Denbo Jason W, Yamashita Suguru, Passot Guillaume, Egger Michael, Chun Yun S, Kopetz Scott E, Maru Dipen, Brudvik Kristoffer Watten, Wei Steven H, Conrad Claudius, Vauthey Jean-Nicolas, Aloia Thomas A
Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1484, Houston, TX, 77030, USA.
Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
J Gastrointest Surg. 2017 Jan;21(1):68-77. doi: 10.1007/s11605-016-3189-9. Epub 2016 Jun 22.
The relationship between RAS mutation status and outcome for patients undergoing repeat hepatectomy (RH) for recurrent colorectal liver metastases (CLM) has not been defined.
The objective of this study was to evaluate the relationship between RAS mutation status and outcome in patients undergoing RH for CLM.
All patients who underwent RH for CLM with known RAS mutation status between January 2005 and November 2014 were identified, and the outcomes of patients with and without RAS mutations were compared.
Ninety-eight patients underwent RH, of whom 34 (35 %) harbored a RAS mutation. Wild-type (WT) and mutant RAS groups had similar clinicopathologic characteristics. Median recurrence-free survival (RFS) for patients with WT and mutant RAS was 12.2 and 6.1 months, respectively (p = 0.03). Median overall survival (OS) for the WT and mutant RAS patients were 42.5 and 26.6 months, respectively (p < 0.01). On multivariate analysis, RAS mutations [hazard ratio (HR) = 1.69, p = 0.04] were associated with worse RFS, while multiple tumors (HR = 1.92, p = 0.045) and RAS mutations (HR = 2.11, p = 0.02) predicted worse OS.
Patients with recurrent CLM that harbor RAS mutations have worse RFS and OS than patients with WT RAS, and RAS mutations are independently associated with worse RFS and OS. RAS mutation status should be determined prior to RH, as it may impact treatment decisions.
对于复发性结直肠癌肝转移（CLM）患者接受再次肝切除术（RH），RAS突变状态与预后之间的关系尚未明确。
本研究的目的是评估接受RH治疗CLM患者的RAS突变状态与预后之间的关系。
确定2005年1月至2014年11月期间所有接受RH治疗且已知RAS突变状态的CLM患者，并比较有和没有RAS突变患者的预后。
98例患者接受了RH，其中34例（35%）存在RAS突变。野生型（WT）和突变型RAS组具有相似的临床病理特征。WT和突变型RAS患者的无复发生存期（RFS）中位数分别为12.2个月和6.1个月（p = 0.03）。WT和突变型RAS患者的总生存期（OS）中位数分别为42.5个月和26.6个月（p < 0.01）。多因素分析显示，RAS突变[风险比（HR）= 1.69，p = 0.04]与较差的RFS相关，而多发肿瘤（HR = 1.92，p = 0.045）和RAS突变（HR = 2.11，p = 0.02）预示着较差的OS。
与WT RAS患者相比，存在RAS突变的复发性CLM患者具有更差的RFS和OS，且RAS突变与较差的RFS和OS独立相关。在RH之前应确定RAS突变状态，因为它可能影响治疗决策。
