医学
结直肠癌
福尔菲里
贝伐单抗
肿瘤科
内科学
原发性肿瘤
福克斯
西妥昔单抗
人口
转移
微卫星不稳定性
伊立替康
胃肠病学
癌症
奥沙利铂
化疗
化学
等位基因
基因
环境卫生
微卫星
生物化学
作者
Javier Sastre,Virginia de la Orden,Antonio Martínez,Inmaculada Bando,Milagros Balbı́n,Beatríz Bellosillo,Sarai Palanca,María Isabel Peligros Gómez,Beatriz Mediero,Patricia Llovet,Virginia Moreno Moral,Jose María Viéitez,Pilar García‐Alfonso,S. Gil Calle,M.J. Ortiz-Morales,Antonieta Salud,Guillermo Quintero,Carlos López,Eduardo Dı́az-Rubio,Enrique Aranda
标识
DOI:10.1016/j.clcc.2020.02.014
摘要
Background Clinicopathologic characteristics and prognostic and predictive factors offer valuable guidance when selecting optimal first-line treatment in patients with metastatic colorectal cancer (CRC). The association between baseline circulating tumor cell (bCTC) count, molecular tumor profile, and clinicopathologic features was analyzed in a chemo-naïve metastatic CRC population. Patients and Methods A total of 1202 patients from the Spanish VISNÚ-1 (FOLFIRINOX/bevacizumab vs. FOLFOX/bevacizumab) and VISNÚ-2 (FOLFIRI/bevacizumab vs. FOLFIRI/cetuximab; RAS-wildtype) studies were analyzed for mutational status and bCTC count. The association between clinicopathologic characteristics and bCTC count, mutational status, and microsatellite instability (MSI) was analyzed in 589 eligible patients. Results Interestingly, 41% of the population studied presented ≥3 bCTC count. bCTC count ≥3 was associated with worse performance status (according Eastern Cooperative Oncology Group scale), stage IV at diagnosis, at least 3 metastatic sites, and elevated carcinoembryonic antigen (CEA) levels; but not with RAS or BRAF mutations or high MSI. BRAFmut (BRAF mutated) tumors were associated with right-sided primary tumors, peritoneum, distant lymph node metastasis, and less frequent liver involvement. RASmut (RAS mutated) was associated with worse performance status; stage IV at diagnosis; right-sided primary tumors; liver, lung, and bone metastases; at least 3 metastatic sites; and elevated CEA, whereas PIK3CAmut (PIK3CA mutated) tumors were associated with right-sided primary tumors, high CEA serum levels, and older age. High MSI was associated with right-sided primary tumors, distant lymph nodes metastasis, and lower CEA levels. Conclusions In our study, elevated bCTCs and RASmut were associated with clinicopathologic features known to be associated with poor prognosis; whereas the poor prognosis of BRAFmut tumors in chemo-naïve metastatic CRC is not explained by associations with poor clinicopathologic prognostic factors, except right-sided primary tumors. Trial registration number VISNU 1 ClinicalTrials.gov ID: NCT01640405/ VISNU 2 ClinicalTrials.gov ID: NCT01640444
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