Clinicopathological and prognostic analysis of anaplastic lymphoma kinase-rearranged non-small cell lung cancer

Abstract Objectives Anaplastic lymphoma kinase (ALK)-rearranged non-small cell lung cancer (NSCLC) accounts for 2‒7% of NSCLC cases and is prone to lymph node and distant metastases. We analyzed the clinicopathologic features and prognosis of patients with ALK-rearranged NSCLC who underwent surgery. Methods This study included 30 patients who underwent surgery for ALK-rearranged NSCLC between January 2017 and September 2025, representing ~ 1.6% of all primary lung cancer surgeries performed during the same period. Results The median age was 68 years, 19 patients were male, and 14 (46.7%) had a smoking history. Clinical stages were I ( n = 22), II ( n = 1), and III ( n = 7). Lobectomy was the most common surgical procedure ( n = 19), followed by partial resection ( n = 6) and segmentectomy ( n = 5). Complete resection was achieved in 26 (86.7%) patients. Pathological upstaging occurred in 11 (36.7%) patients. Postoperative recurrence occurred in 10 patients after complete resection, with a median recurrence-free interval of 554.5 days; eight patients received an ALK tyrosine kinase inhibitor (ALK-TKI). Among five patients with clinical stage III NSCLC receiving induction chemoradiotherapy, four underwent complete resection, but all experienced postoperative recurrence. The 5-year overall survival rate of the entire cohort was 89.5% (95% confidence interval [CI] 64.1‒97.3%), while the 5-year recurrence-free survival rate after complete resection was 51.2% (95% CI 27.4‒70.7%). Conclusions Given the high recurrence rates associated with conventional perioperative treatment and occasional unexpected upstaging, a treatment strategy centered on surgical resection and ALK-TKIs may be important for ALK-rearranged NSCLC.