贝伐珠单抗联合化疗治疗KRAS突变型晚期左、右半结肠癌疗效的对比分析

目的:对比分析姑息一线应用贝伐珠单抗联合化疗治疗KRAS突变型晚期左、右半结肠癌的临床疗效。方法:回顾性分析我院于2016年09月至2020年09月收治的83例一线应用贝伐珠单抗联合化疗治疗KRAS突变型晚期左、右半结肠癌患者，比较KRAS突变型左、右半结肠癌患者的临床特征、客观缓解率（ORR）、疾病控制率（DCR）、无进展生存时间（PFS）、18个月生存率、总生存时间（OS）。结果:KRAS突变型晚期右半结肠癌（RSCC）患者合并不完全肠梗阻及体重减轻＞5 kg所占比例更高（P=0.369、P=0.009）,KRAS突变型晚期左半结肠癌（LSCRC）患者更易合并中重度以上的贫血（P=0.154）。KRAS突变型LSCRC患者发生腹腔种植转移及远处器官转移的患者比例高于RSCC患者（P＞0.05）。KRAS突变型LSCRC患者与RSCC患者ORR分别为29.3%和28.6%（P=0.944）,DCR分别为87.8%和90.5%（P=0.696）。18个月生存率LSCRC组为80.05%，RSCC组为76.2%，差异无统计学意义（P=0.635）。KRAS突变型LSCRC患者中位 PFS差于RSCC患者（8个月 vs 9.8个月，P=0.004）,KRAS突变型LSCRC患者中位OS优于KRAS突变型RSCC患者中位OS（22.8个月 vs 21个月,P=0.001）。结论:姑息一线应用贝伐珠单抗联合化疗治疗KRAS基因突变型mCRC患者，左、右半结肠癌的远期疗效存在差异。

Comparative analysis of the efficacy of bevacizumab combined with chemotherapy in the treatment of KRAS mutant advanced left and right colon cancer

Objective:To compare and analyze the clinical efficacy of first-line bevacizumab combined with chemotherapy in patients with KRAS mutant advanced left and right colon cancer.Methods:A retrospective analysis was performed on 83 patients with KRAS mutant advanced left and right colon cancer treated with first-line bevacizumab combined with chemotherapy in our hospital from September 2016 to September 2020.The clinical characteristics,objective response rate(ORR),disease control rate(DCR),progression-free survival(PFS),18-month survival rate and overall survival(OS) of patients with KRAS mutant left and right colon cancer were compared.Results:Patients with KRAS mutant advanced right colon cancer(RSCC) were more likely to have incomplete intestinal obstruction and weight loss >5 kg(P=0.369,P=0.009),and patients with KRAS mutant advanced left colon cancer(LSCRC) were more likely to have moderate or severe anemia(P=0.154).The proportion of patients with KRAS mutant LSCRC with abdominal implantation metastasis and distant organ metastasis was higher than that of RSCC patients(P>0.05).The ORR and DCR of KRAS mutant LSCRC patients and RSCC patients were 29.3% and 28.6%(P=0.944),87.8% and 90.5%(P=0.696),respectively.The 18-month survival rate was 80.05% in the LSCRC group and 76.2% in the RSCC group,with no significant difference(P=0.635).The median PFS of LSCRC patients with KRAS mutation was worse than that of RSCC patients(8 months vs 9.8 months,P=0.004),and the median OS of LSCRC patients with KRAS mutation was better than that of RSCC patients with KRAS mutation(22.8 months vs 21 months,P=0.001).Conclusion:The long-term efficacy of bevacizumab combined with chemotherapy in the palliative first-line treatment of KRAS mutated mCRC patients is different between left and right colon cancer.