Section of Colon and Rectal Surgery, Massachusetts General Hospital, Boston, MA.
Section of Colon and Rectal Surgery, Massachusetts General Hospital, Boston, MA.
Clin Colorectal Cancer. 2020 Mar;19(1):e8-e17. doi: 10.1016/j.clcc.2019.12.001. Epub 2019 Dec 10.
The impact of primary tumor site on overall survival in patients with stage IV colorectal cancer (CRC) with single-organ metastases to the liver or lung has not been studied. Furthermore, the prognostic significance of commonly tested genetic variants such as KRAS mutation and microsatellite instability (MSI) are not well-described in this population.
This National Cancer Database was used to identify 38,328 patients with CRC that presented with synchronous metastases to the liver or lung between 2010 and 2014. The primary outcome was overall survival, and groups were compared using Kaplan-Meier analyses and Cox proportional hazard models.
On unadjusted analysis, median survival was significantly longer for patients with lung metastases compared with those with liver metastases for left-sided (27 vs. 25 months; P = .02) and right-sided CRC (19 vs. 15 months; P < .001), whereas rectosigmoid and rectal cancers showed no difference. On multivariate analysis, patients with liver metastases demonstrated worse survival compared with those with lung metastasis (hazard ratio, 1.37; 95% confidence interval, 1.31-1.43; P < .001). These trends were confirmed in patients that received chemotherapy but did not have their primary tumor or metastases resected. In patients with genetic testing, both KRAS mutants and MSI tumors had worse survival in left-sided and rectal tumors with liver metastases, but had similar survival to KRAS wild type tumors and microsatellite stable tumors, respectively, across other primary site and metastatic patterns.
For patients with single-organ metastases to the liver or lung, primary tumor site has an impact on overall survival. Further, KRAS mutation and MSI status are of prognostic importance in selected patients with single-organ metastases.
原发肿瘤部位对单一器官肝或肺转移的 IV 期结直肠癌（CRC）患者的总生存率的影响尚未得到研究。此外，KRAS 突变和微卫星不稳定性（MSI）等常用基因变异的预后意义在这一人群中也没有得到很好的描述。
本研究使用国家癌症数据库（National Cancer Database），鉴定了 2010 年至 2014 年间同时发生肝或肺转移的 38328 例 CRC 患者。主要结局是总生存率，采用 Kaplan-Meier 分析和 Cox 比例风险模型比较各组。
在未调整分析中，与肝转移患者相比，肺转移患者的左半侧（27 个月 vs. 25 个月；P =.02）和右半侧 CRC（19 个月 vs. 15 个月；P <.001）的中位生存时间显著延长，而直肠乙状结肠和直肠癌则无差异。多变量分析显示，肝转移患者的生存状况较肺转移患者差（风险比，1.37；95%置信区间，1.31-1.43；P <.001）。这些趋势在接受化疗但未切除原发肿瘤或转移灶的患者中得到了证实。在接受基因检测的患者中，KRAS 突变和 MSI 肿瘤在肝转移的左半侧和直肠肿瘤中生存较差，但在其他原发部位和转移模式中，KRAS 野生型肿瘤和微卫星稳定型肿瘤的生存情况相似。
对于单一器官肝或肺转移的患者，原发肿瘤部位对总生存率有影响。此外，KRAS 突变和 MSI 状态在某些单一器官转移的患者中具有预后意义。
