RAS基因突变对结直肠癌肝转移患者肝切除术后预后的影响

目的分析RAS基因突变对结直肠癌肝转移行肝切除患者预后的影响。方法回顾分析北京大学肿瘤医院肝胆胰外一科2008年1月1日至2016年12月31日连续收治的545例结直肠癌肝转移行肝切除的患者资料,依据纳入和排除标准最终纳入356例,男性232例,女性124例,年龄21?83岁。比较RAS基因野生型和突变型患者的临床和随访资料。采用Kaplan-M eier法进行生存分析,比较采用log-rank检验。单因素和多因素Cox回归分析患者生存的影响因素。结果RAS基因野生型和突变型患者分别为247例和109例。RAS基因野生型患者中位生存期为74个月,突变型为30个月。RAS基因野生型患者累积生存率和累积无病生存率均优于突变型,差异有统计学意义(均P<0.05)。多因素Cox回归分析,肝转移出现间隔≤12个月(HR=1.673,95%CI:1.016~2.637)、肝转移瘤最大直径>5cm(HR=1.717,95%(CI:1.102?2.637)、RAS基因突变型(HR=1.836,95%CI:1.322?2.550)是结直肠癌肝转移患者手术切除后生存的独立危险因素。结论RAS基因突变是结直肠癌肝转移患者肝切除术后生存的危险因素,RAS基因突变型患者预后更差。

Impact of mutant RAS on prognosis of patients after hepatic resection for colorectal cancer liver metastases

Objective To study the impact of RAS status on prognosis of patients after liver resection for colorectal cancer liver metastases(CRLM).Methods The data of 545 consecutive CRLM patients who underwent liver resection at the Hepatopancreatobiliary Surgery Department I,Peking University Cancer Hospital between January 1st,2008 and December 31 st,2016,were retrospectively reviewed.According to the inclusion and exclusion criteria,356 patients were eventually included into this study.There were 232 males and 124 females,with ages ranging from 21 to 83 years.The clinical and follow-up data of patients with wild-type and mutant RAS were compared.Survival was estimated by the Kaplan-Meier method,and the difference was compared by the log-rank test.Factors influencing survival of these patients were assessed by univariate and multivariate Cox regression analyses.Results There were 247 patients with wild-type RAS and 109 patients with mutant RAS,respectively.The median overall survival of patients with wild-type and mutant RAS were 74 and 30 months respectively.Compared with mutant RAS patients,wild-type RAS patients had significantly better cumulative survival and disease free survival rates(both P<0.05).Multivariate Cox regression analyses revealed disease free interval from primary to metastases≤12 months(H R=1.673,95%C l:1.016-2.637),largest hepatic tumor diameter>5 cm(HR=1.717,95%C l:1.102-2.637),and mutant RAS{H R=1.836,95%C l:1.322-2.550)were independent risk factors for patients with colorectal cancer liver metastases after hepatic resection.Conclusion Mutant RAS was a poor prognostic factor of survival after liver resection in CRLM patients.