Colorectal & Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, School of Medical Science, Faculty of Biology, Medicine and Health, University of Manchester, UK.
Colorectal & Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, School of Medical Science, Faculty of Biology, Medicine and Health, University of Manchester, UK.
EBioMedicine. 2019 Feb;40:363-374. doi: 10.1016/j.ebiom.2019.01.050. Epub 2019 Feb 4.
The use of biomarkers to target anti-EGFR treatments for metastatic colorectal cancer (CRC) is well-established, requiring molecular analysis of primary or metastatic biopsies. We aim to review concordance between primary CRC and its metastatic sites.
A systematic review and meta-analysis of all published studies (1991-2018) reporting on biomarker concordance between primary CRC and its metastatic site(s) was undertaken according to PRISMA guidelines using several medical databases. Studies without matched samples or using peripheral blood for biomarker analysis were excluded.
61 studies including 3565 patient samples were included. Median biomarker concordance for KRAS (n = 50) was 93.7% [67-100], NRAS (n = 11) was 100% [90-100], BRAF (n = 22) was 99.4% [80-100], and PIK3CA (n = 17) was 93% [42-100]. Meta-analytic pooled discordance was 8% for KRAS (95% CI = 5-10%), 8% for BRAF (95% CI = 5-10%), 7% for PIK3CA (95% CI = 2-13%), and 28% overall (95% CI = 14-44%). The liver was the most commonly biopsied metastatic site (n = 2276), followed by lung (n = 438), lymph nodes (n = 1123), and peritoneum (n = 132). Median absolute concordance in multiple biomarkers was 81% (5-95%).
Metastatic CRC demonstrates high concordance across multiple biomarkers, suggesting that molecular testing of either the primary or liver and lung metastasis is adequate. More research on colorectal peritoneal metastases is required.
使用生物标志物针对转移性结直肠癌（CRC）的抗 EGFR 治疗已经得到充分证实，需要对原发或转移活检进行分子分析。我们旨在回顾原发性 CRC 与其转移部位之间的一致性。
根据 PRISMA 指南，使用多个医学数据库，对所有发表的报告原发性 CRC 与其转移部位之间生物标志物一致性的研究（1991-2018 年）进行了系统回顾和荟萃分析。排除没有匹配样本或使用外周血进行生物标志物分析的研究。
纳入 61 项研究，共包括 3565 例患者样本。KRAS（n=50）的中位生物标志物一致性为 93.7%[67-100]，NRAS（n=11）为 100%[90-100]，BRAF（n=22）为 99.4%[80-100]，PIK3CA（n=17）为 93%[42-100]。KRAS 的荟萃分析汇总不一致率为 8%（95%CI=5-10%），BRAF 为 8%（95%CI=5-10%），PIK3CA 为 7%（95%CI=2-13%），总体为 28%（95%CI=14-44%）。最常活检的转移部位是肝脏（n=2276），其次是肺（n=438）、淋巴结（n=1123）和腹膜（n=132）。多个生物标志物的中位绝对一致性为 81%（5-95%）。
转移性 CRC 在多个生物标志物上表现出高度一致性，表明对原发性肿瘤或肝脏和肺部转移灶进行分子检测即可。需要进一步研究结直肠腹膜转移。
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