Grassadonia Antonino, Di Marino Pietro, Ficorella Corrado, Cortellini Alessio, Cannita Katia, Parisi Alessandro, Gamucci Teresa, Zoratto Federica, Vici Patrizia, Barba Maddalena, Porreca Ettore, Neri Matteo, Veronese Angelo, Natoli Clara, De Tursi Michele, Tinari Nicola
Department of Medical, Oral & Biotechnological Sciences and CeSI-MeT, G. D'Annunzio University, Chieti-Pescara, Italy.
Department of Medical, Oral & Biotechnological Sciences, G. D'Annunzio University, Chieti-Pescara, Italy.
J Cancer. 2019 Oct 15;10(24):5926-5934. doi: 10.7150/jca.34550. eCollection 2019.
Emerging evidence supports a prognostic role of primary tumor location in metastatic colon cancer (mCC). We conducted a retrospective analysis to evaluate the effect of tumor location on prognosis and efficacy of biological agents (anti-EGFR, Cetuximab and Panitumumab, or anti-VEGF, Bevacizumab) added to first-line chemotherapy in patients with RAS wild-type (wt) mCC. Patients with newly diagnosed RAS wt mCC candidates to first-line chemotherapy with anti-EGFRs or Bevacizumab were selected. Clinical outcomes were assessed and stratified by tumor location and type of treatment. Overall, 351 patients met the inclusion criteria. Primary colon cancer was right-sided (RCC) in 105 (29.9%) patients and left-sided (LCC) in 246 (70.1%). Patients with LCC had a better OS compared to those with RCC (33.6 vs 23.5 months, HR 0.74; 95% CI, 0.55 to 0.99; p=0.049). In the overall study population, OS was not significantly different for patients treated with Cetuximab or Panitumumab as compared to those receiving Bevacizumab. However, when comparing treatment outcome according to tumor sidedness, patients with LCC treated with Cetuximab or Panitumumab had a significantly longer PFS (12.4 vs 10.7 months; HR: 0.69; 95% CI, 0.51 to 0.93; p= 0.015) and OS (40.7 vs 28.6 months; HR: 0.67; 95% CI 0.47 to 0.95; p= 0.026). No relevant differences were observed in patients with RCC. We found evidence in support of the impact of tumor location in RAS wt mCC treated with first-line chemotherapy in association with targeted therapy. More favorable outcomes were observed in LCC patients, but not in RCC patients, treated with anti-EGFR agents compared with those who received Bevacizumab. Further, prospective and adequately sized studies are warranted to confirm our findings.
新出现的证据支持原发性肿瘤位置在转移性结肠癌（mCC）中的预后作用。我们进行了一项回顾性分析，以评估肿瘤位置对接受一线化疗的RAS野生型（wt）mCC患者添加生物制剂（抗EGFR、西妥昔单抗和帕尼单抗，或抗VEGF、贝伐单抗）的预后和疗效的影响。选择新诊断为RAS wt mCC且适合用抗EGFR或贝伐单抗进行一线化疗的患者。根据肿瘤位置和治疗类型评估临床结局并进行分层。总体而言，351例患者符合纳入标准。原发性结肠癌位于右侧（RCC）的有105例（29.9%），位于左侧（LCC）的有246例（70.1%）。与RCC患者相比，LCC患者的总生存期更长（33.6个月对23.5个月，HR 0.74；95%CI，0.55至0.99；p=0.049）。在整个研究人群中，接受西妥昔单抗或帕尼单抗治疗的患者与接受贝伐单抗治疗的患者相比，总生存期无显著差异。然而，根据肿瘤侧别比较治疗结果时，接受西妥昔单抗或帕尼单抗治疗的LCC患者的无进展生存期显著更长（12.4个月对10.7个月；HR：0.69；95%CI，0.51至0.93；p=0.015），总生存期也更长（40.7个月对28.6个月；HR：0.67；95%CI 0.47至0.95；p=0.026）。RCC患者未观察到相关差异。我们发现有证据支持肿瘤位置对接受一线化疗联合靶向治疗的RAS wt mCC的影响。与接受贝伐单抗治疗的患者相比，接受抗EGFR药物治疗的LCC患者观察到更有利的结局，但RCC患者并非如此。此外，需要进行前瞻性且规模足够大的研究来证实我们的发现。
