Survival Outcomes of Resected BRAF V600E Mutant Colorectal Liver Metastases: A Multicenter Retrospective Cohort Study in Japan
Survival Outcomes of Resected BRAF V600E Mutant Colorectal Liver Metastases: A Multicenter Retrospective Cohort Study in Japan
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DOI：
10.1245/s10434-020-08817-8
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发表时间：
2020-07-13
影响因子：
3.7
通讯作者：
Taniguchi, Hiroya
中科院分区：
文献类型：
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作者：
Kobayashi, Shin;Takahashi, Shinichiro;Taniguchi, Hiroya
背景尽管BRAF突变的结直肠肝转移（CRLM）患者切除后的预后较差，但BRAFV 600 E突变对此类患者生存的影响仍不清楚。方法进行了一项多中心回顾性队列研究，以调查2005年1月至2017年12月期间因组织学证实的BRAFV 600 E突变CRLM而接受初次肝切除术的患者的生存结局。结果共纳入6个单位的33例患者。在49.2个月的中位肝切除术后随访期间，31例患者（93.9%）在中位5.3个月后复发，1年无复发生存率（RFS）为24.2%。只有两名患者因复发而接受了重复手术。另29例患者有不可切除的复发病灶，其中27例接受了全身化疗。中位总生存期（OS）为31.1个月，5年OS率为18.2%。RFS预后不良的因素是血清CA 19 -9水平升高肝切除术时（>= 37 IU/ml）（HR：2.139，95%CI：1.009- 4.534，P = 0.047）和R1切除（HR：5.827，95%CI：1.585- 21.42，P = 0.008），仅R1切除对OS的影响（HR：4.129，95%CI：1.104- 15.45，P = 0.035）。结论BRAFV 600 E突变型CRLM早期复发率高，应考虑全身化疗。需要一种新的围手术期治疗策略来提高此类患者的生存率。
Background Although the prognosis for patients with resectedBRAFmutant colorectal liver metastases (CRLM) is poor, the survival impact of theBRAFV600E mutation in such cases remains unclear. Methods A multicenter retrospective cohort study was performed to investigate the survival outcomes of patients who underwent initial hepatectomy for histologically confirmedBRAFV600E mutant CRLM between January 2005 and December 2017. Results Thirty-three patients from 6 institutions were included in this study. During the median duration of the post-hepatectomy follow-up period of 49.2 months, 31 patients (93.9%) developed recurrence after a median period of 5.3 months and the 1-year recurrence-free survival (RFS) rate was 24.2%. Only two patients underwent repeated surgery for recurrence. The other 29 patients had unresectable recurrent lesions, and 27 of them received systemic chemotherapy. The median overall survival (OS) period was 31.1 months and the 5-year OS rate was 18.2%. The factors for a poor RFS prognosis were an elevated serum CA19-9 level (>= 37 IU/ml) at hepatectomy (HR: 2.139, 95% CI: 1.009-4.534,P = 0.047) and R1 resection (HR: 5.827, 95% CI: 1.585-21.42,P = 0.008), and that for OS was R1 resection only (HR: 4.129, 95% CI: 1.104-15.45,P = 0.035). Conclusions Since the early onset unresectable recurrence rate was very high, systemic chemotherapy should be considered for resectableBRAFV600E mutant CRLM. A novel perioperative treatment strategy is needed to improve the survival of such patients.