Shin Sun Hye, Lee Hyun, Jeong Byeong-Ho, Choi Yong Soo, Shin Myung-Hee, Kim Seonwoo, Han Joungho, Lee Kyung Soo, Shim Young Mog, Kwon O Jung, Kim Hojoong
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea.
J Thorac Dis. 2018 Jun;10(6):3460-3467. doi: 10.21037/jtd.2018.05.131.
It has not been determined if adjuvant chemotherapy would be helpful for completely resected early-stage lung adenocarcinoma even with unfavorable genetic markers. As the positive anaplastic lymphoma kinase () rearrangement is associated with aggressive clinical feature in lung adenocarcinoma, we evaluated the treatment outcomes of completely resected stage IA lung adenocarcinoma according to initial status.
This is a retrospective cohort study including 309 patients with surgically resected stage IA lung adenocarcinoma from February 2010 to December 2013. Patients were screened for rearrangement using immunohistochemistry. A positive status was defined as an immunohistochemistry score of 2+ or more. Both disease-free survival (DFS) and the initial recurrence pattern were analyzed according to status.
Twenty-three (7.4%) patients had -positive adenocarcinoma. During the median follow-up of 35.8 months, recurrence developed in 34 (11.0%) patients. The patients with -positive tumor had significantly lower 5-year DFS rate (62.4%) compared to those with -negative tumor (86.5%; P=0.038). The multivariable analysis showed that rearrangement was associated with a higher risk of disease recurrence (adjusted hazard ratio =2.64; 95% confidence interval, 1.08-6.44). In addition, patient with -positive tumor showed more frequent recurrence in regional lymph nodes compared with those with -negative tumor (83.3% 28.6%; P=0.031).
In patients with completely resected stage IA lung adenocarcinoma, ALK rearrangement was associated with unfavorable DFS and more frequent regional lymph node metastasis. Therefore, careful surveillance for recurrence should be performed in this subset of patients.
对于即便具有不良基因标志物的完全切除的早期肺腺癌，辅助化疗是否有益尚未确定。由于间变性淋巴瘤激酶（ALK）重排阳性与肺腺癌的侵袭性临床特征相关，我们根据初始ALK状态评估了完全切除的ⅠA期肺腺癌的治疗结果。
这是一项回顾性队列研究，纳入了2010年2月至2013年12月期间309例接受手术切除的ⅠA期肺腺癌患者。使用免疫组织化学方法筛查患者的ALK重排情况。ALK阳性状态定义为免疫组织化学评分为2+或更高。根据ALK状态分析无病生存期（DFS）和初始复发模式。
23例（7.4%）患者为ALK阳性腺癌。在中位随访35.8个月期间，34例（11.0%）患者出现复发。ALK阳性肿瘤患者的5年DFS率（62.4%）显著低于ALK阴性肿瘤患者（86.5%；P=0.038）。多变量分析显示，ALK重排与疾病复发风险较高相关（调整后风险比=2.64；95%置信区间，1.08-6.44）。此外，与ALK阴性肿瘤患者相比，ALK阳性肿瘤患者区域淋巴结复发更频繁（83.3%对28.6%；P=0.031）。
在完全切除的ⅠA期肺腺癌患者中，ALK重排与不良的DFS及更频繁的区域淋巴结转移相关。因此，应对这部分患者进行仔细的复发监测。
