Clinical Characteristics Of Patients With ALK Gene Fusion Mutation

Objective In this study,the clinical features of lung cancer ALK gene fusion mutation positive and ALK negative patients were analyzed and discussed,and the impact of ALK gene fusion mutations on the prognosis of lung cancer patients was analyzed and discussed,and the clinical features of lung cancer patients ALK gene fusion mutations were explored And its effect on the prognosis of lung cancer patients,analyze the effect of crizotinib on the prognosis of patients with ALK positive lung cancer,and analyze the location of the first relapse and metastasis in patients with positive mutations of ALK gene fusion mutations in stage I-IIIA.Methods We consecutively collected 300 patients with lung cancer diagnosed as ALK negative from January 2014 to January 2018 in the whole hospital of Tianjin Medical University Cancer Hospital and 431 patients with ALK positive lung cancer from March 2011 to March 2017.SPSS 24.0 software was used to process the data,and the clinicopathological characteristics of ALK negative and ALK positive patients were analyzed by chi-square test.Kaplan-Meier method was used to estimate PFS and OS,and the overall survival rate was estimated.A log-rank test was used to compare survival curves.The factors with statistical significance in univariate analysis(p<0.05)were included in the Cox proportional hazard model for multivariate analysis.Cox proportional regression analysis was used to calculate the risk rate HR and 95%confidence interval CI.Two-tailed p<0.05 is statistically significant.Results1.The incidence of mutations in the ALK fusion gene was higher in patients ≤55years of age than those >55 years old(χ 2 =37.606,p<0.05);the incidence of non-smokers was higher than that of smoking group(χ 2 =9.974,p<0.05);the incidence rate in the patient group with no family history of tumor was higher than that of the patient group with family history of tumor(χ 2 =9.823,p<0.05);the incidence rate in the non-adenocarcinoma patient group was higher than that of the adenocarcinoma patient group(χ2=16.643,p<0.05);the incidence rate in the right lung patient group was higher than that in the left lung patient group(χ 2 =4.45,p<0.05);the incidence rate in the T4 patient group was higher than T1,T2,T3 Was higher in the patient group(χ2=11.802,P<0.05);the incidence rate in the N1 patientgroup was higher than that in the N0,N2,and N3 patient groups(χ 2 =10.679,p<0.05);the incidence in the M0 patient group The rate was higher than the M1 stage patient group(χ2=16.942,p<0.05);the incidence rate of the stage I patient group was higher than that of the stage II,III,and IV patient groups(χ2=21.927,p<0.05);the patients were admitted to hospital Examination of tumor markers,including SCC,Cy21,CEA,TPSA,Pro GRP,has a high incidence in patients with normal Cy21,normal TPSA,elevated CEA,elevated SCC,elevated Pro GRP;gender,tumor area,tumor markers There was no correlation between NSE and CA199(p>0.05).2.Kaplan-Meier survival analysis showed that patients with negative ALK gene fusion mutation who underwent radical lung cancer surgery in stage I-IIIA had higher DFS and OS than ALK gene positive group(p<0.05).3.Kaplan-Meier survival analysis showed that there was no significant difference between PFS,OS and ALK gene positive groups in patients with negative ALK gene fusion mutations who did not undergo radical surgery for stage IIIB-IV lung cancer(p>0.05).4.Kaplan-Meier survival analysis showed that the PFS and OS of the crizotinib group in patients with stage IIIB-IV ALK positive lung cancer were higher than those in the crizotinib group(p<0.05).5.Among ALK gene positive patients,the brain metastasis rate of stage I-IIIA is3.8%;bone metastasis rate is 5.0%;liver metastasis rate is 2.7%;pleural metastasis rate is 6.9%;adrenal metastasis rate is 1.5% The rate of pericardial metastasis is 0.8%;the rate of lymph node metastasis is 11.1%;the rate of metastasis in the lungs is22.5%.Conclusion1.EML4-ALK gene fusion mutation in young,no smoking history,no family history of tumor,right lung,large tumor,stage N1,no distant metastasis,early clinical stage,normal Cy21,normal TPSA,elevated CEA,increased SCC,High incidence of non-adenocarcinoma patients with elevated Pro GRP.2.Patients with negative ALK gene fusion mutation who underwent radical operation of stage I-IIIA had better DFS and OS than those with ALK positive.3.There is no significant difference between PFS,OS and ALK positive patients in patients with negative ALK gene fusion mutations who did not undergo radical mastectomy for stage IIIB-IV.4.Crizotinib can prolong the PFS and OS of ALK fusion mutation-positive lungcancer patients.5.In patients with lung cancer positive for ALK gene fusion mutations in stage I-IIIA,the rate of metastasis in the lungs,pleura,and lymph nodes is high.In distant metastatic organs,the rate of bone metastasis is high.