Quan Qi, Huang Yuanyuan, Chen Qi, Qiu Huijuan, Hu Qiaozhen, Rong Yuming, Li Tingwei, Xia Liangping, Zhang Bei
State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China; VIP Region, Sun Yat-Sen University Cancer Center, Guangzhou, China.
Department of Oncology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China.
Transl Oncol. 2017 Apr;10(2):288-294. doi: 10.1016/j.tranon.2017.01.006. Epub 2017 Mar 2.
We aimed to investigate the role of apolipoprotein A-I (ApoA-I) as a predictor of prognosis and treatment efficacy of bevacizumab in patients with metastatic colorectal cancer (mCRC) treated with first-line chemotherapy with or without bevacizumab.
We conducted a retrospective study on consecutive patients who were diagnosed with mCRC at Sun Yat-sen University Cancer Center. According to their pretreatment ApoA-I level, patients were divided into low- and high-ApoA-I groups. Propensity score-matched method was performed to balance baseline characteristics between two groups. Based on whether they accepted bevacizumab as a first-line therapy, patients were further divided into the chemo + bevacizumab group and the chemo group. Overall survival (OS) and progression-free survival (PFS) were assessed with Kaplan-Meier method, log-rank test, and Cox regression.
The optimal cutoff value for the ApoA-I level was determined to be 1.105 g/l. In the propensity-matched cohort of 508 patients, low ApoA-I was significantly associated with inferior OS (P<.001) and PFS (P<.001) than high ApoA-I. Multivariate analysis showed that ApoA-I level was an independent prognostic maker of OS (P<.001) and PFS (P=.001). PFS (P<.001) in either the high- or low-ApoA-I groups could be extended significantly after the administration of bevacizumab, and patients with a high ApoA-I level also had a better OS in the chemo + bevacizumab group than the chemo group (P=.049).
Patients with a low ApoA-I level have poor prognoses, and they did not display an OS benefit from bevacizumab.
我们旨在研究载脂蛋白A-I（ApoA-I）作为接受一线化疗联合或不联合贝伐单抗治疗的转移性结直肠癌（mCRC）患者预后和贝伐单抗治疗疗效预测指标的作用。
我们对中山大学肿瘤防治中心连续诊断为mCRC的患者进行了一项回顾性研究。根据患者治疗前的ApoA-I水平，将其分为低ApoA-I组和高ApoA-I组。采用倾向评分匹配法平衡两组之间的基线特征。根据患者是否接受贝伐单抗作为一线治疗，进一步分为化疗+贝伐单抗组和单纯化疗组。采用Kaplan-Meier法、对数秩检验和Cox回归评估总生存期（OS）和无进展生存期（PFS）。
ApoA-I水平的最佳截断值确定为1.105 g/l。在508例倾向匹配队列中，低ApoA-I组的OS（P<0.001）和PFS（P<0.001）均显著低于高ApoA-I组。多因素分析显示，ApoA-I水平是OS（P<0.001）和PFS（P=0.001）的独立预后指标。在高ApoA-I组和低ApoA-I组中，给予贝伐单抗后PFS均显著延长（P<0.001），且化疗+贝伐单抗组中ApoA-I水平高的患者OS也优于单纯化疗组（P=0.049）。
ApoA-I水平低的患者预后较差，且未从贝伐单抗治疗中获得OS获益。
