Introduction:The rearrangement of the anaplastic lymphoma kinase (ALK) gene accounts for approximately 1%–6%of lung adenocarcinoma cases and deifnes a molecular subgroup of tumors characterized by clinical sensitivity toALK inhibitors such as crizotinib. This study aimed to identify the relationship betweenALK rearrangement and the clinico?pathologic characteristics of non?small cell lung cancer (NSCLC) and to analyze the therapeutic responses of crizotinib and conventional chemotherapy toALK rearrangement in NSCLC patients. Methods:A total of 487 lung cancer patients who underwent testing forALK rearrangement in our department were included in this study.ALK rearrangement was examined by using lfuorescence insitu hybridization (FISH) assay. Results:Among the 487 patients, 44 (9.0%) were diagnosed withALK rearrangement by using FISH assay. In 123 patients with adenocarcinoma who were non?smokers and of a young age (≤58years old), the frequency ofALK rearrangement was 20.3% (25/123). Short overall survival (OS) was associated with non?adenocarcinoma tumor type (P=0.006), poorly differentiated tumors (P=0.001), advanced?stage tumors (P<0.001), smoking history (P=0.008), and wild?type epidermal growth factor receptor (EGFR) (P=0.008). Moreover, patients with poorly differentiated and advanced?stage tumors had a shorter time to cancer progression compared with those with well differentiated (P=0.023) and early?stage tumors (P=0.001), respectively. Conclusions:ALK?rearranged NSCLC tends to occur in younger individuals who are either non?smokers or light smokers with adenocarcinoma. Patients withALK rearrangement might beneift fromALK inhibitor therapy.

Background:The current World Health Organization (WHO) classiifcation of nasopharyngeal carcinoma (NPC) con?veys little prognostic information. This study aimed to propose an NPC histopathologic classiifcation that can poten?tially be used to predict prognosis and treatment response. Methods:We initially developed a histopathologic classiifcation based on the morphologic traits and cell differentia?tion of tumors of 2716 NPC patients who were identiifed at Sun Yat?sen University Cancer Center (SYSUCC) (training cohort). Then, the proposed classiifcation was applied to 1702 patients (retrospective validation cohort) from hospitals outside SYSUCC and 1613 patients (prospective validation cohort) from SYSUCC. The effcacy of radiochemotherapy and radiotherapy modalities was compared between the proposed subtypes. We used Cox proportional hazards models to estimate hazard ratios (HRs) with 95% conifdence intervals (CI) for overall survival (OS). Results:The 5?year OS rates for all NPC patients who were diagnosed with epithelial carcinoma (EC; 3708 patients), mixed sarcomatoid?epithelial carcinoma (MSEC; 1247 patients), sarcomatoid carcinoma (SC; 823 patients), and squamous cell carcinoma (SCC; 253 patients) were 79.4%, 70.5%, 59.6%, and 42.6%, respectively (P<0.001). In mul?tivariate models, patients with MSEC had a shorter OS than patients with EC (HR=1.44, 95% CI=1.27–1.62), SC (HR=2.00, 95% CI=1.76–2.28), or SCC (HR=4.23, 95% CI=3.34–5.38). Radiochemotherapy signiifcantly improved survival compared with radiotherapy alone for patients with EC (HR=0.67, 95% CI=0.56–0.80), MSEC (HR=0.58, 95% CI=0.49–0.75), and possibly for those with SCC (HR=0.63; 95% CI=0.40–0.98), but not for patients with SC (HR=0.97, 95% CI=0.74–1.28). Conclusions:The proposed classiifcation offers more information for the prediction of NPC prognosis compared with the WHO classiifcation and might be a valuable tool to guide treatment decisions for subtypes that are associ?ated with a poor prognosis.