Oncosurgery, Geneva UniversityHospital, Geneva, Switzerland.
J Clin Oncol. 2010 Jan 20;28(3):466-74. doi: 10.1200/JCO.2009.23.3452. Epub 2009 Dec 14.
PURPOSE: Mutations within the KRAS proto-oncogene have predictive value but are of uncertain prognostic value in the treatment of advanced colorectal cancer. We took advantage of PETACC-3, an adjuvant trial with 3,278 patients with stage II to III colon cancer, to evaluate the prognostic value of KRAS and BRAF tumor mutation status in this setting. PATIENTS AND METHODS: Formalin-fixed paraffin-embedded tissue blocks (n = 1,564) were prospectively collected and DNA was extracted from tissue sections from 1,404 cases. Planned analysis of KRAS exon 2 and BRAF exon 15 mutations was performed by allele-specific real-time polymerase chain reaction. Survival analyses were based on univariate and multivariate proportional hazard regression models. RESULTS: KRAS and BRAF tumor mutation rates were 37.0% and 7.9%, respectively, and were not significantly different according to tumor stage. In a multivariate analysis containing stage, tumor site, nodal status, sex, age, grade, and microsatellite instability (MSI) status, KRAS mutation was associated with grade (P = .0016), while BRAF mutation was significantly associated with female sex (P = .017), and highly significantly associated with right-sided tumors, older age, high grade, and MSI-high tumors (all P < 10(-4)). In univariate and multivariate analysis, KRAS mutations did not have a major prognostic value regarding relapse-free survival (RFS) or overall survival (OS). BRAF mutation was not prognostic for RFS, but was for OS, particularly in patients with MSI-low (MSI-L) and stable (MSI-S) tumors (hazard ratio, 2.2; 95% CI, 1.4 to 3.4; P = .0003). CONCLUSION: In stage II-III colon cancer, the KRAS mutation status does not have major prognostic value. BRAF is prognostic for OS in MS-L/S tumors.
目的:KRAS 原癌基因突变具有预测价值,但在晚期结直肠癌的治疗中其预后价值尚不确定。我们利用 PETACC-3 辅助试验,对 3278 例 II 期至 III 期结肠癌患者进行了研究,以评估 KRAS 和 BRAF 肿瘤突变状态在这种情况下的预后价值。
患者和方法:前瞻性采集福尔马林固定石蜡包埋组织块(n = 1564),并从 1404 例病例的组织切片中提取 DNA。通过等位基因特异性实时聚合酶链反应对 KRAS 外显子 2 和 BRAF 外显子 15 突变进行了计划分析。生存分析基于单变量和多变量比例风险回归模型。
结果:KRAS 和 BRAF 肿瘤突变率分别为 37.0%和 7.9%,且根据肿瘤分期无显著差异。在包含分期、肿瘤部位、淋巴结状态、性别、年龄、分级和微卫星不稳定性(MSI)状态的多变量分析中,KRAS 突变与分级相关(P =.0016),而 BRAF 突变与女性显著相关(P =.017),且与右侧肿瘤、年龄较大、高级别和 MSI-高肿瘤高度相关(均 P < 10(-4))。在单变量和多变量分析中,KRAS 突变对无复发生存(RFS)或总生存(OS)无主要预后价值。BRAF 突变对 RFS 无预后价值,但对 OS 有预后价值,尤其是在 MSI-低(MSI-L)和稳定(MSI-S)肿瘤患者中(危险比,2.2;95%置信区间,1.4 至 3.4;P =.0003)。
结论:在 II 期至 III 期结肠癌中,KRAS 突变状态无主要预后价值。BRAF 在 MS-L/S 肿瘤中对 OS 有预后价值。
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