Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2024 Nov 4;66(5):ezae406.
doi: 10.1093/ejcts/ezae406.

Predictive and prognostic factors in patients with anaplastic lymphoma kinase rearranged early-stage lung adenocarcinoma

Filippo Tommaso Gallina  1 , Fabiana Letizia Cecere  2 , Riccardo Tajè  1 , Luca Bertolaccini  3 , Monica Casiraghi  3   4 , Lorenzo Spaggiari  3   4 , Giorgio Cannone  5 , Alberto Busetto  5 , Federico Rea  5 , Nicola Martucci  6 , Giuseppe De Luca  6 , Edoardo Mercadante  6 , Francesca Mazzoni  7 , Stefano Bongiolatti  8 , Luca Voltolini  8 , Enrico Melis  1 , Isabella Sperduti  9 , Federico Cappuzzo  2 , Roni Rayes  10 , Lorenzo Ferri  10 , Francesco Facciolo  1 , Jonathan Spicer  10
Affiliations
Multicenter Study

Predictive and prognostic factors in patients with anaplastic lymphoma kinase rearranged early-stage lung adenocarcinoma

Filippo Tommaso Gallina et al. Eur J Cardiothorac Surg. .

Abstract

Objectives: This study aimed to evaluate the predictive and prognostic factors in clinical stage I, anaplastic lymphoma kinase (ALK)-rearranged lung adenocarcinoma following radical surgery. Additionally, it sought to compare these factors with an external cohort of ALK wild-type patients.

Methods: A multicentric, retrospective, case-control analysis was conducted on patients with clinical T1-2 N0 ALK-rearranged lung adenocarcinoma who underwent anatomical resection and radical lymphadenectomy. Data were collected from 5 high-volume oncological centres. An external cohort of ALK wild-type patients was also analysed for comparison. Survival analyses were performed using the Kaplan-Meier method, and multivariable Cox regression analysis was used to identify prognostic factors.

Results: From January 2016 to December 2022, 63 patients with ALK-rearranged lung adenocarcinoma were included. High-grade tumours (G3) significantly associated with upstaging (odds ratio = 3.904, P = 0.04). Disease-free survival (DFS) and overall survival were significantly improved in upstaged patients receiving adjuvant treatment [hazard ratio (HR) = 0.18, P = 0.0042; HR = 0.24, P = 0.0004, respectively]. The solid or micropapillary histological subtypes were independently associated with worse DFS (HR = 3.41, P = 0.022). Comparison with 435 ALK wild-type patients showed worse DFS in the ALK-rearranged group (HR = 2.09, P = 0.0003). ALK-rearranged patients had higher rates of nodal upstaging, systemic and brain recurrences.

Conclusions: Clinical T1-2 N0 ALK-rearranged lung adenocarcinoma is an aggressive disease with a specific tropism for lymph nodes and the brain. High-grade tumours are predictive of nodal upstaging. Adjuvant treatment significantly improves DFS and overall survival in upstaged patients, highlighting the need for personalized preoperative staging and post-surgical management in this cohort.

Keywords: Anaplastic lymphoma kinase-rearranged; Early stage; Lung adenocarcinoma; Lung cancer; Non-small cell lung cancer.

PubMed Disclaimer

Publication types

MeSH terms

Substances