The survival outcome of patients with metastatic colorectal cancer based on the site of metastases and the impact of molecular markers and site of primary cancer on metastatic pattern
The survival outcome of patients with metastatic colorectal cancer based on the site of metastases and the impact of molecular markers and site of primary cancer on metastatic pattern
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DOI：
10.1080/0284186x.2018.1487581
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发表时间：
2018-11-02
期刊：
影响因子：
3.1
通讯作者：
Yip, Desmond
中科院分区：
文献类型：
--
作者：
Prasanna, Thiru;Karapetis, Christos S.;Yip, Desmond
背景资料：转移性结直肠癌（mCRC）患者的扩散模式是可变的，可能反映了患者亚群的不同生物学特征。这是一项回顾性研究，旨在根据诊断时的转移部位探索mCRC患者的结局，并探索肿瘤特征[KRAS/RAS、BRAF、错配修复（MMR）状态、原发部位]与转移部位之间的相关性。研究方法：根据诊断转移性疾病时的转移部位，将来自两个澳大利亚数据库的患者分为6组;仅肺、仅肝脏、仅淋巴结或任何脑、骨或腹膜转移患者。主要终点是每个队列与其他人群相比的总生存期（OS）。Mantel-Haenszel卡方检验用于探索转移部位与选定肿瘤特征之间的相关性。结果：5967例患者被纳入。在单变量分析中，在两个数据集中，当转移局限于肺或肝时，中位OS显著更高，而脑、骨或腹膜转移的中位OS更短（p <0.001）。BRAF突变与腹膜转移密切相关（相对风险= 1.8，p <0.001），肺（RR = 0.3，p = 0.004）和肝（RR = 0.7，p = 0.005）局限性转移的发生率较低。KRAS/RAS突变患者的仅肺转移更常见（RR = 1.4，p = 0.007）。左半结肠肿瘤与骨转移（RR = 1.6，p <0.001）和仅肺转移（RR = 2.3，p = 0.001）相关，而腹膜转移较右半结肠肿瘤少（RR = 0.6，p <0.001）。直肠癌与脑、骨和肺转移相关（RR = 1.7; p = 0.002，1.7; p <0.001，2.0; p <0.001）。在缺乏MMR的肿瘤中，仅肝脏转移的发生率较低（RR = 0.7，p = 0.01）。结论：mCRC的生存期与肺局限性疾病的转移部位相关，与其他单一转移部位疾病相比，显示出更有利的生存结局。BRAF突变和原发性直肠癌与预后不良的转移部位相关。
Background: Pattern of spread in patients with metastatic colorectal cancer (mCRC) is variable and may reflect different biology in subsets of patients. This is a retrospective study to explore the outcome of patients with mCRC based on their site of metastasis at diagnosis and to explore the association between tumor characteristics [KRAS/RAS, BRAF, mismatch repair (MMR) status, site of primary] and the site of metastasis. Methods: Patients from two Australian databases were divided into six groups based on site of metastasis at time of diagnosis of metastatic disease; lung-only, liver-only, lymph node-only or any patients with brain, bone or peritoneal metastases. Primary endpoint was overall survival (OS) of each cohort compared with the rest of the population. A Mantel-Haenszel chi-squared test used to explore the association between site of metastasis and selected tumor characteristics. Results: Five thousand nine hundred and sixty-seven patients were included. In a univariate analysis, median OS was significantly higher when metastases were limited to lung or liver and shorter for those with brain, bone or peritoneal metastases (p < .001) in both datasets. BRAF mutation was strongly associated with peritoneal metastases (relative risk = 1.8, p < .001) with lower incidence of lung (RR = 0.3, p = .004) and liver (RR = 0.7, p = .005) limited metastases. Lung-only metastases were more frequent with KRAS/RAS mutation (RR = 1.4, p = .007). Left colon tumors were associated with bone (RR = 1.6, p < .001) and lung-only metastases (RR = 2.3, p = .001) while peritoneal spread was less frequent compared with right colon tumors (RR = 0.6, p < .001). Rectal cancer was associated with brain, bone and lung metastases (RR = 1.7; p = .002, 1.7; p < .001, 2.0; p < .001). Liver-only metastases were less frequent in deficient MMR tumors (RR = 0.7, p = .01). Conclusion: Survival duration with mCRC is related to the site of metastases with lung limited disease showing a more favorable survival outcome compared to other single metastatic site disease. The BRAF mutation and primary rectal cancer were associated with poor prognostic metastatic sites.