乙肝病毒感染与KRAS基因突变型晚期结直肠癌患者发生肝内转移的关联分析  

Relationship between hepatitis B virus and colorectal cancer liver metastasis with KRAS gene mutation

作　　者：陈丽华 王贻军 CHEN Li-hua;WANG Yi-jun(Department of Oncology,Zhangzhou Affiliated Hospital of Fujian Medical University,Zhangzhou 363000,China)

机构地区：[1]福建医科大学附属漳州市医院肿瘤内科,福建漳州363000

出　　处：《中华肿瘤防治杂志》2021年第14期1099-1103,共5页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的探讨乙肝病毒(HBV)感染对KRAS基因突变型晚期结直肠癌患者肝转移发生率影响。方法回顾性分析2018-01-01-2019-12-31福建医科大学附属漳州市医院收治的159例晚期结直肠癌患者临床资料,根据乙肝五项指标的检测结果分为HBV感染组[HBV表面抗原和(或)HBV核心抗体阳性组]95例和HBV未感染组64例,其中根据KRAS状态分为KRAS突变组和KRAS野生型组。比较2组患者不同KRAS基因状态肝转移发生率的差异。结果晚期结直肠癌患者中HBV感染率为59.7%(95/159),KRAS突变率为26.1%(41/157)。HBV感染组(60.0%)肝转移率低于HBV未感染组(76.6%),差异有统计学意义,χ^(2)=4.720,P=0.030;HBV感染KRAS突变组[HBV(+)KRAS^(mut)]肝转移率为42.3%,低于HBV感染KRAS野生组[HBV(+)KRAS^(wt)]的67.6%、HBV未感染KRAS突变组[HBV(-)KRAS^(mut)]的80.0%和HBV未感染KRAS野生型组[HBV(-)KRAS^(wt)]的71.1%,χ^(2)值分别为5.060、5.487和8.949,P值分别为0.034、0.019和0.003。多因素二元Logistic回归分析结果显示,HBV(+)KRAS^(mut)(OR=0.023,95%CI为0.002~0.334,P=0.006)、HBV(+)KRAS^(wt)(OR=0.058,95%CI为0.005~0.632,P=0.020)与HBV(-)KRAS^(mut)比较,患者肝内发生转移的危险性降低。结论HBV感染合并KRAS突变或野生型的患者发生肝转移危险性降低。Objective To investigate the effect of hepatitis B virus(HBV)infection on the incidence of liver metastases in patients with KRAS gene mutation in advanced colorectal cancer.Methods Clinicopathological data of total 159 patients diagnosed with metastatic colorectal cancer(mCRC)who were admitted to Zhangzhou Affiliated Hospital of Fujian Medical University from January 1,2018 to December 31,2019 were retrospectively analyzed.According to the five indicators of hepatitis B virus,all patients were divided into 95 cases of HBV infection group(HBV surface antigen and/or HBV core antibody positive group)and 64 cases of HBV uninfected group.Each group was divided into KRAS mutation group and KRAS wild type group in accordance with different KRAS status.The incidence of metastatic colorectal liver metastasis(mCRLM)with different KRAS gene status between the two groups were compared.Results In these mCRC patients,HBV infection rate was 59.7%(95/159),KRAS mutation rate was 26.1%(41/157).The incidence of liver metastasis in the HBV infection group(60%)was significantly lower than that in the non-infection group(76.6%,χ^(2)=4.72,P=0.030).In addition,liver metastatic rate in KRAS mutation patients with HBV infection group[HBV(+)KRAS^(mut)](42.3%)was lower than that in other three groups,including KRAS wild with HBV infection group[HBV(+)KRASwt](67.6%),KRAS mutation with non-HBV infection group[HBV(-)KRAS^(mut)](80.0%)and KRAS wild with non-HBV infection group[HBV(-)KRASwt](71.1%)(χ^(2)=5.060,P=0.034;χ^(2)=5.487,P=0.019;χ^(2)=8.949,P=0.003).Multivariate logistic regression analysis showed that compared with HBV(-)KRAS^(mut)group,the risk of intrahepatic metastasis was lower in the HBV(+)KRAS^(mut)(OR=0.023,95%CI:0.002-0.334,P=0.006)and HBV(+)KRASwtgroups(OR=0.058,95%CI:0.005-0.632,P=0.020).Conclusion HBV infection patients with KRAS mutation or wild type have lower risk of liver metastasis.

关 键 词：结直肠癌 肝转移 乙肝病毒感染 KRAS基因 

分 类 号：R735.3[医药卫生—肿瘤]