BRAF mutation correlates with worse local-regional control following radiation therapy in patients with stage III melanoma.
BRAF mutation correlates with worse local-regional control following radiation therapy in patients with stage III melanoma.
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DOI：
10.1186/s13014-021-01903-5
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发表时间：
2021-09-18
期刊：
影响因子：
--
通讯作者：
Williams TM
中科院分区：
文献类型：
--
作者：
Wolfe AR;Chablani P;Siedow MR;Miller ED;Walston S;Kendra KL;Wuthrick E;Williams TM
对于 III 期黑色素瘤患者，目前可考虑在选定的高危患者中在淋巴结清扫术 (LND) 后使用辅助放射治疗 (RT)，以改善肿瘤控制。 40-50% 的黑色素瘤病例中存在 BRAF 突变 (BRAF+)，其中大多数位于 V600E 残基上。本研究旨在比较 BRAF+ 和 BRAF- 黑色素瘤患者放疗后的临床结果。这是对 2006 年至 2019 年在我们机构接受 LND 治疗后接受辅助 RT 的 105 名 III 期黑色素瘤患者的回顾性评价。对所有患者的原发皮肤或淋巴结组织样本测定了 BRAF 突变状态。我们使用 Fisher 精确检验和 Wilcoxon 秩和检验比较了 BRAF+ 和 BRAF− 组的特征，并使用 Kaplan-Meier 估计、对数秩检验和 Cox 比例风险模型进行单变量和多变量分析，以及局部区域淋巴结控制、无远处转移生存 (DMFS)、无复发生存 (RFS) 和总生存 (OS) 的临床结果。五十三名 (50%) 患者携带 BRAF 突变（92%，pV600E）。与 BRAF- 患者相比，BRAF+ 患者更年轻，原发肿瘤更常见于躯干而不是头颈部 (p<0.05)。 BRAF + 患者的 5 年局部区域控制率为 60%，而 BRAF- 患者为 81%（HR 4.5，95% CI 1.3–15.5，p = 0.02）。两个 BRAF 患者组之间的 5 年 DMFS、RFS 和 OS 率没有显着差异。在多变量分析中，4 个或更多阳性 LN 的存在仍然是局部淋巴结控制、RFS 和 OS 的重要预后因素。具有 BRAF 突变的 III 期黑色素瘤患者接受辅助放疗后，局部复发或区域淋巴结复发的风险增加了 4 倍以上。这些结果可能有助于考虑淋巴结阳性黑色素瘤患者的辅助放疗，并支持 BRAF 突变赋予放射抗性的其他数据。
In patients with stage III melanoma, the use of adjuvant radiation therapy (RT) after lymph node dissection (LND) may be currently considered in selected high-risk patients to improve tumor control. Melanomas harbor BRAF mutations (BRAF+) in 40–50% of cases, the majority of which are on the V600E residue. This study sought to compare the clinical outcomes after RT between patients with BRAF+ and BRAF− melanoma. This was a retrospective review of 105 Stage III melanoma patients treated at our institution with LND followed by adjuvant RT from 2006 to 2019. BRAF mutational status was determined on the primary skin or nodal tissue samples from all patients. We compared characteristics of the BRAF+ and BRAF− groups using Fisher’s exact test and Wilcoxon rank sum test and performed univariate and multivariate analysis using Kaplan–Meier estimates, log-rank tests, and Cox proportional hazards modeling with the clinical outcomes of local–regional lymph node control, distant metastasis-free survival (DMFS), recurrence-free survival (RFS), and overall survival (OS). Fifty-three (50%) patients harbored a BRAF mutation (92%, pV600E). BRAF+ patients were younger and had primary tumors more commonly found in the trunk vs head and neck compared to BRAF- patients (p < 0.05). The 5 year local–regional control in the BRAF + patients was 60% compared to 81% in the BRAF- patients (HR 4.5, 95% CI 1.3–15.5, p = 0.02). There were no significant differences in 5-year DMFS, RFS, and OS rates between the two BRAF patient groups. The presence of 4 or more positive LNs remained a significant prognostic factor for local–regional lymph node control, RFS, and OS in multivariate analysis. Stage III melanoma patients with BRAF mutation treated with adjuvant RT had > 4 times increased risk of local recurrence or regional lymph node recurrence. These results could be useful for adjuvant RT consideration in lymph node positive melanoma patients and supports other data that BRAF mutation confers radiation resistance.
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影响因子：
6.2
作者：
Agrawal, Shefali;Kane, John M., III;Ballo, Matthew T.
通讯作者：
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影响因子：
51.1
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