J Korean Med Sci.  2012 Sep;27(9):1027-1036. 10.3346/jkms.2012.27.9.1027.

Clinicopathologic and Molecular Characteristics of Lung Adenocarcinoma Arising in Young Patients

• Kim L
• Kim KH
• Yoon YH
• Ryu JS
• Choi SJ
• Park IS
• Han JY
• Kim JM
• Chu YC

• KMID: 1782135
• DOI: http://doi.org/10.3346/jkms.2012.27.9.1027

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 < or = 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.

Keyword

Adenocarcinoma; Lung Neoplasm; EML4-ALK; EGFR; Age Groups; Immunohistochemistry

MeSH Terms

Adenocarcinoma/metabolism/mortality/*pathology
Adult
Age Factors
Aged
Aged, 80 and over
Female
Humans
Immunohistochemistry
Kaplan-Meier Estimate
Lung Neoplasms/metabolism/mortality/*pathology
Male
Middle Aged
Mutation
Neoplasm Staging
Receptor Protein-Tyrosine Kinases/metabolism
Receptor, Epidermal Growth Factor/metabolism
Smoking
Receptor Protein-Tyrosine Kinases
Receptor, Epidermal Growth Factor

Figure

• 

  Fig. 1 Kaplan-Meier Curves comparing overall survival between the young and old age groups. (A) Overall survival in the young and older patients with lung carcinoma is not statistically different (P = 0.893). (B) Overall survival in the young and older patients with lung adenocarcinoma is not statistically different (P = 0.450).

• 

  Fig. 2 Kaplan-Meier curves comparing overall survival between presence and absence of signet ring cell feature and between those of lepidic growth pattern. (A) Overall survival of patients having signet ring cell feature is worse than that of patients without signet ring cell feature (P = 0.001). (B) Patients with lepidic growth pattern show better survival rate than those without lepidic growth pattern (P < 0.001).

• 

  Fig. 3 Immunohistochemical stains of lung adenocarcinoma cases. (A) and (B) E746 and L858R EGFR mutation-specific antibodies show a positive staining at tumor cells (A, E746 mutation-specific antibody, × 200; B, L858R mutation-specific antibody, × 400). (C) In a case of adenocarcinoma showing signet ring cell feature, ALK positivity is present at tumor cells (ALK, × 400).

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