Department of Oncology, Sheba Medical Center, Tel-Hashomer, Israel; Tel-Aviv University, Tel-Aviv, Israel.
Department of Oncology, Sheba Medical Center, Tel-Hashomer, Israel; Tel-Aviv University, Tel-Aviv, Israel; Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA.
Clin Colorectal Cancer. 2019 Sep;18(3):e300-e307. doi: 10.1016/j.clcc.2019.06.001. Epub 2019 Jun 26.
Previous studies have shown that prognosis in metastatic colorectal cancer (mCRC) might vary according to sites of metastasis. We evaluated prognosis in individuals with mCRC and single-site metastasis, according to several clinical and genetic variables.
Using the National Cancer Database we identified 58,044 mCRC patients with a synchronous single site of metastasis. We first examined the effect of metastasis site on prognosis. In a secondary analysis, among individuals who had not undergone surgery or received radiotherapy, we examined the prognostic value of chemotherapy intensity, Kirsten ras (KRAS) status, primary tumor location and carcinoembryonic antigen (CEA) levels.
Individuals with lung metastasis had the best prognosis (hazard ratio [HR], 0.80; 95% confidence interval [CI], 0.77-0.83), followed by those with liver metastasis (HR, 1.11; 95% CI, 1.07-1.15), whereas those with bone or brain metastasis had the worse prognosis. In a subgroup analysis, we assessed prognosis among individuals who received multiagent chemotherapy and had not undergone surgery or received radiotherapy. Individuals with lung metastasis and mutant KRAS had better prognosis compared with those with liver metastasis (HR, 0.69; 95% CI, 0.54-0.88), regardless of primary tumor location or CEA levels.
Single-site metastasis to the lungs is associated with better prognosis in mCRC, specifically among patients with KRAS mutant tumors.
先前的研究表明，转移性结直肠癌（mCRC）的预后可能因转移部位而异。我们根据多种临床和遗传变量评估了 mCRC 患者中仅有一处转移的预后。
我们使用国家癌症数据库，确定了 58044 例 mCRC 伴同步单一转移部位的患者。我们首先检查了转移部位对预后的影响。在二次分析中，对于未接受手术或放疗的患者，我们检查了化疗强度、Kirsten ras（KRAS）状态、原发肿瘤位置和癌胚抗原（CEA）水平的预后价值。
肺转移患者的预后最好（风险比 [HR]，0.80；95%置信区间 [CI]，0.77-0.83），其次是肝转移患者（HR，1.11；95%CI，1.07-1.15），而骨转移或脑转移患者的预后最差。在亚组分析中，我们评估了接受联合化疗且未接受手术或放疗的患者的预后。与肝转移患者相比，肺转移且 KRAS 突变的患者具有更好的预后（HR，0.69；95%CI，0.54-0.88），而与原发肿瘤位置或 CEA 水平无关。
mCRC 中仅有一处肺转移与更好的预后相关，尤其是在 KRAS 突变肿瘤患者中。
