Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
Department of General Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China; The Second Department of General Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China.
Eur J Surg Oncol. 2023 Nov;49(11):106981. doi: 10.1016/j.ejso.2023.07.007. Epub 2023 Jul 10.
BRAF V600E mutant-metastatic colorectal cancer (mCRC) is characterized by its short survival time. Treatment approaches vary depending on whether or not the metastases are initially resectable. The benefit of metastasectomy remains unclear, and the optimal first-line treatment is controversial. This study aimed to describe the prognosis of BRAF V600E mutant-mCRC, analyze the recurrence pattern in resectable patients, and explore the optimal first-line treatment for unresectable patients.
Patients diagnosed with BRAF V600E mutant-mCRC between February 2014 and January 2022 in five hospitals were enrolled. Date on clinical and pathological characteristics, treatment features, and survival outcomes were collected.
Of the 220 included patients, 64 initially resectable patients had a significantly longer overall survival (OS) (37.07 vs. 20.20 months, P < 0.001) than initially unresectable patients. Of 156 unresectable patients, 54 received doublet (FOLFOX, XELOX or FOLFIRI) or triplet (FOLFOXIRI) chemotherapies (Chemo), 55 received Chemo plus Bevacizumab (Chemo+Bev), and 33 received vemurafenib plus cetuximab and irinotecan (VIC). The VIC regimen had a better progression-free survival (PFS) (12.70 months) than the Chemo (6.70 months, P < 0.001) and Chemo+Bev (8.8 months, P = 0.044) regimens. Patients treated with VIC had the best overall response rate (60.16%, P < 0.001), disease control rate (93.94%, P < 0.001) and conversional resection rate (24.24%, P = 0.003).
Metastasectomy is beneficial to the survival of patients with BRAF V600E mutant-mCRC. For initially unresectable patients, VIC as first-line therapy is associated with a better prognosis and efficacy than doublet and triplet chemotherapy with or without bevacizumab.
BRAF V600E 突变型转移性结直肠癌（mCRC）的特点是生存时间短。治疗方法因转移灶是否最初可切除而有所不同。转移灶切除术的益处仍不清楚，最佳一线治疗方案存在争议。本研究旨在描述 BRAF V600E 突变型 mCRC 的预后，分析可切除患者的复发模式，并探讨不可切除患者的最佳一线治疗方案。
纳入 2014 年 2 月至 2022 年 1 月五家医院诊断为 BRAF V600E 突变型 mCRC 的患者。收集患者的临床和病理特征、治疗特征和生存结果数据。
在 220 例纳入的患者中，64 例最初可切除患者的总生存期（OS）（37.07 个月 vs. 20.20 个月，P<0.001）明显长于最初不可切除患者。在 156 例不可切除患者中，54 例接受了双药（FOLFOX、XELOX 或 FOLFIRI）或三药（FOLFOXIRI）化疗（化疗），55 例接受了化疗联合贝伐珠单抗（化疗+Bev），33 例接受了维莫非尼联合西妥昔单抗和伊立替康（VIC）。VIC 方案的无进展生存期（PFS）（12.70 个月）优于化疗（6.70 个月，P<0.001）和化疗+Bev（8.8 个月，P=0.044）方案。接受 VIC 治疗的患者总体缓解率（60.16%，P<0.001）、疾病控制率（93.94%，P<0.001）和转化性切除率（24.24%，P=0.003）最高。
转移灶切除术有利于 BRAF V600E 突变型 mCRC 患者的生存。对于最初不可切除的患者，VIC 作为一线治疗与双药和三药化疗联合或不联合贝伐珠单抗相比，具有更好的预后和疗效。
