Ⅳ期结直肠癌轻微症状患者原发灶切除和KRAS基因突变对其预后的影响

doi:10.13481/j.1671-587x.20170427

吉林大学学报(医学版) ›› 2017, Vol. 43 ›› Issue (04): 805-811.doi: 10.13481/j.1671-587x.20170427

Ⅳ期结直肠癌轻微症状患者原发灶切除和KRAS基因突变对其预后的影响

杨冬阳¹, 赖晓嵘¹, 黎莹¹, 马立宇², 罗刚³, 李子俊³, 徐飞¹, 马冬¹

1. 广东省人民医院广东省医学科学院肿瘤中心胃肠肿瘤内科, 广东广州 510080;
2. 广东省人民医院广东省医学科学院协和医疗中心, 广东广州 510080;
3. 广东省人民医院广东省医学科学院消化内科, 广东广州 510080

收稿日期:2017-01-30 出版日期:2017-07-28 发布日期:2017-08-01
通讯作者: 马冬,主任医师(Tel:020-81884713,E-mail:dr_madong@163.com) E-mail:dr_madong@163.com
作者简介:杨冬阳(1981-),男,广东省揭阳市人,主治医师,主要从事消化系统肿瘤内科治疗方面的研究。
基金资助:
广东省科技厅省级科技计划项目资助课题（021800198）

Influence of primary resection and KRAS gene mutation in prognosis of mild symptomatic patients with stage Ⅳ colorectal cancer

YANG Dongyang¹, LAI Xiaorong¹, LI Ying¹, MA Liyu², LUO Gang³, LI Zijun³, XU Fei¹, MA Dong¹

1. Department of Gastrointestinal Cancer, Tumor Center, Guangdong General People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China;
2. Concord Medical Center, Guangdong General People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China;
3. Department of Gastroenterology, Guangdong General People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China

Received:2017-01-30 Online:2017-07-28 Published:2017-08-01

摘要/Abstract

摘要： 目的：探讨Ⅳ期结直肠癌轻微症状行原发灶切除患者KRAS基因突变情况，阐明其对预后的影响。方法：收集46例Ⅳ期结直肠癌轻微症状患者的临床资料，所有患者均行原发灶切除，留取手术切除的肿瘤组织标本，采用直接测序法检测患者KRAS基因突变情况，并进行为期5年的随访，分析Ⅳ期结直肠癌患者原发灶切除和KRAS基因突变对预后的影响，对可能影响预后的临床病理因素进行生存分析。结果：46例患者中，KRAS基因突变20例，突变率为43.4%，其中12密码子突变发生频率最高（95.7%）。KRAS基因突变与肿瘤原发部位和肿瘤的多发转移有密切关联（P<0.05）。Kaplan-Meier生存曲线及单变量分析，原发灶切除术后KRAS基因野生型患者中位生存时间为58.4个月，KRAS基因突变型患者中位生存时间为42.2个月，组间比较差异无统计学意义（P>0.05）。右半结肠癌患者中位生存时间为34.2个月，左半结肠癌患者中位生存时间为58.3个月，组间比较差异有统计学意义（P<0.05）。癌细胞的肝、肺和多发转移与结直肠癌患者术后预后不良有关（P<0.05）。Ⅳ期结直肠癌轻微症状患者术后中位生存时间为39.6个月。结论：Ⅳ期结直肠癌轻微症状患者原发灶切除术后，左半结肠癌患者及右半结肠癌患者生存时间均有延长趋势，右半结肠癌患者预后较左半结肠癌患者差。结直肠癌患者KRAS基因突变与肿瘤原发部位和肿瘤的多发转移有关联，转移部位影响手术预后。

关键词: 原发灶切除, KRAS基因变异, 结直肠肿瘤, 预后

Abstract: Objective: To investigate the relationship between primary resection and KRAS gene mutation in the mild symptomatic patients with stage Ⅳ colorectal cancer,and to clarify its significance of prognosis.Methods: The clinical data of 46 mild symptomatic patients with stage Ⅳ colorectal cancer 2010 to December 2010 were collected. All the patients received primary resection.The KRAS gene mutation in the patients was detected by direct sequencing and the patients were followed up for 5 years.The influence of primary resection and KRAS gene mutation in prognosis of the patients with stage Ⅳ colorectal cancer was analyzed, and the clinical pathological features which might influence the prognosis were analyzed by survival analysis.Results: In 46 patients with colorectal cancer, KRAS gene mutation was found in 20 cases, the mutation rate was 43.4%, and most mutation was found at Codon 12. The KRAS mutation had relationship with the tumor site and multiple metastasis (P<0.05).The Kaplan-Meier survival curve and univariate analysis results showed that the median survival time of the patients with wild type of KRAS gene was 58.4 months, the median survival time of the patients with mutant type of KRAS gene was 42.2 months, and there was no significant difference (P>0.05).The median survival time of right colon cancer patients was 34.2 months, the median survival time of left colon cancer patients was 58.3 months, and there was sigificant difference (P<0.05).The cancer metastases including liver, lung and multiple metastasis were closely related to the poor prognosis of the colorectal cancer patients(P<0.05).The median survival time of the patients with stage Ⅳ colorectal cancer was 39.6 months after operation.Conclusion: After primary resection of the mild symptomatic patients with stage Ⅳ colorectal cancer,the median survival time of the patients with colorectal cancer in left colon site and right colon site were prolonged. Right colon cancer has more poorer prognosis than left colon cancer. KRAS gene mutation is associated with the tumor site and the multiple metastasis. The location of metastasis affect the prognosis.

Key words: colorectal neoplasms, primary resection, prognosis, KRAS gene mutation

中图分类号:

R735.3

杨冬阳, 赖晓嵘, 黎莹, 马立宇, 罗刚, 李子俊, 徐飞, 马冬. Ⅳ期结直肠癌轻微症状患者原发灶切除和KRAS基因突变对其预后的影响[J]. 吉林大学学报(医学版), 2017, 43(04): 805-811.

YANG Dongyang, LAI Xiaorong, LI Ying, MA Liyu, LUO Gang, LI Zijun, XU Fei, MA Dong. Influence of primary resection and KRAS gene mutation in prognosis of mild symptomatic patients with stage Ⅳ colorectal cancer[J]. Journal of Jilin University Medicine Edition, 2017, 43(04): 805-811.

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Ⅳ期结直肠癌轻微症状患者原发灶切除和KRAS基因突变对其预后的影响

Influence of primary resection and KRAS gene mutation in prognosis of mild symptomatic patients with stage Ⅳ colorectal cancer

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