Clinicopathological and Prognostic Significance of Rearrangement in Patients with Surgically Resected Lung Adenocarcinoma: A Propensity Score Matching Study.

OBJECTIVE

The echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase () fusion gene is a key oncogenic driver in non-small cell lung cancer (NSCLC). This study analyzed the clinicopathological characteristics and prognostic significance of fusion gene in patients with surgically resected adenocarcinoma.

METHODS

The clinicopathological characteristics of 1056 consecutive patients with surgically resected stage I-IIIA adenocarcinoma were collected from February 2014 to October 2014, and rearrangement was detected using real-time polymerase chain reaction (RT-PCR) technology. To compare the imaging and pathological features, a propensity score matching (PSM) method was performed. The follow-up information was collected to evaluate the long-term outcomes of patients with rearrangement.

RESULTS

The prevalence of rearrangement was 6.6% in 1056 consecutive patients. A total of 70 positive and 210 negative patients were identified after PSM. Imaging and pathological analyses showed that rearrangement was significantly associated with less ground-glass opacity (GGO) (adjusted OR=1.38, 95% CI=1.03-1.85, =0.029) and higher prevalence of non-invasive mucinous adenocarcinoma mucin-laden adenocarcinomas (non-IMA MLA, adjusted OR=6.79, 95% CI=2.69-17.17, <0.001). rearrangement was found to be an unfavorable prognostic factor for disease-free survival (DFS) in female patients (HR=2.26, 95% CI=1.13-4.53, =0.021).

CONCLUSION

Our results suggest that adenocarcinomas harboring fusion gene exhibit specific radiological and pathological characteristics compared with negative adenocarcinomas. In female patients, rearrangement was associated with shorter DFS.