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L. Hou
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P1.08 - Poster Session/ Thymoma, Mesothelioma and Other Thoracic Malignancies (ID 224)
- Event: WCLC 2015
- Type: Poster
- Track: Thymoma, Mesothelioma and Other Thoracic Malignancies
- Presentations: 1
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P1.08-027 - Clinicopathologic Study and Prognostic Analysis of Bronchial Mucoepidermoid Carcinoma (ID 1133)
09:30 - 17:00 | Author(s): L. Hou
- Abstract
Background:
Bronchial mucoepidermoid carcinoma (MEC) is a rare type of lung cancer. The present study tried to establish the clinicopathologic characteristics and prognostic factors of patients with this cancer who were treated in Shanghai Pulmonary Hospital. In addition, the common genetic changes were analyzed here.
Methods:
Sixty-four cases of bronchial MEC treated in Shanghai Pulmonary Hospital between 1995 and 2013 were collected for our study. Retrospective cohort study was performed to analyze the relationship between clinical characteristics and prognosis. The common genetic changes of non-small cell lung cancer, such as EGFR, ALK ,ROS1,BRAF, KRAS status were tested.
Results:
All 64 MECs were reconfirmed by pathologists and tumor staging of all patients were reevaluated according to AJCC 7th edition system. There were 35male patients and 29 females with median age of 40.5 years old. Cough and hemoptysis were the most common clinical manifestations. The mean time between symptom appearance and going to see doctors was 8.7months. Fibre optic bronchoscopy confirmed the presence of bronchial tumor in 48 of 64 patients, but only half of them were diagnostic of MEC by endobronchial biopsies. The pathological findings were cellular mixture consisting of mucus-secreting cells, squamous cells and mesenchymal cells. There were 52 and 4 patients who were in an early stage (stage I-II) and stage IIIA at the time of diagnosis. All those patients underwent surgical resection with lymph node sampling and dissection and 10 patients received adjuvant chemotherapy, 2 patients adjuvant radiocherapy. There were 5 and 3 patients in stage IIIB and IV. Among them, 4 were treated by chemotherapy. The median survival time for patients with stage I-II ,IIIA and IIIB-IV were 71months (10-223months), 35 months (5.3-126months) and 4 months (1-51months) respectively. Single factor analysis showed that the early TNM staging (p=0.000), no mediastinal lymph node involvement or N1 involvement (p=0.000) and surgery (p=0.001) were the positive prognostic factors for MEC patients. There was a trend that shorter disease course might benefit for survival (p=0.09). Multi-factor analysis showed that TNM staging was an independent prognostic factor for the patients suffering from bronchial MEC. Genetic testing showed that 1of 38 patient presented T790M mutation, 17 of 32 patients had KRAS positive staining and no BRAF mutation was found. Interestingly, we found 3 ALK rearrangement which accounted for 7.5% of all tested patients.
Conclusion:
TNM staging is an independent prognostic factor for bronchial MEC patients. Mediastinoscopy should be performed on patients who are clinically N2 stage to get precise stage and treatment decision. Early diagnosis and early surgery may improve patients’ survival. For advanced MEC patients, ALK fusion gene may be routinely tested so as to provide patients with more therapy options.
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P3.04 - Poster Session/ Biology, Pathology, and Molecular Testing (ID 235)
- Event: WCLC 2015
- Type: Poster
- Track: Biology, Pathology, and Molecular Testing
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.04-014 - High Concordance of ALK Fusion between Primary Tumor and Paired Metastatic Lymph Node in Patients with Adenocarcinoma (ID 1086)
09:30 - 17:00 | Author(s): L. Hou
- Abstract
Background:
Anaplastic lymphoma kinase gene (ALK) rearrangement represents a novel oncogenic gene in NSCLC patients which show response to crizotinib, an ALK inhibitor. Lung cancer is a heterogeneous tumor. It remains unclear whether ALK rearrangement was distributed heterogeneously in tumor from different anatomic site of the same patient. To address this issue, we compared the concordance of ALK gene fusion status between primary tumor and paired lymphatic metastasis. Meanwhile, we evaluated the effectiveness of crizotinib treatment of advanced NSCLC patients with ALK rearrangement detected on biopsy or cytology from primary tumors or metastatic lymph nodes by RT-PCR.
Methods:
A total of 101 NSCLC patients with metastatic lymph nodes by surgical resection were enrolled from September 2013 to Auguast 2014, including 33 patients with N1 and N2 lymphatic metastasis. We performed immuohistochemical(IHC) staining for the ALK protein with Ventana D5F3 antibody on primary tumor and paired metastatic lymph nodes. Reverse transcriptase-polymerase chain reaction (RT-PCR) was used to confirm ALK fusion status. Discordance of ALK fusion gene status between primary tumor and paired metastatic lymph nodes was further confirmed by fluorescence in Situ hybridization (FISH). Progression-free survival (PFS) was evaluated in 13 ALK positive advanced adenocarcinoma patients with crizotinib treatment including 7 patients who harbored ALK rearrangement detected on primary tumor and 6 patients detected on metastatic lymph nodes.
Results:
The concordance rate of ALK rearrangement between primary tumor and paired metastatic lymph nodes was 98%. ALK fusion gene status between different groups of metastatic lymph nodes in the same patient showed totally concordant. PFS (11.1 months) was similar in patients with ALK rearrangement detected on primary tumor and patients (PFS, 10.8 months, P=0.2) detected on metastatic lymph nodes by RT-PCR.
Conclusion:
The current results indicated that ALK rearrangement showed a high concordance between primary tumor and lymphatic metastasis and successfully predict response to ALK inhibitor. RT-PCR detecting ALK rearrangement on biopsy or cytology with limited tissue from primary tumors and metastatic lymph nodes can be important for ALK inhibitor treatment in advanced NSCLC patients.
