Impact of Single-organ Metastasis to the Liver or Lung and Genetic Mutation Status on Prognosis in Stage IV Colorectal Cancer
Impact of Single-organ Metastasis to the Liver or Lung and Genetic Mutation Status on Prognosis in Stage IV Colorectal Cancer
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DOI：
10.1016/j.clcc.2019.12.001
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发表时间：
2020-03-01
影响因子：
3.4
通讯作者：
Ricciardi, Rocco
中科院分区：
文献类型：
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作者：
Cavallaro, Paul;Bordeianou, Liliana;Ricciardi, Rocco
对国家癌症数据库中患者的分析表明，单器官肺转移患者的生存率低于单器官肝转移患者，即使考虑原发肿瘤位置。此外，KRAS突变和微卫星不稳定状态是预后的重要性，在选定的患者与单器官转移，并测试应考虑在所有患者的IV期结直肠cancer.Background：原发肿瘤部位对总生存期的影响IV期结直肠癌（CRC）与单器官转移到肝或肺的患者尚未研究。此外，在该人群中，通常检测的遗传变异（如KRAS突变和微卫星不稳定性（MSI））的预后意义尚未得到充分描述。材料与方法：该国家癌症数据库用于识别2010年至2014年期间出现肝或肺同步转移的38，328例CRC患者。主要结局是总生存期，使用Kaplan-Meier分析和考克斯比例风险模型对各组进行比较。结果如下：在未校正的分析中，肺转移患者的中位生存期显著长于肝转移患者，左侧（27 vs. 25个月; P = 0.02）和右侧CRC（19 vs. 15个月; P <0.001），而直肠乙状结肠癌和直肠癌没有差异。多变量分析显示，肝转移患者的生存率低于肺转移患者（风险比，1.37; 95%可信区间，1.31-1.43; P <0.001）。这些趋势在接受化疗但未切除原发肿瘤或转移灶的患者中得到证实。在进行基因检测的患者中，KRAS突变体和MSI肿瘤在左侧和直肠肿瘤伴肝转移中的生存率较差，但在其他原发部位和转移模式中分别与KRAS野生型肿瘤和微卫星稳定肿瘤的生存率相似。结论：对于肝或肺单器官转移患者，原发肿瘤部位对总生存率有影响。此外，KRAS突变和MSI状态在选定的单器官转移患者中具有预后重要性。(C)2019爱思唯尔公司All rights reserved.
This analysis of patients in the National Cancer Database demonstrates that patients with single-organ lung metastases had worse survival than single-organ liver metastases, even when accounting for primary tumor location. Furthermore, KRAS mutation and microsatellite instability status are of prognostic importance in selected patients with single-organ metastases, and testing should be considered in all patients with stage IV colorectal cancer.Background: The impact of primary tumor site on overall survival in patients with stage IV colorectal cancer (CRC) with single-organ metastases to the liver or lung has not been studied. Furthermore, the prognostic significance of commonly tested genetic variants such as KRAS mutation and microsatellite instability (MSI) are not well-described in this population. Materials and Methods: This National Cancer Database was used to identify 38,328 patients with CRC that presented with synchronous metastases to the liver or lung between 2010 and 2014. The primary outcome was overall survival, and groups were compared using Kaplan-Meier analyses and Cox proportional hazard models. Results: On unadjusted analysis, median survival was significantly longer for patients with lung metastases compared with those with liver metastases for left-sided (27 vs. 25 months; P = .02) and right-sided CRC (19 vs. 15 months; P < .001), whereas rectosigmoid and rectal cancers showed no difference. On multivariate analysis, patients with liver metastases demonstrated worse survival compared with those with lung metastasis (hazard ratio, 1.37; 95% confidence interval, 1.31-1.43; P < .001). These trends were confirmed in patients that received chemotherapy but did not have their primary tumor or metastases resected. In patients with genetic testing, both KRAS mutants and MSI tumors had worse survival in left-sided and rectal tumors with liver metastases, but had similar survival to KRAS wild type tumors and microsatellite stable tumors, respectively, across other primary site and metastatic patterns. Conclusions: For patients with single-organ metastases to the liver or lung, primary tumor site has an impact on overall survival. Further, KRAS mutation and MSI status are of prognostic importance in selected patients with single-organ metastases. (C) 2019 Elsevier Inc. All rights reserved.