The Second Clinical Medical College of Zhejiang, Chinese Medical University, Hangzhou, People's Republic of China.
Department of Clinical Trail, Zhejiang Cancer Hospital, No.1 East Banshan Road, Gongshu District, Hangzhou, 310022, Zhejiang, People's Republic of China.
Med Oncol. 2023 Jun 9;40(7):198. doi: 10.1007/s12032-023-02059-w.
Invasive mucinous adenocarcinoma (IMA) is a rare variant of adenocarcinoma with unique clinical, radiological, and pathological features, among which KRAS mutation is the most common. However, the differences in the efficacy of immunotherapy between KRAS-positive IMA and invasive non-mucinous adenocarcinoma (INMA) patients remain unclear. Patients with KRAS mutated adenocarcinomas receiving immunotherapy between June 2016 and December 2022 were enrolled. Based on mucin-producing status, the patients were placed into two subgroups: the IMA group and INMA group. Patients with IMA were further classified into two subtypes according to the presence of mucin patterns: pure IMA (≥ 90%) and mixed mucinous/nonmucinous adenocarcinoma (≥ 10% of each histological component). Kaplan-Meier Curves and log-rank tests were used to analyze survival. Cox regression analysis of PFS were used to analyze the independent factors associated with efficacy. Sixty-five advanced adenocarcinoma patients with KRAS mutations received immunotherapy, including 24 patients with IMA and 41 with INMA. The median progression-free survival (PFS) was 7.7 months, whereas the median overall survival (OS) was 24.0 months. Significant difference in PFS could be observed in IMA and INMA (3.5 months vs. 8.9 months; P = 0.047). Patients with pure IMA tended toward prolonger survival in contrast to mixed mucinous/nonmucinous adenocarcinoma in PFS (8.4 months vs. 2.3 months; P = 0.349). The multivariable analysis demonstrated that IMA was an independent risk factor for PFS. In KRAS mutated patients, IMA was associated with poorer PFS after immunotherapy compared with INMA.
浸润性黏液性腺癌（IMA）是一种罕见的腺癌变体，具有独特的临床、影像学和病理学特征，其中 KRAS 突变最为常见。然而，KRAS 阳性 IMA 与浸润性非黏液性腺癌（INMA）患者免疫治疗疗效的差异尚不清楚。本研究纳入了 2016 年 6 月至 2022 年 12 月期间接受免疫治疗的 KRAS 突变型腺癌患者。根据产黏液状态，将患者分为两组：IMA 组和 INMA 组。根据黏液模式的存在，将 IMA 患者进一步分为两种亚型：纯 IMA（≥90%）和混合黏液/非黏液性腺癌（每种组织学成分均≥10%）。采用 Kaplan-Meier 曲线和对数秩检验分析生存情况。采用 COX 回归分析 PFS 的独立影响因素。65 例 KRAS 突变的晚期腺癌患者接受免疫治疗，其中 24 例为 IMA，41 例为 INMA。无进展生存期（PFS）的中位值为 7.7 个月，总生存期（OS）的中位值为 24.0 个月。IMA 和 INMA 之间的 PFS 差异有统计学意义（3.5 个月 vs. 8.9 个月；P=0.047）。纯 IMA 患者的生存时间长于混合黏液/非黏液性腺癌（8.4 个月 vs. 2.3 个月；P=0.349）。多变量分析表明，IMA 是 PFS 的独立危险因素。在 KRAS 突变患者中，与 INMA 相比，IMA 与免疫治疗后的 PFS 较差相关。
