Clinical characteristics of non-small cell lung cancer patients with EGFR mutations and ALK&ROS1 fusions.

Objective: To study the relationship between clinical characteristics and anaplastic lymphoma kinase (ALK) fusions, c-ros oncogene 1, receptor tyrosine kinase (ROS1) gene fusions, and epidermic growth factor receptor (EGFR) mutations in non-small cell lung cancer (NSCLC) patients to distinguish these different types.

Methods: Both ALK, ROS1 gene rearrangements and EGFR mutations testing were performed. The clinical characteristics and associated pulmonary abnormalities were investigated.

Results: Four hundred fifty-three NSCLC patients were included for analysis. One hundred seventy (37.5%), 32 (7.1%), and 9 cases (2.0%) with EGFR mutations, ALK gene fusions, and ROS1 gene fusions were identified, respectively. The EGFR-positive and ALK&ROS1-positive were more common in female (χ  = 61.934, P < 0.001 and χ  = 28.152, P < 0.001), non-smoking (χ  = 59.315, P < 0.001 and χ  = 11.080, P = 0.001), and adenocarcinoma (χ  = 44.864, P < 0.001 and χ  = 12.318, P = 0.002) patients; proportion of patients with emphysema was lower (χ  = 35.494, P < 0.001 and χ  = 15.770, P < 0.001) than the wild-type patients. The results of logistic regression analysis indicated that female (adjusted odds ratio [OR] 1.834, 95% confidence interval [CI] 1.069-3.144, P = 0.028), non-smoking (adjusted OR 2.504, 95% CI 1.456-4.306, P = 0.001), lung adenocarcinoma (adjusted OR 4.512, 95% CI 2.465-8.260, P < 0.001), stage III-IV (adjusted OR 2.232, 95% CI 1.066-4.676, P = 0.033), and no symptoms of emphysema (adjusted OR 2.139, 95% CI 1.221-3.747, P = 0.008) were independent variables associated with EGFR mutations. Young (adjusted OR 3.947, 95% CI 1.873-8.314, P < 0.001) and lung adenocarcinoma (adjusted OR 2.950, 95% CI 0.998-8.719, P = 0.050) were associated with ALK/ROS1 fusions.

Conclusions: EGFR mutations were more likely to occur in non-smoking, stage III-IV, and female patients with lung adenocarcinoma, whereas ALK&ROS1 gene fusions were more likely to occur in young patients with lung adenocarcinoma. Emphysema was less common in patients with EGFR mutations.