Local tumour progression after percutaneous ablation of colorectal liver metastases according to RAS mutation status.
Local tumour progression after percutaneous ablation of colorectal liver metastases according to RAS mutation status.
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DOI：
10.1002/bjs.10490
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发表时间：
2017-05
期刊：
影响因子：
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通讯作者：
Vauthey JN
中科院分区：
文献类型：
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作者：
Odisio BC;Yamashita S;Huang SY;Harmoush S;Kopetz SE;Ahrar K;Shin Chun Y;Conrad C;Aloia TA;Gupta S;Hicks ME;Vauthey JN
经皮消融是结直肠肝转移瘤（CLM）的常见治疗方法。然而，RAS突变对CLM消融后结局的影响尚不清楚。分析了2004年至2015年接受图像引导经皮CLM消融术并具有已知大鼠肉瘤病毒癌基因同源物（RAS突变状态）的患者。评价患者在CLM接受消融治疗时成像观察到的局部肿瘤进展。进行多变量考克斯回归分析，以确定与局部肿瘤无进展生存期相关的因素。该研究包括92名接受137例CLM消融的患者。36例患者（39%）有突变型RAS。野生型RAS患者的局部肿瘤进展率为14%（8/56），突变型RAS患者为39%（14/36）（p= 0.007）。突变型RAS患者经皮消融术后的局部肿瘤无进展生存率比野生型RAS患者差（3年局部肿瘤无进展生存率：35% vs. 71%，p=0.001）。在多变量分析中，局部肿瘤无进展生存率的阴性预测因子是最小消融边缘<5 mm（风险比[HR] 2.48，95%置信区间[CI] 1.31 - 4.72; p= 0.006）和突变型RAS（HR 3.01，95% CI 1.60 - 5.77; p= 0.001）。突变型RAS与接受CLM消融术的患者中局部肿瘤进展的早期和更高速率相关。
Percutaneous ablation is a common treatment for colorectal liver metastases (CLM). However, the effect of RAS mutation on outcome after ablation of CLMs is unclear. Patients who underwent image-guided percutaneous ablation of CLMs from 2004 through 2015 and had known Rat sarcoma viral oncogene homolog (RAS mutation status were analyzed. Patients were evaluated for local tumor progression as observed on imaging at CLM treated with ablation. Multivariable Cox regression analysis was performed to determine factors associated with local tumour progression-free survival. The study included 92 patients who underwent ablation of 137 CLMs. Thirty-six patients (39%) had mutant RAS. Rates of local tumour progression were 14% (8/56) for patients with wild-type RAS and 39% (14/36) for patients with mutant RAS (p=0·007). Actuarial local tumour progression-free survival after percutaneous ablation were worse in patients with mutant RAS than wild-type RAS (3-year local tumour progression-free survival rate: 35% vs. 71%, p=0.001). In multivariable analysis, negative predictors of local tumour progression-free survival were minimal ablation margin <5 mm (hazard ratio [HR] 2·48, 95% confidence interval [CI] 1·31–4·72; p=0·006) and mutant RAS (HR 3·01, 95% CI 1·60–5·77; p=0·001). Mutant RAS is associated with an earlier and higher rate of local tumour progression in patients undergoing ablation of CLM.