RAS Mutation Predicts Positive Resection Margins and Narrower Resection Margins in Patients Undergoing Resection of Colorectal Liver Metastases.
RAS Mutation Predicts Positive Resection Margins and Narrower Resection Margins in Patients Undergoing Resection of Colorectal Liver Metastases.
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DOI：
10.1245/s10434-016-5187-2
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发表时间：
2016-08
影响因子：
3.7
通讯作者：
Vauthey JN
中科院分区：
文献类型：
--
作者：
Brudvik KW;Mise Y;Chung MH;Chun YS;Kopetz SE;Passot G;Conrad C;Maru DM;Aloia TA;Vauthey JN
探讨结直肠癌肝转移（CLM）切除术患者RAS突变与切缘状态的关系。在接受CLM切除术的患者中，切缘状态是生存的重要预测因素，特别是对术前治疗反应不佳的患者。RAS突变与更具侵袭性和迁移性的肿瘤生物学以及对现代化疗的不良反应有关。从前瞻性维护的数据库中确定了2005年至2013年接受CLM根治性切除术且具有已知RAS突变状态的患者。阳性边缘定义为肿瘤细胞距离实质横切线小于1 mm。该研究纳入了633例患者，其中229例（36.2%）患有突变型RAS。突变型RAS的阳性边缘率为11.4%（26/229），野生型RAS的阳性边缘率为5.4%（22/404）（P = 0.007）。在多变量分析中，与阳性界值相关的唯一因素是RAS突变（风险比[HR]，2.439; P = 0.005）和癌胚抗原水平≥ 4.5 ng/mL（HR，2.060; P = 0.026）。在随访期间出现肝脏首次复发的患者中，突变型RAS患者在初始CLM切除时的切缘较窄（中位数，4 mm vs. 7 mm; P = 0.031）。边缘阳性（HR，3.360; P < 0.001）和RAS突变（HR，1.629; P = 0.044）与总生存率差独立相关。RAS突变与接受CLM切除术的患者的阳性切缘相关。RAS突变的肿瘤应谨慎处理，以达到阴性切缘。
To evaluate the relationship between RAS mutation and resection margin status in patients undergoing resection of colorectal liver metastases (CLM). In patients undergoing resection of CLM, resection margin status is a significant predictor of survival, particularly in patients with suboptimal response to preoperative therapy. RAS mutations have been linked to more invasive and migratory tumor biology and poor response to modern chemotherapy. Patients who underwent curative resection of CLM from 2005 through 2013 with known RAS mutation status were identified from a prospectively maintained database. A positive margin was defined as tumor cells less than 1 mm from the parenchymal transection line. The study included 633 patients, of whom 229 (36.2%) had mutant RAS. The positive margin rate was 11.4% (26/229) for mutant RAS and 5.4% (22/404) for wild-type RAS (P = 0.007). In multivariate analysis, the only factors associated with a positive margin were RAS mutation (hazard ratio [HR], 2.439; P = 0.005) and carcinoembryonic antigen level 4.5 ng/mL or greater (HR, 2.060; P = 0.026). Among patients presenting with liver-first recurrence during follow-up, those with mutant RAS had narrower margins at initial CLM resection (median, 4 mm vs. 7 mm; P = 0.031). A positive margin (HR, 3.360; P < 0.001) and RAS mutation (HR, 1.629; P = 0.044) were independently associated with worse overall survival. RAS mutations are associated with positive margins in patients undergoing resection of CLM. Tumors with RAS mutation should prompt careful efforts to achieve negative resection margins.
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影响因子：
11.2
作者：
Pollock, CB;Shirasawa, S;Dhillon, AS
通讯作者：
Dhillon, AS
影响因子：
9
作者：
Hamady, Zaed Z. R.;Lodge, J. Peter A.;Rees, Myrddin
通讯作者：
Rees, Myrddin
影响因子：
1.9
作者：
Altendorf-Hofmann, Annelore;Scheele, Johannes
通讯作者：
Scheele, Johannes
影响因子：
9
作者：
Fong, Y;Fortner, J;Blumgart, LH
通讯作者：
Blumgart, LH
影响因子：
45.3
作者：
Blazer, Dan G., III;Kishi, Yoji;Vauthey, Jean-Nicolas
通讯作者：
Vauthey, Jean-Nicolas