抗血管生成治疗和全身炎症因子对 BRAF v600 突变转移性结直肠癌患者结局的影响：西班牙的真实世界研究。
Effect of antiangiogenic-based treatment and systemic inflammatory factors on outcomes in patients with BRAF v600-mutated metastatic colorectal cancer: a real-world study in Spain.
机构信息
Medical Oncology Department, University Hospital A Coruña, Xubias de Arriba, 84, 15006, A Coruña, Galicia, Spain.
Complexo Hospitalario Universitario de Ourense, Ourense, Galicia, Spain.
出版信息
BMC Cancer. 2021 Jan 14;21(1):64. doi: 10.1186/s12885-020-07758-5.
BACKGROUND
Outcomes are poorer in metastatic colorectal cancer (mCRC) patients with BRAF V600E mutations than those without it, but the effect of these mutations on treatment response is unclear. This real-world study assessed the effects of antiangiogenic-based treatment and systemic inflammatory factors on outcomes in patients with BRAF V600-mutated mCRC.
METHODS
This real-world, multicenter, retrospective, observational study included patients with BRAF V600-mutated mCRC treated in eight hospitals in Spain. The primary endpoints were overall survival (OS) and progression-free survival (PFS); overall response rate (ORR) and disease control rate (DCR) were also assessed. The effect of first- and second-line treatment type on OS, PFS, ORR, and DCR were evaluated, plus the impact of systemic inflammatory markers on these outcomes. A systemic inflammation score (SIS) of 1-3 was assigned based on one point each for platelet-lymphocyte ratio (PLR) ≥200, neutrophil-lymphocyte ratio (NLR) ≥3, and serum albumin < 3.6 g/dL.
RESULTS
Of 72 patients, data from 64 were analyzed. After a median of 69.1 months, median OS was 11.9 months and median first-line PFS was 4.4 months. First-line treatment was triplet chemotherapy-antiangiogenic (12.5%), doublet chemotherapy-antiangiogenic (47.2%), doublet chemotherapy-anti-EGFR (11.1%), or doublet chemotherapy (18.1%). Although first-line treatment showed no significant effect on OS, antiangiogenic-based regimens were associated with prolonged median PFS versus non-antiangiogenic regimens. Negative predictors of survival with antiangiogenic-based treatment were NLR, serum albumin, and SIS 1-3, but not PLR. Patients with SIS 1-3 showed significantly prolonged PFS with antiangiogenic-based treatment versus non-antiangiogenic-based treatment, while those with SIS=0 showed no PFS benefit.
CONCLUSIONS
Antiangiogenic-based regimens, SIS, NLR, and albumin were predictors of survival in patients with mCRC, while SIS, NLR and serum albumin may predict response to antiangiogenic-based chemotherapy.
TRIAL REGISTRATION
GIT-BRAF-2017-01.
背景
BRAF V600E 突变的转移性结直肠癌（mCRC）患者的预后比没有突变的患者差，但这些突变对治疗反应的影响尚不清楚。这项真实世界的研究评估了抗血管生成治疗和全身炎症因子对 BRAF V600 突变 mCRC 患者结局的影响。
方法
这是一项真实世界、多中心、回顾性、观察性研究，纳入了在西班牙 8 家医院接受治疗的 BRAF V600 突变的 mCRC 患者。主要终点为总生存期（OS）和无进展生存期（PFS）；还评估了总缓解率（ORR）和疾病控制率（DCR）。评估了一线和二线治疗类型对 OS、PFS、ORR 和 DCR 的影响，以及全身炎症标志物对这些结局的影响。根据血小板-淋巴细胞比值（PLR）≥200、中性粒细胞-淋巴细胞比值（NLR）≥3 和血清白蛋白<3.6g/dL，分别计 1 分，确定了一个全身炎症评分（SIS）为 1-3。
结果
在 72 名患者中，有 64 名患者的数据进行了分析。中位随访 69.1 个月后，中位 OS 为 11.9 个月，中位一线 PFS 为 4.4 个月。一线治疗为三联化疗-抗血管生成（12.5%）、双药化疗-抗血管生成（47.2%）、双药化疗-抗 EGFR（11.1%）或双药化疗（18.1%）。尽管一线治疗对 OS 无显著影响，但抗血管生成方案与非抗血管生成方案相比，中位 PFS 延长。抗血管生成治疗的生存不良预测因素为 NLR、血清白蛋白和 SIS 1-3，但不是 PLR。SIS 1-3 的患者接受抗血管生成治疗的 PFS 明显延长，而非 SIS 1-3 的患者则无 PFS 获益。
结论
抗血管生成方案、SIS、NLR 和白蛋白是 mCRC 患者生存的预测因素，而 SIS、NLR 和血清白蛋白可能预测抗血管生成化疗的反应。
试验注册
GIT-BRAF-2017-01。
Zotero 插件