结直肠癌肝转移切除术后患者RAS基因突变影响生存的整合分析  

Effect of RAS gene mutation on survival after liver metastasis resection for patients with colorectal cancer combined with liver metastasis:integrated analysis

作　　者：岳育民 陈曦 王慧 蔡祥礽 郑波波 YUE Yumin;CHEN Xi;WANG Hui;CAI Xiangren;ZHENG Bobo(The First Department of General Surgery,Shaanxi Provincial People’s Hospital,Xi’an 710068,P.R.China;Yan’an University,Yan’an,Shaanxi 716000,P.R.China;Xi’an Medical College,Xi’an 710021,P.R.China)

机构地区：[1]陕西省人民医院普外一科,西安710068 [2]延安大学,陕西延安716000 [3]西安医学院,西安710021

出　　处：《中国普外基础与临床杂志》2022年第12期1583-1590,共8页Chinese Journal of Bases and Clinics In General Surgery

基　　金：陕西省人民医院科技发展孵化基金项目(项目编号:2020YXM-17)。

摘　　要：目的评估结直肠癌肝转移切除术后患者RAS基因突变对生存的影响。方法对PubMed等数据库中的文献进行全面系统地检索,检索时间截至2022年1月5日。使用Stata 12.0软件和Review Manager version5.3软件对纳入的整体文献和按研究类型、地区及RAS基因突变位点数目亚组进行整合分析,分析结直肠癌肝转移切除术后患者RAS基因突变对生存的影响。结果共纳入26项研究共13356例患者,整合分析结果显示,相对于RAS基因野生型患者,RAS基因突变型患者的总生存时间[HR=1.54,95%CI(1.43,1.65),P<0.001]和无病生存时间[HR=1.32,95%CI(1.19,1.44),P<0.001]均缩短。除1年总生存率外,RAS基因突变型患者的2~5年总生存率和1~5年无病生存率均低于RAS基因野生型患者(P<0.05)。亚组分析结果显示,无论是在回顾性还是在前瞻性研究中以及无论是亚洲国家还是欧洲国家的研究均发现,RAS基因突变型患者相比野生型患者其OS和DFS均缩短(P<0.05);同时针对RAS基因突变位点数目(>2个和≤2个)进行的亚组分析结果发现,突变位点数目>2个较≤2个其OS与DFS也均缩短(P<0.05)。结论从本整合分析结果总体来看,结直肠癌肝转移切除术后RAS基因突变型患者的生存情况差于RAS基因野生型患者。Objective To evaluate effect of RAS gene mutation after liver metastasis resection on overall survival(OS)and disease-free survival(DFS)for patients with colorectal cancer combined with liver metastasis.Methods A comprehensive and systematic literature search in the PubMed and other databases was conducted,with the final search ending on January 5,2022.The impact of RAS gene mutation after liver metastasis resection on survival of patients with colorectal cancer combined with liver metastasis was analyzed by the Stata 12.0 software and Review Manager version 5.3software,meanwhile which were analyzed according to subgroups,including study type(retrospective and prospective studies),region(Asian and European),and number of RAS gene mutation sites(>2 and≤2).Results A total of 26studies with 13356 patients were included.The integrated analysis results showed that the patients with RAS mutations had statistically shorter OS[HR=1.54,95%CI(1.43,1.65),P<0.001]and DFS[HR=1.32,95%CI(1.19,1.44),P<0.001]as compared with RAS wild-type.Except the 1-year overall survival rate,the 2–5-year overall survival rate and 1–5-year disease-free survival rate of patients with RAS gene mutation were statistically lower than those of patients with RAS wild-type(P<0.05).The results of subgroup analysis showed that no matter retrospective and prospective studies,as well as studies in Asian and European countries,it was found that the OS and DFS for patients with RAS gene mutation were shorter than those of patients with wild-type(P<0.05);At the same time,subgroup analysis of the number of RAS gene mutation sites showed that OS and DFS of patients with number of mutation sites>2 were shortened as compared with≤2(P<0.05).Conclusion From the overall analysis results,the survival of patients with RAS gene mutation after liver metastasis resection is worse than that of patients with RAS wild-type for patients with colorectal cancer combined with liver metastasis.

关 键 词：结直肠癌 肝转移 RAS基因 突变 生存 整合分析 

分 类 号：R735.34[医药卫生—肿瘤]