Fuccio Lorenzo, Correale Loredana, Arezzo Alberto, Repici Alessandro, Manes Gianpiero, Trovato Cristina, Mangiavillano Benedetto, Manno Mauro, Cortelezzi Claudio Camillo, Dinelli Marco, Cennamo Vincenzo, de Bellis Mario
Gastroenterology Unit, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
Im3D Medical Imaging Lab, Turin, Italy.
Dig Liver Dis. 2014 Jun;46(6):561-7. doi: 10.1016/j.dld.2014.02.006. Epub 2014 Mar 14.
This study aimed to explore the relationship between K-ras status, anti-tumour treatments, and the complications of colorectal self-expandable metallic stenting in colorectal cancer.
This is a retrospective, multicentre study of 91 patients with obstructive advanced colorectal cancer palliated with enteral stents between 2007 and 2011.
K-ras wild-type tumours were diagnosed in 44 patients (48.4%); 82 (90.1%) received chemotherapy and 45 (49.4%) had additional biological therapy (34 bevacizumab, 11 cetuximab). Twenty-one (23.1%) experienced stent-related complications: 11 (52.4%) occurred in the K-ras mutant group (P=0.9). K-ras wild-type patients were not less likely to develop adverse events than K-ras mutant patients (OR, 0.99; 95% CI: 0.4-2.7). Overall mean time to complication was 167.6 days (range 4-720 days), with no difference between the two groups (141 vs. 197 days; P=0.5). Chemotherapy did not influence the risk of complications (OR, 0.56; 95% CI: 0.14-2.9), and there was no evidence that patients treated with chemotherapy and cetuximab were more likely to experience stent-related complications than patients treated with chemotherapy alone, or untreated (OR, 1.2; 95% CI: 0.2-5.9). Although perforation rates were higher with bevacizumab-based treatment (11.8% vs. 7%), this result was not statistically significant (P=0.69).
K-ras mutation status, chemotherapy, and biological treatments should not influence colorectal stent-related complication rates.
本研究旨在探讨K-ras状态、抗肿瘤治疗与结直肠癌结直肠自膨式金属支架置入术并发症之间的关系。
这是一项回顾性多中心研究，研究对象为2007年至2011年间91例接受肠内支架置入术缓解梗阻性晚期结直肠癌的患者。
44例患者（48.4%）诊断为K-ras野生型肿瘤；82例（90.1%）接受了化疗，45例（49.4%）接受了额外的生物治疗（34例使用贝伐单抗，11例使用西妥昔单抗）。21例（23.1%）发生了支架相关并发症：11例（52.4%）发生在K-ras突变组（P=0.9）。K-ras野生型患者发生不良事件的可能性并不低于K-ras突变型患者（OR，0.99；95%CI：0.4-2.7）。并发症的总体平均发生时间为167.6天（范围4-720天），两组之间无差异（141天对197天；P=0.5）。化疗不影响并发症风险（OR，0.56；95%CI：0.14-2.9），没有证据表明接受化疗和西妥昔单抗治疗的患者比单独接受化疗或未接受治疗的患者更易发生支架相关并发症（OR，1.2；95%CI：0.2-5.9）。尽管基于贝伐单抗的治疗穿孔率较高（11.8%对7%），但该结果无统计学意义（P=0.69）。
K-ras突变状态、化疗和生物治疗不应影响结直肠支架相关并发症发生率。
