Impact of ALK rearrangement on survival in resected lung adenocarcinoma: A real-world analysis.

Authors

Yi-Hsiang Lai, Yan-Lin Li, Hsiu-Ping Chou, Kuan-Hsun Lin, Ying-Yi Chen, Hsu-Kai Huang, Kai-Hsiung Ko, Tsai-Wang Huang

Published in

Journal of the Formosan Medical Association = Taiwan yi zhi. Oct 07, 2026. Epub Oct 07, 2026.

Abstract

The prognostic significance of ALK rearrangement after curative-intent resection of non-small-cell lung cancer (NSCLC) remains uncertain. Although the ALINA trial established adjuvant alectinib for resected ALK-positive NSCLC, patients with contemporary stage IA-IB disease were not fully represented. We evaluated stage-stratified outcomes of ALK-rearranged lung adenocarcinoma within an EGFR-excluded framework.
We retrospectively analyzed patients undergoing curative-intent resection from 2005 to 2020. ALK status was determined using a two-step immunohistochemistry algorithm (p80/D5F3), and EGFR-mutant tumors were excluded. Propensity score matching (1:2) was used to balance clinicopathologic characteristics. Overall survival (OS) and disease-free survival (DFS) were compared according to ALK status and pathologic stage.
Among 554 eligible patients, matching yielded 52 ALK-positive and 104 ALK-negative patients. In the matched cohort, OS and DFS did not differ significantly according to ALK status (p = 0.161 and p = 0.860, respectively). ALK rearrangement was not independently associated with OS (aHR, 0.584; 95% CI, 0.225-1.513) or DFS (aHR, 1.183; 95% CI, 0.562-2.489). In stage IA-IB disease, DFS was comparable (p = 0.602), while OS was numerically higher in the ALK-positive group but not statistically significant (p = 0.092). In stage II-III disease, neither OS nor DFS differed significantly by ALK status (p = 0.822 and p = 0.317, respectively).
ALK rearrangement was not independently associated with postoperative OS or DFS. Patients with stage IA-IB disease demonstrated favorable long-term outcomes, whereas those with stage II-III disease remained at substantial risk of recurrence. These findings suggest that postoperative risk stratification should primarily consider pathologic stage rather than ALK status alone.

PMID:
42844043
Bibliographic data and abstract were imported from PubMed on 08 Oct 2026.

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