| ObjectiveWith aim to assess whether radiologic features and other relative factors are predictive of anapalstic lymphoma kinase(ALK)rearrangement in bronchogenic carcinomas.Materials and MethodsALK rearrangement was screened by IHC in 530 patients with pathologic proved lung cancer.Of those 48 patients detected with positive ALK fused gene were enrolled.The mean age,gender,clinicopathologic findings,computed tomographic(CT)features,and clinic stages were investigated with univariate and multivariate analyses among groups according to ALK positiveand negative types.A receiver operating characteristic(ROC)curve analysis was performed to quantify the predictive value of these factors.ResultsThe prevalence of ALK positivity in bronchogenic carcinoma was 9.06%(48 of530),including 27 female cases(9.38%,27/288)and 21 male cases(8.68%,21/242)(χ~2=0.08,p>0.05).The mean ages were 53.71±10.98 yrs and 59.94±9.75 yrs,in positive and negative group resptectively,which has significant difference(t=-4.208,p<0.01);the positive rate in age≤50 was 15.38%(12/78),and in group>50,7.86%(36/452)(χ~2=4.45,p<0.05).The number of non-cigarette smokers was more than that of smokers(χ~2=4.35,p<0.05).Clinic stages in group with ALK rearrangement was significantly higher than in group of the negative group(χ~2=7.02,p<0.01).Pathologic types in positive group,there were 40 of adenocarcinoma(83.33%),5 of squamous cell(10.42%),3 of small cell carcinoma(6.25%),percentage rate of adenocarcinoma in positive group is much greater than it of negative one(χ~2=5.15,p<0.05).There were 43 cases of periphery bronchogenic carcinomas and 5 of central type(χ~2=1.24,p>0.05).Of periphery group,the mean diameter of ALK positive group and of negative group were 26.53±14.39mm and 24.37±12.39mm,respectively,which has no significant difference(t=0.163,p>0.05).There also were difference between two groups in lobuated shape and solid components within lesion(χ~2=10.31,16.54,respectively,p<0.01);whereas radiologic features such as spiculate margin,irregular shape,clear edge,bronco-air grams,and so on,there is no significant difference(χ~2=0.64,2.67,0.04,0.17,respectively,p>0.05).The mean SUVmax were 4.23±2.31 and 3.81±2.51,in positive and negative group resptectively.The area under the ROC curve of the predictive model was 0.644(95%CI:0.540-0.747).when SUVmax=3.45was used as threshold,positive rate in≥3.45 was much higher than less than<3.45 in diameter group(χ~2=4.03,p<0.05).when multivariate factors such as age less than 50yrs,no-smoker,lobulated shape solid components and SUVmax≥3.45 in lesions used as predictive factors of ALK rearrangement,the area under the ROC curve of the predictive model was 0.809(95%CI:0.744-0.875),with sensitivity of 62.8%,and specifity of 77.6%,respectively.ConclusionAlthough patients with ALK fused gene showed more frequently in pulmonary adenocarcinoma,less also may detected in squamous cell and small cell lung cancer with high concerning importance.Age less than 50yrs,non-cigarette smokers,with lobulated shape,contain solid components and SUVmax≥3.45 as predictor factor of ALK fused gene.The area under the ROC curve of the predictive model was 0.809,which suggests good discrimination.lung cancers with ALK fused gene show characteristic clinical and imaging features.Our findings suggest that young age,lobulated margin,solid lesion are important predictors of lung cancer with ALK fused gene. |
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