Primary Tumor Sidedness Predicts Bevacizumab Benefit in Metastatic Colorectal Cancer Patients
Primary Tumor Sidedness Predicts Bevacizumab Benefit in Metastatic Colorectal Cancer Patients
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原发性肿瘤单侧预测贝伐珠单抗对转移性结直肠癌患者的益处
DOI：
10.3389/fonc.2019.00723
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发表时间：
2019-08-14
影响因子：
4.7
通讯作者：
Zong, Zhen
中科院分区：
文献类型：
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作者：
You, Xia-Hong;Wen, Can;Zong, Zhen
原发性肿瘤位置和贝伐单抗治疗转移性结直肠癌（mCRC）的临床结局之间的争论仍在继续。本研究的目的是研究原发肿瘤位置与115例接受贝伐单抗治疗的mCRC患者的临床结局之间的相关性。对21项研究进行了荟萃分析，以证实这一结论。在我们的前瞻性研究中，我们发现右侧mCRC通常发生在老年病例（p = 0.03）和多部位转移（p = 0.03）中。接受贝伐珠单抗联合FOLFIRI方案的左侧患者的无进展生存期（PFS）上级优于右侧病例（p = 0.03，粗HR = 0.31，95% CI = 0.11-0.87;校正HR = 0.21，95% CI = 0.06-0.66）。荟萃分析证实，在总体人群中，基于贝伐珠单抗的治疗在左侧mCRC患者中的疗效优于右侧病例（P-h = 0.24，合并OR = 1.36，95% CI = 1.07-1.72），RAS/BRAF野生型（P-h = 0.19，合并OR = 1.66，95% CI = 1.17-2.34），临床试验（P-h = 0.23，合并OR = 1.42，95% CI = 1.07-1.88），白人人群（P-h = 0.18，合并OR = 1.37，95% CI = 1.02-1.85）和一线（P-h = 0.19，合并OR = 1.48，95% CI = 1.13-1.96）亚组。在总体人群中观察到贝伐珠单抗联合化疗治疗的左侧mCRC患者的生存期改善[P-h < 0.01，PFS的合并MSR = 1.09，95% CI = 1.00-1.18; P-h < 0.01，总生存期（OS）的合并MSR = 1.24，95% CI = 1.13-1.36]，尤其是RAS/BRAF野生型（PFS的P-h = 0.09，合并MSR = 1.10，95% CI = 1.03-1.19; OS的P-h = 0.02，合并MSR = 1.34，95% CI = 1.21-1.49）。这些结果表明，原发肿瘤的单侧性可以预测贝伐珠单抗治疗RAS/BRAF野生型mCRC患者的临床结局，左侧患者可能从贝伐珠单抗联合FOLFIRI中获益更多。
The emerging debate between primary tumor location and clinical outcome of bevacizumab treated metastatic colorectal cancer (mCRC) continues. The aim of the present study is to investigate the association between the primary tumor location and clinical outcome of 115 mCRC patients receiving bevacizumab based treatment. A meta-analysis including 21 studies was carried out to confirm the conclusion. In our prospective study, we found that right-sided mCRC commonly occurred in older cases (p = 0.03) with multiple-site metastasis (p = 0.03). Progression-free survival (PFS) of the left-sided patients undergoing bevacizumab plus a FOLFIRI regimen was superior to the right-sided cases (p = 0.03, crude HR = 0.31, 95% CI = 0.11-0.87; adjusted HR = 0.21, 95% CI = 0.06-0.66). The meta-analysis confirmed that efficacy of bevacizumab-based treatment in left-sided mCRC patients was better than the right-sided cases in the overall population (P-h = 0.24, combined OR = 1.36, 95% CI = 1.07-1.72), RAS/BRAF wild-type (P-h = 0.19, combined OR = 1.66, 95% CI = 1.17-2.34), clinical trial (P-h = 0.23, combined OR = 1.42, 95% CI = 1.07-1.88), Caucasian population (P-h = 0.18, combined OR = 1.37, 95% CI = 1.02-1.85) and first-line (P-h = 0.19, combined OR = 1.48, 95% CI = 1.13-1.96) subgroups. Improved survival of bevacizumab plus chemotherapy treated left-sided mCRC patients was observed in the overall population [P-h < 0.01, combined MSR = 1.09, 95% CI = 1.00-1.18 for PFS; P-h < 0.01, combined MSR = 1.24, 95% CI = 1.13-1.36 for overall survival (OS)], especially in the RAS/BRAF wild-type (P-h = 0.09, combined MSR = 1.10, 95% CI = 1.03-1.19 for PFS; P-h = 0.02, combined MSR = 1.34, 95% CI = 1.21-1.49 for OS). These findings indicate that primary tumor sidedness can predict clinical outcome of bevacizumab-treated RAS/BRAF wild-type mCRC patients and the left-sided patients may benefit more from bevacizumab plus FOLFIRI.