Affected Factors Of Progression-free Survival In ALK-Rearrangement Non-small-cell Lung Cancer Treated By Crizotinib Or Chemotherapy

[Background]Many lung cancer patients are in the inoperable late stage when diagnosis.Targeted therapy of lung cancer is new treatment method which develops rapidly in recent years.It attracts us a lot since its significant efficacy and slight toxicity.Study has showed that about 3%-7%non-small-cell lung cancer patients exist EML4-ALK rearrangement.And these patients can benefit from crizotinib,the tyrosine kinase inhibitor targeted ALK.But we should not neglect that progression free survival of patients treated by crizotinib varies from short to long.So it is necessary to research affected factors of progression-free survival in ALK-rearrangement non-small-cell lung cancer treated by crizotinib.[Objectives]This study mainly collected ALK positive non-small-cell lung cancer patients who were treated by crizotinib or first-line chemotherapy.And we evaluated the effect of clinicopathologic factors on progression free survival of ALK positive non-small-cell lung cancer,such as age,gender,smoking history,pathological type,the location of primary tumors etc.[Materials and Methods]We retrospectively collected the data of ALK-rearrangement non-small-cell lung cancer patients(mainly stage ? and ?)in Shandong Province Tumor Hospital from September l,2012 to December 31,2018.And we analyzed the clinicopathologic factors such as age,gender,smoking history,pathological type,the location of primary cancer and treatment regimen etc.Then we analyze the progression free survival of patients via Kaplan-Meier analysis and multivariable Cox analysis,and p value<0.05 was considered to be significant statistically.[Results]Data of 69 ALK positive non-small-cell lung cancer has been collected.Female patients accounts for 52.2%(36 patients),and the proportion of male patients is 47.8%(33 patients).Patients' age ranges from 26 to 74 years old,with the median age 48 years old.The proportion of patients without smoking history is 78.3%(54 patients),and patients with smoking history 21.7%(15 patients),respectively.Considering the pathological types,the proportion of adenocarcinoma,squamous carcinoma,adenosquamous carcinoma,large cell lung cancer is 88.4%,5.8%,4.3%,1.5%respectively.We analyzed the progression free survival of ALK positive non-small-cell patients via Kaplan-Meier method and multivariable Cox analysis.The median progression free survival of patients in no-smoking group is 13.37 months,which is longer than the median progression free survival of patient in smoking group(7.47 months).But the difference between groups was found not significant statistically(x2=3.424,P=0.064).The median progression free survival of patients in smoking index<400 group is 13.37 months,which is longer than the median progression free survival of patient in smoking index)400 group(1.77 months).And the difference is found significant statistically(x2=6.330,P=0.012).The median progression free survival of patients in the first-line crizotinib treatment group is 13.53 months,which is longer than that in non-first-line crizotinib treatment group(9.87 months).But the difference between two groups was found not significant statistically(x2=1.967,P=0.161).The median progression free survival of ALK positive patients with adenocarcinoma is 13.53 months,which is longer than that of the non-adenocarcinoma group(4.93 groups).And the difference is found significant statistically(x2=8.198,P=0.004).Multivariable Cox analysis suggested that progression free survival of ALK positive non-small-cell lung cancer patients treated by crizotinib is associated with whether smoking index)400 or not,whether pathological type is adenocarcinoma or not(P values<0.05).In these ALK-positive non-small-cell lung cancer patients who accepted chemotherapy as first-line therapy,the difference of progression free survival in patients between the non-smoking group and the smoking group is not significant statistically(median PFS 6.77months and 8.00 months respectively,x2=1.109,P=0.292).And the difference of progression free survival between the smoking index<400 group and smoking group)400 group is not significant statistically(median PFS 6.77 months and 8.00 months respectively,x2=0.427,P= 0.513).Although the median PFS of adenocarcinoma patients(7.67 months)is longer than the median PFS of non-adenocarcinoma patients(5.33 months),the difference is not significant statistically(x2=2.285,P=0.131).Multivariable Cox analysis shows that the progression free survival of ALK positive non-small-cell lung cancer patients treated by first-line chemotherapy was not associated with the factors such as whether smoking index)400 or not,and whether the pathological type is adenocarcinoma or not.[Conclusions]Progression free survival of ALK positive non-small-cell lung cancer patients treated by crizotinib is associated with whether smoking index?400 or not,whether pathological type is adenocarcinoma or not.We found that ALK positive non-small-cell lung cancer patients with smoking index<400,adenocarcinoma type had a longer progression free survival than those who were not.And the difference was found significant statistically between those groups.But the progression free survival of ALK positive non-small-cell lung cancer patients treated by first-line chemotherapy was not associated with the factors such as whether smoking index?400 or not,whether pathological type is adenocarcinoma or not.And no statistically significant difference was found between those groups.