Department of Medical Oncology, Qilu Hospital of Shandong University, Jinan, China.
Department of Internal Medicine, Third Peoples Hospital of Liaocheng City, China.
J Cancer Res Ther. 2022 Apr;18(2):445-451. doi: 10.4103/jcrt.jcrt_2334_21.
Invasive mucinous adenocarcinoma (IMA) is a distinct variant of lung adenocarcinoma, which typically has a worse survival. However, its pathogenesis is potentially associated with a high degree of molecular heterogeneity, which might determine its different prognosis.
We retrospectively analyzed 2207 consecutive lung adenocarcinoma patients who underwent radical resection at Qilu Hospital of Shandong University and Shandong Provincial Hospital from 2013 to 2019. Anaplastic lymphoma kinase (ALK) fusion protein expression was routinely detected by immunohistochemistry. The clinicopathological characteristics and treatment outcomes of IMA patients were retrieved, and compared between ALK-positive and ALK-negative IMA patients as well as between pure IMA and mixed IMA patients. The last follow-up was on December 31, 2020, and the median follow-up was 42 months.
A total of 98 patients (4.4%) were diagnosed with IMA. ALK protein expression was positive in 24.5% of IMAs, which was significantly higher than that of non-IMA lung adenocarcinomas (4.7%, P < 0.001). ALK-positive and ALK-negative IMA, as well as pure IMA and mixed IMA, showed similar distribution in terms of patients' age, gender and smoking history, stage, and primary tumor location, except for a higher rate of lymph node metastasis in mixed IMA (22.0% vs. 46.2%, P = 0.012). Five cases (20.8%) of ALK-positive IMAs and 28 cases (40.6%) of ALK-negative IMAs experienced recurrence. Multivariable-adjusted Cox regression analysis demonstrated that ALK expression was a favorable prognostic factor for both disease-free survival (hazard ratio [HR]: 0.354; 95% confidence interval [CI]: 0.131-0.960; P = 0.041) and overall survival (HR: 0.138; 95% CI: 0.029-0.658; P = 0.013) in resected IMA. No difference in disease-free survival (HR: 0.524; 95% CI: 0.237-1.157; P = 0.110) and OS (HR: 0.553; 95% CI: 0.199-1.537; P = 0.256) was observed between pure IMA and mixed IMA.
Invasive mucinous lung adenocarcinoma showed higher ALK protein expression, which was a favorable prognostic factor for survival in early resected patients.
浸润性黏液性腺癌（IMA）是肺腺癌的一种特殊亚型，其生存预后通常较差。然而，其发病机制可能与高度的分子异质性相关，这可能决定了其不同的预后。
我们回顾性分析了 2013 年至 2019 年期间在山东大学齐鲁医院和山东省立医院接受根治性切除术的 2207 例连续肺腺癌患者。常规采用免疫组织化学法检测间变性淋巴瘤激酶（ALK）融合蛋白的表达。检索 IMA 患者的临床病理特征和治疗结果，并比较 ALK 阳性和 ALK 阴性 IMA 患者以及纯 IMA 和混合 IMA 患者之间的差异。最后一次随访时间为 2020 年 12 月 31 日，中位随访时间为 42 个月。
共诊断 98 例 IMA（4.4%）。IMA 中 ALK 蛋白表达阳性率为 24.5%，明显高于非 IMA 肺腺癌（4.7%，P < 0.001）。ALK 阳性和 ALK 阴性 IMA 以及纯 IMA 和混合 IMA 在患者年龄、性别、吸烟史、分期和原发肿瘤位置方面的分布相似，除混合 IMA的淋巴结转移率较高（22.0% vs. 46.2%，P = 0.012）外。5 例（20.8%）ALK 阳性 IMA 和 28 例（40.6%）ALK 阴性 IMA 出现复发。多变量调整 Cox 回归分析表明，ALK 表达是可切除 IMA 患者无病生存率（风险比[HR]：0.354；95%置信区间[CI]：0.131-0.960；P = 0.041）和总生存率（HR：0.138；95%CI：0.029-0.658；P = 0.013）的有利预后因素。在无病生存率（HR：0.524；95%CI：0.237-1.157；P = 0.110）和 OS（HR：0.553；95%CI：0.199-1.537；P = 0.256）方面，纯 IMA 和混合 IMA 之间无差异。
浸润性黏液性腺癌显示出更高的 ALK 蛋白表达，这是早期接受根治性切除的患者生存的有利预后因素。
