肿瘤负荷评分在预测一线全身治疗后初始不可切除的结直肠癌肝转移患者转化结局中的应用
Application of Tumor Burden Score for predicting conversion outcome in patients with initially unresectable colorectal liver metastases after first-line systemic therapy.
作者信息
Peng Jianhong, Liu Yujun, Li Weihao, Lin Yuzhu, Sun Hui, Pan Zhizhong, Wu Xiaojun, Fan Wenhua, Lin Junzhong
机构信息
Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China.
Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, P.R. China.
出版信息
Therap Adv Gastroenterol. 2021 Dec 19;14:17562848211066206. doi: 10.1177/17562848211066206. eCollection 2021.
BACKGROUND
Patients with initially unresectable colorectal liver metastases (CRLM) could achieve survival benefit from successful conversion therapy. Recently, Tumor Burden Score (TBS) was proposed as a valuable index to predict outcome following resection of CRLM. The study is aimed to investigate the association of TBS with conversion outcome.
METHODS
A total of 234 patients who underwent first-line treatment in our center were enrolled as training cohort. The validation cohort was developed from 89 patients in our previous study. Cut-off value of TBS was calculated to stratify patients into two groups. Significance test and logistic regression model were used to examine the prediction value of TBS for conversion outcome after first-line systemic therapy. Kaplan-Meier method and Cox proportional hazard model were applied to assess the prognostic value of TBS.
RESULTS
TBS showed good discriminatory power [area under curve (AUC) 0.726, < 0.001] with cut-off value defined as 14.3 in training cohort, which was validated in the validation cohort. Increasing TBS was related to adverse chemotherapy response and conversion outcome. Low TBS group had three times higher conversion rate than that in high TBS group (57.3% 19.0%, < 0.001). Multivariate analysis indicated that high TBS [odds ratio (OR) = 3.676, 95% confidence interval (CI) 1.671-8.429, = 0.002], first-line treatment response as stable disease (SD) or progressive disease (PD) (OR = 9.247; 95% CI 4.736-18.846, < 0.001), and absence of targeted therapy (OR = 2.453, 95% CI 1.139-5.455, = 0.024) were three independent risk factors for failure conversion outcome. High TBS was significantly associated with conversion outcome whatever chemotherapy response, addition of targeted therapy, and Kirsten rat sarcoma viral oncogene homolog (KRAS) status. High TBS was also associated with worse overall survival.
CONCLUSION
TBS should be applied in clinical practice to predict conversion outcome in patients with initially unresectable CRLM.
背景
最初无法切除的结直肠癌肝转移（CRLM）患者可通过成功的转化治疗获得生存益处。最近，肿瘤负荷评分（TBS）被提出作为预测CRLM切除术后预后的一个有价值的指标。本研究旨在探讨TBS与转化结果之间的关联。
方法
共有234例在本中心接受一线治疗的患者被纳入训练队列。验证队列来自我们之前研究中的89例患者。计算TBS的临界值以将患者分为两组。采用显著性检验和逻辑回归模型来检验TBS对一线全身治疗后转化结果的预测价值。应用Kaplan-Meier法和Cox比例风险模型来评估TBS的预后价值。
结果
TBS显示出良好的鉴别能力[曲线下面积（AUC）为0.726，P<0.001]，训练队列中的临界值定义为14.3，这在验证队列中得到了验证。TBS升高与化疗不良反应和转化结果相关。低TBS组的转化率比高TBS组高三倍（57.3%对19.0%，P<0.001）。多因素分析表明，高TBS[比值比（OR）=3.676，95%置信区间（CI）为1.671 - 8.429，P=0.002]、一线治疗反应为疾病稳定（SD）或疾病进展（PD）（OR = 9.247；95% CI为4.736 - 18.846，P<0.001）以及未接受靶向治疗（OR = 2.453，95% CI为1.139 - 5.455，P=0.024）是转化结果失败的三个独立危险因素。无论化疗反应、是否添加靶向治疗以及 Kirsten 大鼠肉瘤病毒癌基因同源物（KRAS）状态如何，高TBS均与转化结果显著相关。高TBS还与较差的总生存期相关。
结论
TBS应应用于临床实践，以预测最初无法切除的CRLM患者的转化结果。
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