KRAS基因突变对经肝动脉化疗栓塞术治疗的中晚期原发性肝癌患者预后的预测价值  

Prognostic value of KRAS mutations in patients with advanced primary liver cancer treated with transcatheter arterial chemoembolization

作　　者：刘旭初 覃世运[1] 陈丽君[1] 陈娟 尤晓光 LIU Xuchu;QIN Shiyun;CHEN Lijun;CHEN Juan;YOU Xiaoguang(Tumor Treatment Center,The Third People’s Hospital of Hainan Province,Sanya,Hainan 572000,China;Department of Pharmacy,Sanya Central Hospital,The Third People’s Hospital of Hainan Province,Sanya,Hainan 572000,China;Department of Radiology,the First Affiliated Hospital of Hainan Medical College,Haikou 570102,China)

机构地区：[1]海南省第三人民医院(三亚中心医院)肿瘤治疗中心,海南三亚572000 [2]海南省第三人民医院(三亚中心医院)药学部,海南三亚572000 [3]海南医学院第一附属医院放射科,海口570102

出　　处：《临床肝胆病杂志》2022年第11期2514-2519,共6页Journal of Clinical Hepatology

基　　金：海南省重点研发科技发展项目(SQ2019KJHZ0073)。

摘　　要：目的探讨KRAS基因状态对经肝动脉化疗栓塞(TACE)治疗中晚期肝癌患者预后的预测价值。方法选择2017年4月—2020年5月在海南省第三人民医院接受TACE治疗的中晚期肝癌患者97例为研究对象。检测患者KRAS基因突变状态,并分析KRAS基因突变状态与患者TACE治疗预后的关系。计量资料两组间比较采用t检验,计数资料两组间比较采用χ2检验,生存分析绘制Kaplan-Meier生存曲线,生存曲线比较采用Log-rank检验,对可能影响患者预后的各因素进行Cox回归分析。结果97例患者中共检出KRAS基因突变患者34例(35.05%),其中检出12号密码子突变患者21例(61.76%),13号密码子突变患者13例(38.24%)。KRAS基因突变与患者肝硬化、肝内转移、肿瘤数目均显著相关(χ2值分别为0.035、3.965、6.593,P值均<0.05)。Kaplan-Meier生存分析结果显示,KRAS基因野生型患者无进展生存期及总体生存时间均显著优于KRAS突变型(χ2值分别为4.465、4.280,P值均<0.05)。Cox分析结果显示,KRAS基因状态、肝内转移、肿瘤数目、BCLC分期进入回归模型为影响患者总体生存预后的重要因素(P值均<0.05)。结论KRAS基因突变在肝癌患者中较为常见,KRAS基因突变与患者TACE术后不良预后密切相关,可成为患者临床预后监测的潜在指标。Objective To assess the prognostic value of KRAS mutation in patients with advanced primary liver cancer treated with transcatheter arterial chemoembolization(TACE).Methods Ninety-seven patients with advanced primary liver cancer who received TACE treatment in The Third People’s hospital from April 2017 to May 2020 were included.The mutation status of KRAS was detected,and its relationship with the prognosis of TACE was investigated.The t-test was used for comparison of continuous data between two groups,and the chi-square test was used for comparison of categorical data between two groups.Survival analysis was performed using Kaplan-Meier survival curve and compared using Log-rank test.Cox regression analysis was performed to identify the prognostic factors.Results Among 97 patients with advanced liver cancer,KRAS mutations were detected in 34 patients(35.05%),including 21 patients with codon 12 mutation(61.76%)and 13 patients with codon 13 mutation(38.24%).KRAS mutation was associated with liver cirrhosis,intrahepatic metastasis and the number of tumors(χ2=0.035,3.965,and 6.593,all P<0.05).Survival analysis showed that the progression free survival and overall survival were significantly longer in KRAS wild-type patients than in KRAS mutant patients(χ2=4.465 and 4.280,all P<0.05).Multivariate Cox analysis revealed that KRAS mutation,intrahepatic metastasis,number of tumors and BCLC stage were important factors affecting the overall survival and prognosis of patients(all P<0.05).Conclusion KRAS mutation is common in patients with advanced primary liver cancer and is closely associated with a poor prognosis after TACE.It may become a potential indicator of clinical prognosis.

关 键 词：肝肿瘤 基因 化学栓塞 治疗性 预后 

分 类 号：R735.7[医药卫生—肿瘤]