Wong Hui-Li, Lee Belinda, Field Kathryn, Lomax Anna, Tacey Mark, Shapiro Jeremy, McKendrick Joe, Zimet Allan, Yip Desmond, Nott Louise, Jennens Ross, Richardson Gary, Tie Jeanne, Kosmider Suzanne, Parente Phillip, Lim Lionel, Cooray Prasad, Tran Ben, Desai Jayesh, Wong Rachel, Gibbs Peter
Systems Biology and Personalised Medicine Division, Walter & Eliza Hall Institute of Medical Research (WEHI), Parkville, Melbourne, Australia; Department of Medical Oncology, The Royal Melbourne Hospital, Parkville, Melbourne, Victoria, Australia.
Systems Biology and Personalised Medicine Division, Walter & Eliza Hall Institute of Medical Research (WEHI), Parkville, Melbourne, Australia; Department of Medical Oncology, The Royal Melbourne Hospital, Parkville, Melbourne, Victoria, Australia; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.
Clin Colorectal Cancer. 2016 Jun;15(2):e9-e15. doi: 10.1016/j.clcc.2016.02.007. Epub 2016 Feb 13.
With an ever-increasing focus on personalized medicine, all factors known to affect treatment response need to be considered when defining optimal therapy for individual patients. While the prognostic impact of primary tumor site on colorectal cancer (CRC) outcomes is established, emerging data suggest potential differences in response to biologic therapies. We studied the impact of tumor site on bevacizumab efficacy in patients with metastatic CRC.
We analyzed data of patients in an Australian prospective multicenter metastatic CRC (mCRC) registry who received first-line chemotherapy. Tumor site was defined as right colon, cecum to transverse; left colon, splenic flexure to rectosigmoid; and rectum. Kaplan-Meier and Cox models were used for survival analyses.
Of 926 patients, 297 had right colon, 354 left colon, and 275 rectum primary disease. Median age was 68.6, 65.9, and 63.3 years, respectively (P = .001). Right colon disease was significantly associated with intraperitoneal spread (P < .0001), while left colon and rectum disease preferentially metastasized to the liver and lungs, respectively (P < .0001 in both settings). A total of 636 patients (68.7%) received bevacizumab. Progression-free survival was superior for bevacizumab-treated patients in all groups but appeared greatest in right colon disease (hazard ratio, 0.46; 95% confidence interval, 0.36-0.60; P ≤ .001). Overall survival was longest in patients with disease of the rectum, followed by left colon and right colon (median, 26.2, 23.6, and 18.2 months, respectively; P = .0004).
Tumor site appears to be prognostic in mCRC, with rectum and right colon disease associated with the best and worst outcomes, respectively. Patients who received bevacizumab in addition to chemotherapy had superior outcomes, with the effect appearing greatest in patients with right colon disease.
随着对个性化医疗的关注度不断提高，在为个体患者确定最佳治疗方案时，需要考虑所有已知会影响治疗反应的因素。虽然原发性肿瘤部位对结直肠癌（CRC）预后的影响已得到证实，但新出现的数据表明，对生物疗法的反应可能存在差异。我们研究了肿瘤部位对转移性CRC患者贝伐单抗疗效的影响。
我们分析了澳大利亚一项前瞻性多中心转移性CRC（mCRC）登记中接受一线化疗的患者数据。肿瘤部位定义为右半结肠（盲肠至横结肠）、左半结肠（脾曲至直肠乙状结肠）和直肠。采用Kaplan-Meier法和Cox模型进行生存分析。
926例患者中，297例原发性疾病位于右半结肠，354例位于左半结肠，275例位于直肠。中位年龄分别为68.6岁、65.9岁和63.3岁（P = 0.001）。右半结肠疾病与腹膜内播散显著相关（P < 0.0001），而左半结肠和直肠疾病分别优先转移至肝脏和肺（两种情况P均< 0.0001）。共有636例患者（68.7%）接受了贝伐单抗治疗。所有组中，接受贝伐单抗治疗的患者无进展生存期均更优，但在右半结肠疾病患者中似乎最为显著（风险比，0.46；95%置信区间，0.36 - 0.60；P≤0.001）。总生存期以直肠疾病患者最长，其次是左半结肠和右半结肠患者（中位生存期分别为26.2个月、23.6个月和18.2个月；P = 0.0004）。
肿瘤部位似乎对mCRC具有预后意义，直肠和右半结肠疾病分别与最佳和最差预后相关。除化疗外接受贝伐单抗治疗的患者预后更佳，在右半结肠疾病患者中效果似乎最为显著。
