K-ras基因状况预测转移性结直肠癌药物治疗后生存期

目的旨在通过前瞻性检测转移性结直肠癌的K-ras基因表达状况,观察比较化疗单用或联合靶向治疗的长期疗效,为临床医生提供可靠预测指标。方法初治的转移性结直肠癌62例,一线化疗前全部检测了癌组织K-ras基因,62例癌组织K-ras基因进行检测,突变率为30.6%(19/62),其中G12占89.5%(17/19),G13占10.5%(2/19);43例K-ras野生型者分两组进行姑息化疗,包括单纯化疗组及化疗联合靶向治疗组,治疗期间密切随访,统计疗效及毒性并进行统计学分析。结果 K-ras突变者中位PFS和OS分别为4.7月和14.5月,野生型者中位PFS和OS分别为8.5月和24.0月,差异均有统计学意义(Log-rank检验P﹤0.05);10名K-ras野生型者在化疗基础上加用靶向治疗(西妥昔单抗),其中位生存期36.5月,显著高于未用靶向治疗患者的18.0月(Log-rank检验P﹤0.01)。结论癌组织K-ras基因突变者生存期明显短于K-ras基因野生型者,表明K-ras基因突变可作为本组转移性结直肠癌的有效预后预测指标;化疗联合靶向治疗转移性结直肠癌,可有效改善K-ras基因野生型者的PFS和OS,值得推广应用。

Prediction on survival in metastatic colorectal cancer treated with medicine with K-ras gene status

OBJECTIVE To evaluate the prognostic value of KRAS by prospective detection of expression status of K-ras gene of metastatic colorectal cancer.To compare the long-term efficacy of chemotherapy alone or combined with EGFR-targeted therapy and provide clinicians with a reliable predictor.METHODS All 62 cases of previously untreated metastatic colorectal cancer were detected cancerous tissue K-ras gene before the first-line chemotherapy.The mutation rate was 30.6%(19/62).G12 mutations accounted for 89.5%(17/19),G13 mutations accounting for 10.5%(2/19);43 cases with K-ras wild-type were divided into two treatment groups:including chemotherapy group and chemotherapy in combination with EGFR-targeted therapy group.After close follow-up,statistical efficacy and toxicity were analyzed statistically.RESULTS The median PFS and OS in the cases with K-ras mutation were 4.7 months and 14.5 months.In the cases with K-ras wild-type,the median PFS and OS were 8.5 months and 24.0 months,the difference was statistically significant(log-rank test,P﹤0.05);10 cases with K-ras wild-type received chemotherapy in combination with EGFR-targeted therapy(cetuximab).The median survival was 36.5 months,which significantly higher than those without EGFR-targeted therapy with 18.0 months(Log-rank test,P﹤0.01).CONCLUSION The survival of patients which K-ras gene mutation in cancer tissue is significantly shorter than that with K-ras wild-type,indicating that the K-ras gene mutation can be used as an effective prognostic indicators of metastatic colorectal cancer;Combination of chemotherapy and EGFR-targeted therapy can effectively improve the PFS and OS of metastatic colorectal cancer with K-ras wild-type,should be widely applied.