Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hsin-Chu Branch, Biomedical Park Hospital, No. 2, Section 1, Shengyi Road, Zhubei City, Hsinchu County 302, Taiwan.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, No. 7, Chung-Shan South Road, Taipei 100225, Taiwan.
J Formos Med Assoc. 2023 Aug;122(8):731-737. doi: 10.1016/j.jfma.2022.12.011. Epub 2022 Dec 30.
Among the histologic types of lung cancer, adenocarcinoma is the most common. Moreover, lung adenocarcinoma with neuroendocrine differentiation (LANED) is a rare histologic character. So far, the clinical significance remains unclear.
We searched for the patients diagnosed with LANED from the electronic pathology database between January 2000 and June 2020 in a tertiary hospital. The tumor specimens were reviewed by a pathologist to confirm the diagnosis. EGFR mutation, ALK translocation, as well as programmed death ligand 1 (PD-L1) and rearranged during transfection (RET) expression were tested in the specimens of LANED. The clinical data were also collected and analyzed.
A total of 10 patients diagnosed with LANED were included. Most were male (80%) and ever smokers (70%). The median age was 71.5 years old. At diagnosis, most had tumors harboring no EGFR mutation (70%), negative ALK translocation (88.9%), and without PD-L1 expression (90%). All specimens tested by immunohistochemical staining for RET expression (n = 9) showed positive results. Among the 10 patients, five underwent operation (stage I, n = 4; stage II, n = 1). The patient with stage II disease had recurrence 11 months later. For patients with advanced stages (stage III, n = 1; stage IV, n = 4), the treatment modalities varied and the overall survival ranged from 11.0 to 46.7 months.
LANED might be associated with a high proportion of RET expression, whereas EGFR mutation, ALK alteration, and PD-L1 expression were uncommon. Further large-scale prospective studies on molecular testing profile and clinical significance of LANED are warranted.
在肺癌的组织学类型中，腺癌最为常见。此外，具有神经内分泌分化的肺腺癌（LANGED）是一种罕见的组织学特征。到目前为止，其临床意义尚不清楚。
我们在一家三级医院的电子病理数据库中搜索了 2000 年 1 月至 2020 年 6 月期间诊断为 LANGED 的患者。由病理学家对肿瘤标本进行复查以确认诊断。对 LANGED 标本进行 EGFR 突变、ALK 易位以及程序性死亡配体 1（PD-L1）和转染重排（RET）表达检测。同时收集并分析临床资料。
共纳入 10 例诊断为 LANGED 的患者。大多数为男性（80%）和既往吸烟者（70%）。中位年龄为 71.5 岁。诊断时，大多数肿瘤无 EGFR 突变（70%）、ALK 易位阴性（88.9%）且无 PD-L1 表达（90%）。所有进行 RET 免疫组织化学染色检测的标本（n=9）均显示阳性结果。10 例患者中，5 例行手术治疗（Ⅰ期，n=4；Ⅱ期，n=1）。Ⅱ期疾病患者 11 个月后复发。对于晚期患者（Ⅲ期，n=1；Ⅳ期，n=4），治疗方式各异，总生存期为 11.0-46.7 个月。
LANGED 可能与较高比例的 RET 表达相关，而 EGFR 突变、ALK 改变和 PD-L1 表达并不常见。进一步开展关于 LANGED 分子检测谱和临床意义的大规模前瞻性研究是必要的。
