We conducted a study to explore the relationship between pathological cytomorphologic features and the percentage of anaplastic lymphoma kinase (ALK)-positive cells to better predict pulmonary adenocarcinoma prognosis with crizotinib treatment. We investigated 60 cases of patients with ALK-positive advanced or metastatic non-small cell lung cancer (NSCLC). Immunohistochemistry was performed to screen for ALK rearrangement. Fluorescence in situ hybridization (FISH) was used to detect the percentage of ALK-positive cells. The primary objectives of the study were the progression-free survival (PFS), the 3-year overall survival, and the 3-year overall survival (OS) rates. The secondary objectives of the study were the disease control rate (DCR) and the overall response rate (ORR). We compared the pathological cytomorphologic features of 60 cases of ALK-positive pulmonary adenocarcinoma, of which 21 cases were ALK-positive with signet ring cell cytomorphologic characteristics. There were statistical differences in the ORR (p = 0.019), DCR (p = 0.032), and PFS (p = 0.047) between the signet ring cell group and group without signet ring cells. Of these, 37 cases were ALK-positive with EML4 (echinoderm microtubule associated protein like 4)-ALK high percentage of positivity group. These cases benefited more from crizotinib treatment in the ORR (p = 0.046) and achieved a longer PFS (p = 0.036) compared to those with EML4-ALK low percentage of positivity group. Signet ring cell cytomorphologic characteristics of pulmonary adenocarcinoma are associated with the percentage of ALK-positive cells. Signet ring cell cytomorphologic characteristics and the percentage of ALK-positive cells might predict the prognosis of pulmonary adenocarcinoma with crizotinib treatment. The study was approved by the Institutional Review Board (Medical Ethics Committee of Yantai Yuhuangding Hospital). The registration number is NO.2016[193].

中文翻译：

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病理细胞形态学特征和 ALK FISH 阳性细胞百分比预测肺腺癌预后：一项前瞻性队列研究

我们进行了一项研究，探讨病理细胞形态学特征与间变性淋巴瘤激酶 (ALK) 阳性细胞百分比之间的关系，以更好地预测克唑替尼治疗后肺腺癌的预后。我们调查了 60 例 ALK 阳性晚期或转移性非小细胞肺癌 (NSCLC) 患者。进行免疫组织化学以筛选 ALK 重排。荧光原位杂交 (FISH) 用于检测 ALK 阳性细胞的百分比。该研究的主要目标是无进展生存率 (PFS)、3 年总生存率和 3 年总生存率 (OS)。该研究的次要目标是疾病控制率 (DCR) 和总体反应率 (ORR)。我们比较了 60 例 ALK 阳性肺腺癌的病理细胞形态学特征，其中 21 例为 ALK 阳性并具有印戒细胞细胞形态学特征。印戒细胞组与无印戒细胞组的 ORR (p = 0.019)、DCR (p = 0.032) 和 PFS (p = 0.047) 存在统计学差异。其中，37例为ALK阳性，EML4（棘皮动物微管相关蛋白样4）-ALK高百分比阳性组。与 EML4-ALK 低百分比阳性组相比，这些病例在 ORR 中从克唑替尼治疗中获益更多（p = 0.046），并实现了更长的 PFS（p = 0.036）。肺腺癌的印戒细胞形态学特征与 ALK 阳性细胞的百分比有关。印戒细胞的细胞形态学特征和 ALK 阳性细胞的百分比可能预测克唑替尼治疗肺腺癌的预后。该研究得到了机构审查委员会（烟台玉皇顶医院医学伦理委员会）的批准。注册号为NO.2016[193]。