KRAS基因突变对结直肠癌肝转移患者长期预后的影响及临床相关因素研究  

The impact of KRAS gene status on clinical parameters and long-term prognosis of patients with colorectal cancer liver metastases

作　　者：李慧馨 卢实春[1] 杨占宇[1] 李若凡 吕文平[1] Li Huixin;Lu Shichun;Yang Zhanyu;Li Ruofan;Lyu Wenping(Department of Hepatobiliary Surgery,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心肝胆外科,北京100853

出　　处：《中华肝胆外科杂志》2020年第5期326-329,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：国家自然科学基金(30772493)。

摘　　要：目的探讨KRAS基因状态与结直肠癌肝转移(CRLM)患者临床因素和预后的关系。方法回顾分析2005年1月至2019年12月连续在解放军总医院第一医学中心诊治的1248例CRLM患者资料,其中男性880例,女性368例,年龄范围21~88岁,中位年龄56岁。比较不同临床特征患者的KRAS基因突变率。单因素和多因素logistic回归分析KRAS基因突变的影响因素。Kaplan-Meier法分析生存情况,生存率比较采用log-rank检验。结果KRAS基因野生型729例,突变型519例,突变率41.6%(519/1248)。11例原发病灶位于双侧结肠。女性与男性、糖类抗原19-9≥38 g/L与<38 g/L、糖尿病与非糖尿病、原发病灶位于右半结肠(52.1%,160/307)与左半结肠(38.2%,355/930)的CRLM患者KRAS基因突变率比较,差异均有统计学意义(均P<0.05)。单因素回归分析显示,KRAS基因突变与性别、糖类抗原19-9、有无糖尿病、原发肿瘤部位相关。多因素logistic回归分析,原发肿瘤部位(OR=0.557,95%CI:0.423~0.733)是KRAS基因突变的独立影响因素。KRAS基因野生型CRLM患者累积生存率优于突变型,差异有统计学意义(P<0.05)。结论CRLM中,KRAS基因突变型更易出现在右半结肠癌患者中,KRAS基因突变型患者长期预后相对较差。Objective To study the relationship between KRAS gene mutation and clinical parameters and prognosis in patients with colorectal cancer liver metastases (CRLM).Methods To retrospectively study the impact of different KRAS status on the clinical parameters parameters and prognosis of 1 248 patients with CRLM treated from January 2005 to December 2019 at the First Medical Center, Chinese PLA General Hospital. There were 880 male and 368 female, age ranged from 21 to 88, median 56. The single factor and multi-factor logistic regression analyses were used to identify factors relating to KRAS mutation. Survival was analyzed by the Kaplan-Meier method, and survival rate by the log-rank test.Results There were 729 KRAS gene wild-type patients and 519 mutant patients. The mutation rate was 41.6%(519/1 248). Primary site of tumor in 11 patients were located in the bilateral colon. The KRAS gene mutation rates between the male and female CRLM patients whose CA19-9 level were ≥38 g/L and <38 g/L, with or without diabetes, and whose primary sites were on the right (52.1%, 160/307) or the left colon (38.2%, 355/930) was significantly different (all P<0.05). A single factor logistic regression analysis showed that gender, CA19-9 levels, diabetes and the primary site were associated with KRAS mutations, with significant difference (P<0.05). Multivariate logistic regression analysis showed that the primary site of tumor was an independent influencing factor of KRAS mutation (OR=0.557, 95% CI: 0.423-0.733, P<0.05). The overall survival rates of KRAS wild-type patients was significantly higher than mutant patients (P<0.05).Conclusion Among patients with CRLM, KRAS mutation was more frequently appeared in those patients with right sided colonic cancer. The long-term prognosis of patients with KRAS mutant was significantly worse.

关 键 词：结直肠肿瘤 肝转移 KRAS基因 预后 

分 类 号：R735.34[医药卫生—肿瘤]