Price Timothy J, Beeke Carol, Townsend Amanda Rose, Lo Louisa, Amitesh Roy, Padbury Robert, Roder David, Maddern Guy, Moore James, Karapetis Christos
Department of Medical Oncology, The Queen Elizabeth Hospital, Woodville Road, Woodville, SA, 5011, Australia.
School of Medicine, University of Adelaide, Adelaide, SA, Australia.
Mol Diagn Ther. 2016 Feb;20(1):75-82. doi: 10.1007/s40291-015-0179-7.
Patients with metastatic colorectal cancer (mCRC) with BRAF mutation (BRAF MT) generally have a poorer prognosis. BRAF MT may also have implications for treatment strategy. Despite this, inclusion of BRAF in routine molecular testing varies. Here we report the frequency of BRAF reporting in the South Australian (SA) mCRC registry reflecting community practice, together with the survival outcomes based on mutation status.
The SA population-based mCRC registry was analysed to assess the number of patients where a BRAF MT result was available. The patient characteristics are reported and overall survival was analysed using the Kaplan-Meier method.
Of the 3639 patients who have been entered in the registry, only 6.2% (227) have BRAF MT results available. Of the patients tested, the BRAF MT rate is 12.7%. The mutation rate was highest in rightsided primary; right colon 23 versus left colon 8.9% and rectum 7%. There was no significant difference in median age or male/female proportion. The median overall survival (mOS) for BRAF MT versus wild-type (WT) patients is 14.0 versus 32.9 months (p = 0.003). For patients who have chemotherapy (plus or minus surgery) the mOS is 14.6 months BRAF MT versus 36.1 months (p ≤ 0.001) WT. Liver or lung resection was performed on only 8% of the BRAF MT group versus 26.5% of the WT group.
Results in a population setting confirm our understanding that BRAF MT is more frequently right sided and of lower frequency in rectal cancer. Survival is lower for patients with mCRC that have BRAF MT, regardless of the therapy. BRAF testing is currently performed infrequently in an Australian setting despite its importance as a significant prognostic factor, and the implications for alternate therapeutic approaches.
伴有BRAF突变（BRAF MT）的转移性结直肠癌（mCRC）患者通常预后较差。BRAF MT也可能对治疗策略有影响。尽管如此，BRAF在常规分子检测中的纳入情况各不相同。在此，我们报告南澳大利亚（SA）mCRC登记处反映社区实践的BRAF报告频率，以及基于突变状态的生存结果。
对基于SA人群的mCRC登记处进行分析，以评估有BRAF MT结果的患者数量。报告患者特征，并使用Kaplan-Meier方法分析总生存期。
在登记处登记的3639例患者中，只有6.2%（227例）有BRAF MT结果。在接受检测的患者中，BRAF MT率为12.7%。突变率在右侧原发性肿瘤中最高；右半结肠为23%，左半结肠为8.9%，直肠为7%。中位年龄或男女比例无显著差异。BRAF MT患者与野生型（WT）患者的中位总生存期（mOS）分别为14.0个月和32.9个月（p = 0.003）。接受化疗（加或减手术）的患者中，BRAF MT组的mOS为14.6个月，WT组为36.1个月（p≤0.001）。BRAF MT组仅8%的患者进行了肝或肺切除，而WT组为26.5%。
人群研究结果证实了我们的认识，即BRAF MT在直肠癌中更常见于右侧且频率较低。无论采用何种治疗方法，伴有BRAF MT的mCRC患者的生存率都较低。尽管BRAF检测作为一个重要的预后因素以及对替代治疗方法的影响具有重要意义，但目前在澳大利亚的环境中进行得并不频繁。
