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Chen H, Xu Y, Lin H, Wan S, Luo L. A prognostic framework for predicting lung signet ring cell carcinoma via a machine learning based cox proportional hazard model. J Cancer Res Clin Oncol 2024; 150:364. [PMID: 39052087 PMCID: PMC11272739 DOI: 10.1007/s00432-024-05886-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 07/08/2024] [Indexed: 07/27/2024]
Abstract
PURPOSE Signet ring cell carcinoma (SRCC) is a rare type of lung cancer. The conventional survival nomogram used to predict lung cancer performs poorly for SRCC. Therefore, a novel nomogram specifically for studying SRCC is highly required. METHODS Baseline characteristics of lung signet ring cell carcinoma were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate Cox regression and random forest analysis were performed on the training group data, respectively. Subsequently, we compared results from these two types of analyses. A nomogram model was developed to predict 1-year, 3-year, and 5-year overall survival (OS) for patients, and receiver operating characteristic (ROC) curves and calibration curves were used to assess the prediction accuracy. Decision curve analysis (DCA) was used to assess the clinical applicability of the proposed model. For treatment modalities, Kaplan-Meier curves were adopted to analyze condition-specific effects. RESULTS We obtained 731 patients diagnosed with lung signet ring cell carcinoma (LSRCC) in the SEER database and randomized the patients into a training group (551) and a validation group (220) with a ratio of 7:3. Eight factors including age, primary site, T, N, and M.Stage, surgery, chemotherapy, and radiation were included in the nomogram analysis. Results suggested that treatment methods (like surgery, chemotherapy, and radiation) and T-Stage factors had significant prognostic effects. The results of ROC curves, calibration curves, and DCA in the training and validation groups demonstrated that the nomogram we constructed could precisely predict survival and prognosis in LSRCC patients. Through deep verification, we found the constructed model had a high C-index, indicating that the model had a strong predictive power. Further, we found that all surgical interventions had good effects on OS and cancer-specific survival (CSS). The survival curves showed a relatively favorable prognosis for T0 patients overall, regardless of the treatment modality. CONCLUSIONS Our nomogram is demonstrated to be clinically beneficial for the prognosis of LSRCC patients. The surgical intervention was successful regardless of the tumor stage, and the Cox proportional hazard (CPH) model had better performance than the machine learning model in terms of effectiveness.
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Affiliation(s)
- Haixin Chen
- The First Clinical College, Guangdong Medical University, Zhanjiang, Guangdong, 524023, China
| | - Yanyan Xu
- The First Clinical College, Guangdong Medical University, Zhanjiang, Guangdong, 524023, China
| | - Haowen Lin
- The First Clinical College, Guangdong Medical University, Zhanjiang, Guangdong, 524023, China
| | - Shibiao Wan
- Department of Genetics, Cell Biology and Anatomy, University of Nebraska Medical Center, Omaha, NE, USA.
| | - Lianxiang Luo
- The Marine Biomedical Research Institute of Guangdong Zhanjiang, School of Ocean and Tropical Medicine, Guangdong Medical University, Zhanjiang, Guangdong, 524023, China.
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2
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Hirakawa T, Tanimoto T, Hattori Y, Katsura R, Miyake S, Fujita S, Ueno S, Masuda K, Nishisaka T, Ishikawa N. Pseudomesotheliomatous Carcinoma of the Lung with Morphological Characteristics of Signet Ring Cell Carcinoma: An Autopsy Case Report. Intern Med 2024; 63:979-983. [PMID: 37587043 PMCID: PMC11045383 DOI: 10.2169/internalmedicine.2138-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/27/2023] [Indexed: 08/18/2023] Open
Abstract
A 50-year-old woman presented with left pleural effusion. A pleural fluid cell-block specimen and longitudinal lymph node needle biopsy suggested signet ring cell carcinoma (SRCC). Although computed tomography showed a consolidation shadow in the left lower lobe, a left lung biopsy could not be performed. Upper gastrointestinal endoscopy revealed no malignancies. We administered carboplatin, pemetrexed, ipilimumab, and nivolumab for lung cancer; however, she died due to progressive respiratory failure. Pathological autopsy revealed that the left pleura was thickened as in mesothelioma, based on which pseudomesotheliomatous carcinoma of the lung (PMCL) was diagnosed. PMCLs exhibiting an SRCC morphology are rare.
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Affiliation(s)
- Tetsu Hirakawa
- Department of Respiratory Medicine, Hiroshima Prefectural Hospital, Japan
| | - Takuya Tanimoto
- Department of Respiratory Medicine, Hiroshima Prefectural Hospital, Japan
| | - Yui Hattori
- Department of Pathology and Laboratory Medicine, Hiroshima Prefectural Hospital, Japan
| | - Ryo Katsura
- Department of Respiratory Medicine, Hiroshima Prefectural Hospital, Japan
| | - Shinya Miyake
- Department of Respiratory Medicine, Hiroshima Prefectural Hospital, Japan
| | - Suguru Fujita
- Department of Respiratory Medicine, Hiroshima Prefectural Hospital, Japan
| | - Sayaka Ueno
- Department of Respiratory Medicine, Hiroshima Prefectural Hospital, Japan
| | - Ken Masuda
- Department of Respiratory Medicine, Hiroshima Prefectural Hospital, Japan
| | - Takashi Nishisaka
- Department of Pathology and Laboratory Medicine, Hiroshima Prefectural Hospital, Japan
| | - Nobuhisa Ishikawa
- Department of Respiratory Medicine, Hiroshima Prefectural Hospital, Japan
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3
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Tan Y, Huang YH, Xue JW, Zhang R, Liu R, Wang Y, Feng ZB. Clinicopathological features and prognostic significance of pulmonary adenocarcinoma with signet ring cell components: meta-analysis and SEER analysis. Clin Exp Med 2023; 23:4341-4354. [PMID: 37779169 DOI: 10.1007/s10238-023-01200-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 09/19/2023] [Indexed: 10/03/2023]
Abstract
Pulmonary adenocarcinoma is a common type of lung cancer that has been on the rise in recent years. Signet ring cell components (SRCC) can be present in various patterns of pulmonary adenocarcinoma, including papillary, acinar, and solid patterns. "Signet ring cell carcinoma" is a distinct subtype in the 2014 WHO classification of lung neoplasms, subsequent WHO classifications in 2015 and 2021 have deemed signet ring cells as accompanying morphological features with no clinical significance. The prognostic and clinical implications of SRCC in pulmonary adenocarcinoma remain controversial. Therefore, we conducted a meta-analysis to investigate the clinicopathological features and prognostic factors of SRCC in pulmonary adenocarcinoma. We conducted a comprehensive search in PubMed, EMBASE, and Web of Science to identify studies that examined the clinicopathological features and prognostic implications of pulmonary adenocarcinoma with SRCC. We used both fixed- and random-effects models to analyze the data and calculate the pooled hazard ratio (HR) and odds ratio (OR) with 95% confidence intervals (CIs). Additionally, we explored the prognostic significance of SRCC in pulmonary adenocarcinoma using the Surveillance, Epidemiology, and End Results (SEER) database. Our meta-analysis included 29 studies with pulmonary adenocarcinoma and SRCC components. The results showed that pulmonary adenocarcinoma with SRCC was associated with larger tumor size (OR = 1.99; 95% CI, 1.62-2.44, p < 0.001), advanced overall stage (OR = 5.18, 95% CI, 3.28-8.17, p < 0.00001) and lymph node stage (OR = 5.79, 95% CI, 1.96-17.09, p = 0.001), and worse overall survival (OS) compared to those without SRCC (HR = 1.80, 95% CI, 1.50-2.16, p < 0.00001). Analysis using the SEER dataset confirmed these findings. Our meta-analysis provides evidence that pulmonary adenocarcinoma with SRCC is associated with distinct clinicopathological features and a poorer prognosis. These findings have important implications for the management and treatment of patients. However, further studies are needed to validate these findings and explore the significance of SRCC in various subtypes of pulmonary adenocarcinoma.
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Affiliation(s)
- Yang Tan
- Department of Pathology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, China
| | - Ying-He Huang
- Department of Pathology, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi, China
| | - Jia-Wen Xue
- Department of Pathology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, China
| | - Rui Zhang
- Department of Pathology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, China
| | - Run Liu
- Department of Pathology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, China
| | - Yan Wang
- Department of Pathology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, China
| | - Zhen-Bo Feng
- Department of Pathology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, China.
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4
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Yang M, Yang Y, Chen J, Stella GM, Um SW, Tandon YK, Liu H. A case report of primary signet ring cell carcinoma of the lung: imaging study and literature review. Transl Lung Cancer Res 2021; 10:3840-3849. [PMID: 34733632 PMCID: PMC8512459 DOI: 10.21037/tlcr-21-654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/15/2021] [Indexed: 12/18/2022]
Abstract
Signet ring cell carcinoma (SRCC) is a subtype of adenocarcinoma with characteristics of strong invasion and a poor prognosis. While it can occur in various organs, including the stomach, colon, esophagus, bladder, prostate, pancreas, and breast, primary lung SRCC is rare, and most SRCC found there are from gastrointestinal metastasis. Reports on primary lung SRCC are few and the aim of this study is to describe the imaging, histopathological, and immunohistochemical characteristics of a case of primary lung SRCC in our hospital. A 68-year-old female with no smoking history was admitted with recurrent cough, chest pain, and dyspnea of 2 months duration. Computed tomographic (CT) chest showed multiple solids nodules of different sizes and mass in the left upper lobe, lower lobe, and subpleural region. Multiple enlarged lymph nodes were seen in the mediastinum and left hilum. The aim of this paper is to improve the understanding of this tumor. A literature review identified 15 cases of primary lung SRCC with available CT imaging. Except for two patients with multiple ground glass nodules and multiple small nodules, the rest were solid, and ranged in size from 1.0 to 8 cm. Only one patient had a cavity in the solid lesion. Immunohistochemical stains for thyroid transcription factor-1 (TTF-1) (13/13) and CK7 (12/12) showed positive reaction in all cases evaluated, and napsin A (3/4) were also positive, while all cases including CK20 (12/12) and CDX2 (6/6) were negative.
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Affiliation(s)
- Mingguang Yang
- Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Medical Imaging Department, Chongqing University Central Hospital, Chongqing, China
| | - Yanli Yang
- Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Jing Chen
- Department of Pathology, Chongqing University Central Hospital, Chongqing, China
| | - Giulia M Stella
- Department of Medical Sciences and Infective Diseases, Unit of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation and University of Pavia Medical School, Pavia, Italy
| | - Sang-Won Um
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | - Heng Liu
- Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
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5
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Peng T, Yau A, Ding L, David EA, Wightman SC, Atay SM, Kim AW. Primary signet ring cell histology does not portend worse survival for early stage lung cancer following lobectomy. Asian Cardiovasc Thorac Ann 2021; 30:185-189. [PMID: 34549632 DOI: 10.1177/02184923211045910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Signet ring cell (SRC) histology is considered a poor prognostic factor in various cancers. However, primary SRC lung adenocarcinoma is rare and poorly understood. METHODS The National Cancer Database was queried to identify treatment-naïve patients who received lobectomy for primary SRC or non-SRC pT1-2N0 lung adenocarcinoma <4 cm within four months of diagnosis. SRC lung adenocarcinoma was defined by ICD-O-3 code 8490, while non-SRC lung adenocarcinoma was defined by ICD-O-3 codes 8140, 8141, 8143, 8147, 8255, 8260, 8310, 8481, 8560, and 8570-8574. The Kaplan-Meier curve and log-rank test was used to compare five-year OS between SRC versus non-SRC lung adenocarcinoma cohorts. The impact of SRC histology on risk of death was assessed using the Cox proportional hazards regression model. RESULTS 48,399 patients were included in this study: 62 with primary SRC lung adenocarcinoma and 48,337 with non-SRC lung adenocarcinoma. The mean age of the overall cohort was 67.0 ± 9.6 years. Five-year OS following lobectomy did not differ significantly between SRC lung adenocarcinoma and non-SRC lung adenocarcinoma cohorts (SRC 73.9% vs. non-SRC 69.3%, p = 0.64). SRC histology did not significantly impact risk of death within five years after lobectomy (HR 0.89, p = 0.66). CONCLUSIONS Following lobectomy for pT1-2N0 tumors <4 cm, patients with primary SRC lung adenocarcinoma do not experience worse five-year OS or increased risk of death within five years relative to those with non-SRC lung adenocarcinoma. Additional study, including exploration of emerging molecular profiling data, may serve to better define optimal treatment for this histopathologic group of lung adenocarcinomas.
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Affiliation(s)
- Terrance Peng
- Division of Thoracic Surgery, Department of Surgery, 12223Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Anita Yau
- Department of Preventive Medicine, 12223Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Li Ding
- Department of Preventive Medicine, 12223Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Elizabeth A David
- Division of Thoracic Surgery, Department of Surgery, 12223Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Sean C Wightman
- Division of Thoracic Surgery, Department of Surgery, 12223Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Scott M Atay
- Division of Thoracic Surgery, Department of Surgery, 12223Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Anthony W Kim
- Division of Thoracic Surgery, Department of Surgery, 12223Keck School of Medicine of USC, Los Angeles, CA, USA
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Yildiz I. Liver and Pancreatic Injury in Response to ALK Inhibitors in a Patient with Primary Signet Ring Cell Carcinoma of the Lung: A Case Report. Case Rep Oncol 2021; 14:107-111. [PMID: 33776691 PMCID: PMC7983653 DOI: 10.1159/000512829] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 10/27/2020] [Indexed: 11/21/2022] Open
Abstract
We report a patient with stage IV anaplastic lymphoma kinase (ALK)-rearranged non-small cell lung cancer (primary lung signet ring cell adenocarcinoma) who received serial crizotinib, chemotherapy, and lorlatinib over more than 4 years. The patient discontinued crizotinib after approximately 4 months due to crizotinib-associated hepatotoxicity. Twenty-five days later, when transaminases had normalized, crizotinib was resumed. However, the patient's liver enzymes rapidly increased again, and crizotinib was discontinued. After 6 cycles of platinum-based chemotherapy, lorlatinib was initiated. Hepatotoxicity did not recur with lorlatinib, a next-generation ALK inhibitor, but grade 4 hypertriglyceridemia and acute pancreatitis were induced by lorlatinib after 4 months. To our knowledge, this is the first case report of acute pancreatitis with lorlatinib. Additionally, stereotactic body radiation therapy (SBRT) was performed for residual small primary lesions in the lung without stopping lorlatinib. Given the rarity of radiation pneumonitis, especially with the relatively small fields treated by SBRT, we suspect that lorlatinib enhanced the pulmonary toxicity. Physicians should be aware that ALK inhibitors, such as lorlatinib and crizotinib, have potentially lethal side effects.
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Affiliation(s)
- Ibrahim Yildiz
- Department of Medical Oncology, Acibadem Mehmet Ali Aydinlar University Atakent Hospital, Istanbul, Turkey
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7
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Chen C, Wang L, Gu C, Wang Y, Pan X, Fu S, Yang J, Wang R. Survival analyses and immunohistochemical study of primary signet ring cell carcinoma of the lung adenocarcinoma. Transl Cancer Res 2020; 9:620-628. [PMID: 35117407 PMCID: PMC8797340 DOI: 10.21037/tcr.2019.11.54] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 08/08/2019] [Indexed: 12/26/2022]
Abstract
Background The clinicopathological features, immunohistochemical (IHC) characteristics and survival outcomes of primary lung adenocarcinoma with signet ring cells (LAdSRCs) component were analyzed. Methods A retrospective analysis of primary LAdSRCs consecutively collected from 2010 to 2014 was performed and compared with lung adenocarcinoma (ADC). We investigated the survival outcomes and the expression of cytokeratin 7 (CK7), CK20, thyroid transcription factor-1 (TTF-1) and villin in these 35 cases of primary LAdSRCs. Results We identified 1,715 patients in total, 35 (2.0%) of whom had signet ring cell (SRC) component. Excepting for 2 cases without IHC information, a CK profile (CK7+/CK20-) were identified in 69.7% (23/33) of LAdSRC; 22 (66.7%) of 33 LAdSRCs exhibited positive TTF-1 expression, but no other TTF-1 positive was found in signet ring cell carcinoma (SRCC) of other organs, and villin was not identified in these 33 cases. Age, sex, tumor size, surgery resection, smoking history, tumor stage, nodal stage, predominant histology subtype, pathology and adjuvant therapy were all significant predictors of relapse-free survival (RFS) and overall survival (OS) in univariable analysis. Compared to lung ADC, the lung ADCs with SRC component had an inferior prognosis. In multivariable analysis, sex, tumor size, tumor stage, nodal stage, predominant histology subtype and adjuvant therapy were still significant predictors for both RFS and OS while the pathology [RFS: hazard ratio (HR), 0.918; 95% confidence interval (CI), 0.581-1.492; P=0.712; OS: HR, 1.392; 95% CI, 0.820-2.364; P=0.221, respectively] was not. Conclusions Univariable analysis revealed primary LAdSRC is a rare ADC subtype with a worse prognosis compared with ADC. The high percentage expression of TTF-1 and immunostaining profiles CK7+/CK20- in primary LAdSRC is significant to identify the source of SRCCs.
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Affiliation(s)
- Chunji Chen
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Lei Wang
- Department of Ultrasound in Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Chang Gu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Yiyang Wang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Xufeng Pan
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Shijie Fu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Jun Yang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Rui Wang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
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8
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Danzinger S, Köstler WJ, Funovics M, Herac M, Müllauer L, Prosch H, Kölbl H. Signet Ring Cell Carcinoma of the Lung: A Diagnostic Pitfall in Pregnancy. Case Rep Obstet Gynecol 2019; 2019:9461579. [PMID: 31281696 PMCID: PMC6594277 DOI: 10.1155/2019/9461579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/20/2019] [Accepted: 05/25/2019] [Indexed: 12/17/2022] Open
Abstract
Lung cancer during pregnancy represents a rare disease. In this case report, we present a patient at advanced and metastasized stage of signet ring cell carcinoma who presented in the 22nd week of gestation.
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Affiliation(s)
- Sabine Danzinger
- Department of Obstetrics and Gynecology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria
| | - Wolfgang J. Köstler
- Clinical Division of Oncology, Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria
| | - Martin Funovics
- Department of Biomedical Imaging and Image-Guided Therapy, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria
| | - Merima Herac
- Department of Pathology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria
| | - Leonhard Müllauer
- Department of Pathology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria
| | - Helmut Prosch
- Department of Biomedical Imaging and Image-Guided Therapy, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria
| | - Heinz Kölbl
- Department of Obstetrics and Gynecology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria
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Voena C, Varesio LM, Zhang L, Menotti M, Poggio T, Panizza E, Wang Q, Minero VG, Fagoonee S, Compagno M, Altruda F, Monti S, Chiarle R. Oncogenic ALK regulates EMT in non-small cell lung carcinoma through repression of the epithelial splicing regulatory protein 1. Oncotarget 2017; 7:33316-30. [PMID: 27119231 PMCID: PMC5078097 DOI: 10.18632/oncotarget.8955] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 03/29/2016] [Indexed: 11/25/2022] Open
Abstract
A subset of Non-Small Cell Lung Carcinoma (NSCLC) carries chromosomal rearrangements involving the Anaplastic Lymphoma Kinase (ALK) gene. ALK-rearranged NSCLC are typically adenocarcinoma characterized by a solid signet-ring cell pattern that is frequently associated with a metastatic phenotype. Recent reports linked the presence of ALK rearrangement to an epithelial-mesenchymal transition (EMT) phenotype in NSCLC, but the extent and the mechanisms of an ALK-mediated EMT in ALK-rearranged NSCLC are largely unknown. We found that the ALK-rearranged H2228 and DFCI032, but not the H3122, cell lines displayed a mesenchymal phenotype. In these cell lines, oncogenic ALK activity dictated an EMT phenotype by directly suppressing E-cadherin and up-regulating vimentin expression, as well as expression of other genes involved in EMT. We found that the epithelial splicing regulatory protein 1 (ESRP1), a key regulator of the splicing switch during EMT, was repressed by EML4-ALK activity. The treatment of NSCLC cells with ALK tyrosine kinase inhibitors (TKIs) led to up-regulation of ESRP1 and E-cadherin, thus reverting the phenotype from mesenchymal to epithelial (MET). Consistently, ESRP1 knock-down impaired E-cadherin up-regulation upon ALK inhibition, whereas enforced expression of ESRP1 was sufficient to increase E-cadherin expression. These findings demonstrate an ALK oncogenic activity in the regulation of an EMT phenotype in a subset of NSCLC with potential implications for the biology of ALK-rearranged NSCLC in terms of metastatic propensity and resistance to therapy.
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Affiliation(s)
- Claudia Voena
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy.,Center for Experimental Research and Medical Studies (CERMS), Città della Salute e della Scienza, Torino, Italy.,Department of Pathology, Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Lydia M Varesio
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy.,Center for Experimental Research and Medical Studies (CERMS), Città della Salute e della Scienza, Torino, Italy
| | - Liye Zhang
- Section of Computational Biomedicine, Boston University School of Medicine, Boston, MA, USA
| | - Matteo Menotti
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy.,Center for Experimental Research and Medical Studies (CERMS), Città della Salute e della Scienza, Torino, Italy
| | - Teresa Poggio
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy.,Center for Experimental Research and Medical Studies (CERMS), Città della Salute e della Scienza, Torino, Italy
| | - Elena Panizza
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy.,Center for Experimental Research and Medical Studies (CERMS), Città della Salute e della Scienza, Torino, Italy
| | - Qi Wang
- Department of Pathology, Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Valerio G Minero
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy.,Center for Experimental Research and Medical Studies (CERMS), Città della Salute e della Scienza, Torino, Italy
| | - Sharmila Fagoonee
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy.,Molecular Biotechnology Center, University of Torino, Torino, Italy
| | - Mara Compagno
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy.,Center for Experimental Research and Medical Studies (CERMS), Città della Salute e della Scienza, Torino, Italy.,Department of Pathology, Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Fiorella Altruda
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy.,Molecular Biotechnology Center, University of Torino, Torino, Italy
| | - Stefano Monti
- Section of Computational Biomedicine, Boston University School of Medicine, Boston, MA, USA
| | - Roberto Chiarle
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy.,Center for Experimental Research and Medical Studies (CERMS), Città della Salute e della Scienza, Torino, Italy.,Department of Pathology, Children's Hospital and Harvard Medical School, Boston, MA, USA
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10
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Truini A, Santos Pereira P, Cavazza A, Spagnolo P, Nosseir S, Longo L, Jukna A, Lococo F, Vincenzi G, Bogina G, Tiseo M, Rossi G. Classification of different patterns of pulmonary adenocarcinomas. Expert Rev Respir Med 2015; 9:571-86. [PMID: 26313326 DOI: 10.1586/17476348.2015.1083428] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The epidemic increase of adenocarcinoma histology accounting for more than 50% of primary lung malignancies and the advent of effective molecular targeted-therapies against specific gene alterations characterizing this tumor type have led to the reconsideration of the pathologic classification of lung cancer. The new 2015 WHO classification provided the basis for a multidisciplinary approach emphasizing the close correlation among clinical, radiologic and molecular characteristics and histopathologic pattern of lung adenocarcinoma. The terms 'bronchioloalveolar carcinoma' and 'mixed adenocarcinoma' have been eliminated, introducing the concepts of 'adenocarcinoma in situ', 'minimally invasive adenocarcinoma' and the use of descriptive predominant patterns in invasive adenocarcinomas (lepidic, acinar, papillary, solid and micropapillary patterns). 'Invasive mucinous adenocarcinoma' is the new definition for mucinous bronchioloalveolar carcinoma, and some variants of invasive adenocarcinoma have been included, namely colloid, enteric and fetal-type adenocarcinomas. A concise update of the immunomorphologic, radiological and molecular characteristics of the different histologic patterns of lung adenocarcinoma is reported here.
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Affiliation(s)
- Anna Truini
- a 1 Lung Cancer Unit, IRCCS AOU San Martino - IST and Dipartimento di Medicina Interna e Specialità Mediche (DIMI), Università di Genova, Genova, Italy
| | - Poliana Santos Pereira
- b 2 Operative Unit of Pathologic Anatomy Hospital "Maggiore della Carità" of Novara, Novara, Italy
| | - Alberto Cavazza
- c 3 Department of Oncology and Advanced Technologies, Operative Unit of Oncology, Arcispedale S. Maria Nuova/ I.R.C.C.S., Reggio Emilia, Reggio Emilia, Italy
| | - Paolo Spagnolo
- d 4 Medical University Clinic, Canton Hospital Baselland, and University of Basel, Basel, Switzerland
| | - Sofia Nosseir
- e 5 Section of Pathologic Anatomy, University Hospital Policlinico of Modena, Modena, Italy
| | - Lucia Longo
- f 6 Medical Oncology Unit, Civic Hospital "Ramazzini", Carpi, Carpi, Italy
| | - Agita Jukna
- g 7 Pathology Institute, Pauls Stradins Clinical University Hospital, Riga, Riga, Latvia
| | - Filippo Lococo
- h 8 Department of Surgery, Operative Unit of Thoracic Surgery, Arcispedale S. Maria Nuova/ I.R.C.C.S., Reggio Emilia, Reggio Emilia, Italy
| | - Giada Vincenzi
- i 9 Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Giuseppe Bogina
- j 10 Section of Pathologic Anatomy, Hospital "Don Calabria", Negrar, Verona, Italy
| | - Marcello Tiseo
- k 11 Division of Medical Oncology University Hospital, Parma, Italy
| | - Giulio Rossi
- l 12 University Hospital of Modena, Modena, Italy
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11
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Hao YQ, Tang HP, Liu HY. Primary signet-ring cell carcinoma of the lung treated with crizotinib: A case report. Oncol Lett 2015; 9:2205-2207. [PMID: 26137041 DOI: 10.3892/ol.2015.3003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 01/08/2015] [Indexed: 11/06/2022] Open
Abstract
Primary signet-ring cell adenocarcinoma (SRCA) of the lung is an extremely rare subtype of lung adenocarcinoma with a poor prognosis. The presence of an SRC component is considered to be a prominent clinicopathological characteristic of EML4-ALK-positive non-small cell lung cancer (NSCLC). Crizotinib, an anaplastic lymphoma kinase inhibitor, has been approved for the treatment of EML4-ALK NSCLC by previous studies, but its effect on SRCA, an extremely rare subtype of lung adenocarcinoma, has yet to be elucidated. Therefore, the present study aimed to evaluate the clinical response of SRCA to crizotinib, and examine the potential use of crizotinib as a treatment for the carcinoma. A 43-year-old male was admitted to the Qingdao Municipal Hospital (Qingdao, China) with dyspnea. Chest computed tomography (CT) revealed a mass in the middle lobe of the right lung. Transbronchial lung biopsies revealed the presence of SRCA (70%) mixed with poorly-differentiated adenocarcinoma (30%). Immunohistochemically, the SRCA cells were positive for cytokeratin (CK)7 and thyroid transcription factor-1, and negative for CK20. An inversion of the EML4-ALK gene was detected by fluorescence in situ hybridization and crizotinib was injected by nasogastric tube. The patient was highly responsive to crizotinib. The symptoms of dyspnea were relieved and the volumes of pericardial and pleural effusion were gradually reduced. A CT scan revealed lung tumor regression. The overall response was a partial response. Therefore, crizotinib exists an attractive therapeutic option for patients with SRCA. However, in the present study, acquired drug resistance to crizotinib developed after only one month of treatment. It would consequently be valuable to investigate the mechanisms underlying acquired crizotinib resistance in future studies.
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Affiliation(s)
- Yue-Qin Hao
- Department of Respiratory Medicine, Qingdao Municipal Hospital, Qingdao, Shandong 266600, P.R. China
| | - Hua-Ping Tang
- Department of Respiratory Medicine, Qingdao Municipal Hospital, Qingdao, Shandong 266600, P.R. China
| | - Hong-Yun Liu
- Department of Pathology, Qingdao Municipal Hospital, Qingdao, Shandong 266600, P.R. China
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Pulmonary adenocarcinoma with signet ring cell features: a comprehensive study from 3 distinct patient cohorts. Am J Surg Pathol 2015; 38:1681-8. [PMID: 25007143 DOI: 10.1097/pas.0000000000000280] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Comprehensive biological characteristics of pulmonary adenocarcinomas with signet ring cell features (SRC⁺) are not well known. Herein, we systematically evaluated clinical and molecular features of SRC⁺ cases with particular attention to smoking status. Surgically treated lung adenocarcinomas (n=763) with follow-up ≥5 years in 3 cohorts were reviewed: all patients in 2006 to 2007 ("all-comers," n=222; 168 ever-smokers), a never-smoker cohort (n=266), and a cohort of ever-smokers (n=275). SRC⁺ tumors had ≥10% of SRCs agreed by 2 pathologists. SRC⁺ cases were tested for rearrangement of ALK and ROS1, as well as 187 known mutations in 10 oncogenes including EGFR, KRAS, BRAF, ERBB2, JAK2, AKT1, AKT2, KIT, MET, and PIK3CA. Overall, 53 of 763 cases (7%) were SRC⁺. In the 2006 to 2007 "all comer" cohort, 9% were SRC⁺. In the never-smoker cohort, 9% were SRC⁺. In the smoker cohort, 3% were SRC⁺. Univariable analysis showed that SRC⁺ never-smokers had shorter overall and disease-free survival (P=0.006 and 0.0004, respectively), but the significance faded in the multivariable analysis. For the other 2 cohorts, crude 5-year survival was decreased by 6% to 27% in SRC⁺ cases without reaching statistical significance. In SRC⁺ tumors, KRAS mutation was most common (29%), followed by ALK (26%), EGFR (18%), ROS1 (6%), BRAF (6%), and PIK3CA (3%). In summary, SRC⁺ tumors in never-smokers had a worse survival by univariable analysis only. SRC⁺ cases seemed enriched for ALK⁺ and ROS1⁺, and other mutations were generally in keeping with the patient's smoking status.
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Ly6/uPAR-related protein C4.4A as a marker of solid growth pattern and poor prognosis in lung adenocarcinoma. J Thorac Oncol 2013; 8:152-60. [PMID: 23287851 DOI: 10.1097/jto.0b013e318279d503] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION We have recently shown that the protein C4.4A is induced in early precursor lesions of pulmonary adenocarcinomas and squamous cell carcinomas. In the present study, we aimed at analyzing the impact of C4.4A on the survival of non-small cell lung cancer patients and determining whether its unexpected expression in adenocarcinomas could be attributed to a specific growth type (lepidic, acinar, papillary, micropapillary, solid). METHODS Sections from the center and periphery of the primary tumor, as well as N2-positive lymph node metastases, were stained by immunohistochemistry for C4.4A and scored semi-quantitatively for intensity and frequency of positive tumor cells. RESULTS C4.4A score (intensity × frequency) in the tumor center was a highly significant prognostic factor in adenocarcinomas (n = 88), both in univariate (p = 0.004; hazard ratio [95% confidence interval] = 1.44 [1.12-1.85]) and multivariate statistical analysis (p = 0.0005; hazard ratio = 1.65 [1.24-2.19]), demonstrating decreasing survival with increasing score. In contrast, C4.4A did not provide prognostic information in squamous cell carcinomas (n = 104). Pathological stage was significant in both groups. In the adenocarcinomas, C4.4A expression was clearly associated with, but a stronger prognostic factor than, solid growth. CONCLUSIONS The present results substantiate the potential value of C4.4A as a prognostic marker in pulmonary adenocarcinomas seen earlier in a smaller, independent patient cohort. Importantly, we also show that C4.4A is a surrogate marker for adenocarcinoma solid growth. Recent data suggest that C4.4A is negatively regulated by the tumor suppressor liver kinase B1, which is inactivated in some adenocarcinomas, providing a possible link to the impact of C4.4A on the survival of these patients.
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Kim L, Kim KH, Yoon YH, Ryu JS, Choi SJ, Park IS, Han JY, Kim JM, Chu YC. Clinicopathologic and molecular characteristics of lung adenocarcinoma arising in young patients. J Korean Med Sci 2012; 27:1027-36. [PMID: 22969248 PMCID: PMC3429819 DOI: 10.3346/jkms.2012.27.9.1027] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 06/26/2012] [Indexed: 01/15/2023] Open
Abstract
Lung cancer rarely occurs in young patients. Recent studies have demonstrated that epidemiologic data are closely correlated to some molecular characteristics. We investigated the clinicopathologic characteristics of lung adenocarcinoma in young patients and evaluated immunohistochemically detected epidermal growth factor receptor (EGFR) mutation status and anaplastic lymphoma kinase (ALK) positivity. Among lung adenocarcinoma patients, 31 cases were of the ≤ 40 yr-old group and 261 cases of > 50 yr-old group. Young patients were more likely to be females (67.7% vs 40.2%), and nonsmokers (58.1% vs 45.2%) and more often had high TNM stage (stage IV was 80.6% vs 52.1%) and had a high rate of distant metastasis (51.6% vs 28.0%) compared with older patients. The signet ring cell feature was more common (25.8% vs 11.5%) and lepidic growth pattern was rarely present (3.2% vs 16.5%) in the adenocarcinoma of young patients. There was no significant survival difference between the two age groups. The rate of EGFR mutation status and ALK positivity did not show a statistical difference between two groups. In conclusion, lung adenocarcinoma of young patients demonstrates distinct pathologic features with frequent presence of a signet ring cell feature and rare occurrence of lepidic growth pattern. Further investigation for other genetic abnormalities would be needed.
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Affiliation(s)
- Lucia Kim
- Department of Pathology, Inha University School of Medicine, Incheon, Korea.
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15
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Yoshida A, Tsuta K, Watanabe SI, Sekine I, Fukayama M, Tsuda H, Furuta K, Shibata T. Frequent ALK rearrangement and TTF-1/p63 co-expression in lung adenocarcinoma with signet-ring cell component. Lung Cancer 2010; 72:309-15. [PMID: 21036415 DOI: 10.1016/j.lungcan.2010.09.013] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Revised: 09/09/2010] [Accepted: 09/19/2010] [Indexed: 01/25/2023]
Abstract
Primary adenocarcinoma with signet-ring cell component (Ad-SRCC) of the lung has been well characterized clinicopathologically and histologically, but their genetics has rarely been investigated. A recent report suggesting an association between Ad-SRCC and EML4-ALK fusion prompted us to undertake a histological, immunohistochemical, and molecular analysis of 10 cases of primary Ad-SRCC identified out of 699 lung adenocarcinomas (1.4%). Most of the Ad-SRCCs showed characteristic architectural as well as cytological features including cohesive clustering of signet-ring cells, a solid/acinar growth pattern, and alveolar filling at the tumor periphery. Diffuse co-expression of TTF-1 and p63 was observed in half of the Ad-SRCCs, and this immunoprofile has not been recognized previously. Four Ad-SRCCs (40%) harbored ALK translocations detected by reverse-transcriptase polymerase chain reaction, fluorescence in situ hybridization, and immunohistochemistry. One new EML4-ALK fusion variant was identified. One ALK-rearranged tumor showed focal squamous differentiation. None of the present Ad-SRCCs had EGFR or KRAS mutations, regardless of ALK status. This study successfully utilized tumor histology alone to identify a subset of adenocarcinomas showing a high rate of ALK translocation. The characteristic histology, immunoprofile, frequent ALK translocation, and total lack of EGFR or KRAS mutations, may suggest that Ad-SRCC forms a histologically/molecularly coherent subgroup of adenocarcinoma.
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Affiliation(s)
- Akihiko Yoshida
- Clinical Laboratory Division, National Cancer Center Hospital, Japan
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Primary Signet-Ring Carcinoma (SRC) of the Lung: A Population-Based Epidemiologic Study of 262 Cases with Comparison to Adenocarcinoma of the Lung. J Thorac Oncol 2010; 5:420-7. [DOI: 10.1097/jto.0b013e3181ce3b93] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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