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Pulmonary adenocarcinoma with signet ring cell features: a comprehensive study from 3 distinct patient cohorts.

伴印戒细胞特征的肺腺癌:3组不同患者的综合性研究

Boland JM,Wampfler JA,Jang JS,Wang X,Erickson-Johnson MR,Oliveira AM,Yang P,Jen J,Yi ES

Abstract

Comprehensive biological characteristics of pulmonary adenocarcinomas with signet ring cell features (SRC) are not well known. Herein, we systematically evaluated clinical and molecular features of SRC cases with particular attention to smoking status. Surgically treated lung adenocarcinomas (n=763) with follow-up ≥5 years in 3 cohorts were reviewed: all patients in 2006 to 2007 ("all-comers," n=222; 168 ever-smokers), a never-smoker cohort (n=266), and a cohort of ever-smokers (n=275). SRC tumors had ≥10% of SRCs agreed by 2 pathologists. SRC cases were tested for rearrangement of ALK and ROS1, as well as 187 known mutations in 10 oncogenes including EGFR, KRAS, BRAF, ERBB2, JAK2, AKT1, AKT2, KIT, MET, and PIK3CA. Overall, 53 of 763 cases (7%) were SRC. In the 2006 to 2007 "all comer" cohort, 9% were SRC. In the never-smoker cohort, 9% were SRC. In the smoker cohort, 3% were SRC. Univariable analysis showed that SRC never-smokers had shorter overall and disease-free survival (P=0.006 and 0.0004, respectively), but the significance faded in the multivariable analysis. For the other 2 cohorts, crude 5-year survival was decreased by 6% to 27% in SRC cases without reaching statistical significance. In SRC tumors, KRAS mutation was most common (29%), followed by ALK (26%), EGFR (18%), ROS1 (6%), BRAF (6%), and PIK3CA (3%). In summary, SRC tumors in never-smokers had a worse survival by univariable analysis only. SRC cases seemed enriched for ALK and ROS1, and other mutations were generally in keeping with the patient's smoking status.

摘要

目前有关伴印戒细胞特征(SRC)肺腺癌的综合生物学特性仍未完全明了。因此作者系统性的评估了伴SRC病例的临床和分子特征,特别是其与吸烟间的关系。回顾性复习了3组随访时间均≥5年的经外科切除的肺腺癌患者(n=763):2006年至2007年的所有患者组(总数n=222,其中168例曾经吸烟)、从不吸烟组(n=266)和曾经吸烟组(n=275)。2位病理学家认为≥10%的区域伴SRC就认定为SRCs。对伴SRC病例进行了ALK和 ROS1重排检测,以及包括EGFR、KRAS、BRAF、ERBB2、JAK2、AKT1、AKT2、KIT、MET和PIK3CA 10个突变基因的检测。结果763例中有53例(7%)伴SRC。在2006年至2007年所有患者组中,9%伴SRC;从不吸烟组中,9%伴SRC;曾经吸烟组中,3%伴SRC;单因素分析显示伴SRC的从不吸烟患者,其总的和无病生存期均较短(P值分别为0.006和0.0004),而在多变量分析时这种显著性就消失了。对于其它两组,伴SRC的患者,5年生存期减少6%到27%,没有统计学意义。伴SRC肿瘤中,KRAS突变最常见(29%),然后分别是ALK(26%)、EGFR(18%)、ROS1(6%)、BRAF(6%)和PIK3CA(3%)。总之,伴SRC肿瘤的从不吸烟患者仅在单因素分析时有更差的生存期。SRC患者似乎ALK 和ROS1的重排增加,而其它突变与患者的抽烟状况密切相关。

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