Prognostic factors of resectable anaplastic lymphoma kinase (ALK)-rearranged non-small cell lung cancer (NSCLC) patients: a retrospective analysis based on a single center

Ao Zeng ¹, Yicheng Xiong ¹, Jing Zhang ¹

⁰Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.

Translational Lung Cancer Research +

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February 26, 2024

View abstract on PubMed

Summary

Anaplastic lymphoma kinase (ALK)-rearranged non-small cell lung cancer (NSCLC) patients with larger tumors and high CT density face a higher risk of occult lymph node metastasis. Close monitoring is advised for nodal-negative patients with large tumors or pleural invasion.

Area Of Science

Oncology
Thoracic Surgery
Medical Imaging

Background

Anaplastic lymphoma kinase (ALK)-rearranged non-small cell lung cancer (NSCLC) demonstrates a notable tendency for lymph node metastasis (LNM).
Occult lymph node metastasis (OLNM) and recurrence are significant concerns in resectable ALK-rearranged NSCLC.

Purpose Of The Study

To identify predictors of occult lymph node metastasis (OLNM) in patients with resectable ALK-rearranged NSCLC.
To determine risk factors for recurrence in these patients post-resection.

Main Methods

Retrospective analysis of 603 patients with resectable ALK-rearranged NSCLC who underwent lung resection.
Logistic regression analysis to identify OLNM predictors.
Cox regression analysis to identify recurrence risk factors.

Main Results

Clinical tumor size and CT density were independent predictors of OLNM.
Pleural invasion and pathological tumor size predicted recurrence in pathologically nodal-negative patients.
Adjuvant ALK-tyrosine kinase inhibitors (TKI) showed similar recurrence-free survival (RFS) to chemotherapy in pathologically nodal-positive patients.

Conclusions

Patients with ALK-rearranged NSCLC and large tumors with high CT density require assessment for OLNM risk.
Nodal-negative patients with large pathological tumor size or pleural infiltration warrant close surveillance.
Adjuvant ALK-TKI therapy may offer comparable RFS to chemotherapy for pathologically nodal-positive patients.

Keywords:

Non-small cell lung cancer (NSCLC) adjuvant treatment anaplastic lymphoma kinase (ALK) occult lymph node metastasis (OLNM) recurrence