Li Wentao, Liu Ming, Wu Liula, Zhu Bosen, Li Xiangtao, Yang Ziyi, Liang Yi, Lin Junqiong
Department of Gastroenteroanal Surgery, The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, China.
HaploX Biotechnology, Shenzhen, China.
Clin Transl Oncol. 2025 Aug 29. doi: 10.1007/s12094-025-04021-w.
PURPOSE: Colorectal liver metastases (CRLM) pose a significant clinical challenge due to their high recurrence rates, even after surgical resection. There is an urgent need for reliable prognostic biomarkers to improve risk stratification and guide treatment decisions for CRLM patients. METHODS/PATIENTS: In this study, we performed whole-exome sequencing (WES) on 57 CRLM patients and conducted a comparative genomic analysis of primary tumors and matched liver metastases in 8 patients. We systematically identified prognostic factors associated with overall survival (OS) and developed a predictive nomogram for CRLM patients. RESULTS AND CONCLUSIONS: The most frequently mutated genes in our cohort were APC (64.91%) and TP53 (64.91%), followed by KRAS (50.88%), PIK3CA (24.56%), and SMAD4 (24.56%). Pathway analysis revealed significant enrichment in p53, IGF, and Ras signaling pathways. Notably, primary and metastatic lesions exhibited high mutational concordance. Multivariate analysis identified five independent prognostic factors for OS: number of metastasis-positive lymph node stations in primary resected tumor tissue, mutational status of ZNF717 and MUC2, APC mutation status, and chr9p13.3 amplification. The nomogram integrating these factors achieved a C index of 0.798 for OS prediction. Our findings suggest that integrating genomic profiling into clinical practice could enhance prognostic assessment and optimize treatment stratification for CRLM patients.
目的:结直肠癌肝转移(CRLM)即使在手术切除后仍具有较高的复发率,给临床带来了重大挑战。迫切需要可靠的预后生物标志物来改善风险分层并指导CRLM患者的治疗决策。 方法/患者:在本研究中,我们对57例CRLM患者进行了全外显子组测序(WES),并对8例患者的原发性肿瘤和匹配的肝转移灶进行了比较基因组分析。我们系统地确定了与总生存期(OS)相关的预后因素,并为CRLM患者开发了预测列线图。 结果与结论:我们队列中最常发生突变的基因是APC(64.91%)和TP53(64.91%),其次是KRAS(50.88%)、PIK3CA(24.56%)和SMAD4(24.56%)。通路分析显示p53、IGF和Ras信号通路有显著富集。值得注意的是,原发性和转移性病变表现出高度的突变一致性。多变量分析确定了OS的五个独立预后因素:原发性切除肿瘤组织中转移阳性淋巴结站的数量、ZNF717和MUC2的突变状态、APC突变状态以及chr9p13.3扩增。整合这些因素的列线图在OS预测方面的C指数为0.798。我们的研究结果表明,将基因组分析纳入临床实践可以增强CRLM患者的预后评估并优化治疗分层。
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