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Molecular characterization of pulmonary sarcomatoid carcinoma: analysis of 33 cases.

33例肺肉瘤样癌分子特征分析

Terra SB,Jang JS,Bi L,Kipp BR,Jen J,Yi ES,Boland JM

Abstract

Several targetable genetic alterations have been found in lung cancer, predominantly in adenocarcinomas, which have led to important therapeutic advancements with the advent of targeted therapy. In contrast, the molecular features and presence of targetable genetic abnormalities in pulmonary sarcomatoid carcinomas are largely unknown. Thirty-three cases of pulmonary sarcomatoid carcinoma were tested for approximately 2800 mutations in 50 oncogenes and tumor-suppressor genes, including EGFR, KRAS, NRAS, TP53, BRAF, ERBB2, JAK3, AKT1, ATM, MET, KIT, and PIK3CA. ALK immunostaining was performed, and ALK FISH was performed on cases with any degree of staining. Twenty-four of the 33 cases (72%) had at least one genetic abnormality: 19 cases (58%) had TP53 mutations; 10 cases (30%) had KRAS mutations; AKT1, JAK3, BRAF, NRAS, and PIK3CA mutations were observed in 1 case each (3%). Six of the 19 cases (32%) with a mutation in TP53 had simultaneous mutations in KRAS (18%). The cases with alterations in JAK3, BRAF, and NRAS also had mutations in TP53. The case showing a mutation in PIK3CA had a mutation in KRAS. No EGFR mutations were observed. One case had ALK gene rearrangement. ALK rearrangement was observed in a single case of sarcomatoid carcinoma (3%), which has currently available targeted therapy. Four tumors had mutations in genes with experimental molecular-based therapy, including BRAF, NRAS, PIK3CA, and AKT1. Testing for targetable mutations should be considered for patients with pulmonary sarcomatoid carcinoma, as a subset may benefit from currently approved drugs or clinical trials of novel therapeutic options available for other types of lung cancer.

摘要

目前肺癌中已发现了一些遗传学改变,主要集中在腺癌这一类型,这些发现与靶向治疗的出现给临床带来了重要治疗进展。相比之下,肺肉瘤样癌的分子特征和靶向相关遗传异常仍很不清楚。

我们对33例肺肉瘤样癌进行了50种致癌基因及抑癌基因的2800种突变检测,包括:EGFR、KRAS、NRAS、TP53、BRAF、ERBB2、JAK3、AKT1、ATM、MET、KIT和PIK3CA。我们用免疫组化染色检测了样本ALK的表达,并对免疫组化中有着色的标本进行了ALK的FISH检测。33例肺肉瘤样癌中有24例(72%)具有至少1种遗传学异常:19例(58%)存在TP53突变;10例(30%)存在KRAS突变;AKT1、JAK3、BRAF、NRAS以及PIK3CA突变各1例(3%)。19例TP53突变的病例中有6例同时存在KRAS突变(18%)。JAK3、BRAF和NRAS突变者也存在TP53突变。PIK3CA突变的病例同时存在KRAS突变。33例均未发现EGFR突变的。1例存在ALK基因重排(3%),目前已有相应的靶向治疗。4例肿瘤存在与试验性分子治疗相关的基因突变,包括BRAF、NRAS、PIK3CA以及AKT1。

我们认为,肺的肉瘤样癌应接受靶向性基因突变的检测,因为部分患者也许能够从目前已批准的靶向药物和针对其他类型肺癌新型治疗方案的临床试验中获益。

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