺腺癌患者，其中 54 例（6.8%）为 ALK 易位阳性患者。与整个患者组相比，ALK 易位阳性患者更年轻（P <.01），更可能为非吸烟者（P =.017），但表现为更晚期的疾病（P =.022）和淋巴结转移（P =.006）的发生率更高。ALK 易位阳性患者的肿瘤组织学分化程度较差，肿瘤生长模式以实体为主，与 ALK 易位阴性患者相比。形态上，ALK 易位与细胞外黏液分泌、黏液筛状结构和印戒细胞（SRC）成分有关。ALK 易位存在于 SRC 成分或野生型 EGFR 阳性的腺癌中分别为 42.5%和 34.0%。在中国患者中，ALK 易位的发生率为 6.8%，定义了肺肿瘤的一个独特的分子亚群。对于具有 SRC 成分或野生型 EGFR 的肺腺癌，应进行荧光原位杂交，以识别 ALK 易位阳性患者。
