CAJ | 학술논문

背景与目的:随着西妥昔单抗联合化疗在转移性结直肠癌患者中的不断应用,预测其治疗疗效的研究也越来越深入.本文旨在探讨转移性结直肠癌患者肿瘤组织中K-ras基因表达状态(野生型或突变型)及其与西妥昔单抗联合化疗疗效之间的关系.方法:2006年3月-2008年6月期间应用西妥昔单抗联合化疗治疗转移性结直肠癌27例.采用聚合酶链反应(PCR)技术和直接测序法检测肿瘤组织中K-ras基因表达状态.分析K-ras基因表达状态与西妥昔单抗联合化疗疗效之间的关系.结果:全组27例患者中,K-ras野生型15例(55.6%),K-ras突变型12例(44.4%).在K-ras野生型中,西妥昔单抗联合化疗的总有效率(ORR)为66.7%,其中CR 2例(13.3%),PR 8例(53.3%),中位无进展生存期(PFS)8个月.在K-ras突变型中,总有效率为25.0%,PR 3例(25.0%),中位PFS 4个月.在K-ras野生型转移性结直肠癌患者中应用西妥昔单抗联合化疗的疗效明显优于K-ras突变型患者.结论:K-ras野生型是西妥昔单抗联合化疗疗效良好的预测指标.在西妥昔单抗联合化疗前明确患者的K-ras基因状态有助于选择合适的患者,获得最佳疗效.
배경여목적:수착서타석단항연합화료재전이성결직장암환자중적불단응용,예측기치료료효적연구야월래월심입.본문지재탐토전이성결직장암환자종류조직중K-ras기인표체상태(야생형혹돌변형)급기여서타석단항연합화료료효지간적관계.방법:2006년3월-2008년6월기간응용서타석단항연합화료치료전이성결직장암27례.채용취합매련반응(PCR)기술화직접측서법검측종류조직중K-ras기인표체상태.분석K-ras기인표체상태여서타석단항연합화료료효지간적관계.결과:전조27례환자중,K-ras야생형15례(55.6%),K-ras돌변형12례(44.4%).재K-ras야생형중,서타석단항연합화료적총유효솔(ORR)위66.7%,기중CR 2례(13.3%),PR 8례(53.3%),중위무진전생존기(PFS)8개월.재K-ras돌변형중,총유효솔위25.0%,PR 3례(25.0%),중위PFS 4개월.재K-ras야생형전이성결직장암환자중응용서타석단항연합화료적료효명현우우K-ras돌변형환자.결론:K-ras야생형시서타석단항연합화료료효량호적예측지표.재서타석단항연합화료전명학환자적K-ras기인상태유조우선택합괄적환자,획득최가료효.
Background and purpose: Cetuximab-containing regimen has been increasingly applied in the treatment of patients with metastatic colorectal cancer. Simultaneously, the predictive factors of outcome for cetuximab have been thoroughly researched. The aim of this study was to evaluate the relationship between K-ras status and efficacy of cetuximab containing regimen in the treatment of patients with metastatic eolorectal cancer. Methods: Between March 2006 and June 2008, twenty-seven patients with metastatic colorectal cancer were treated with cetuximab in combination with chemotherapy. The K-ras mutation status [wild-type (wt) or mutation (nat)] was examined by polymerase chain reaction (PCR) and direct sequencing. The influence of K-ras mutation status on efficacy of cetuximab-containing regimen was analyzed. Results: For 27 patiants in this cohort, K-ras wt was detected in 55.6% (15/27) cases and K-ras mt in 44.4% (12/27) cases. Statistically significant differences were found between the patients with K-ras wt and K-ras mt in terms of overall response rate (ORR) (66.7% vs 25.0%,P=0.035) and progression-free survival (PFS) (8 months vs 4 months, P=0.0028). However, there was no significant difference in overall survival (OS) (19 months vs 12 months, P>0.05). The most common treatment-related adverse effect was skin reaction, with incidence rate of 80.0% and 66.7% (P>0.05), respectively. No treatment related death was observed. Conclusion: K-ras mutation status is a predictive factor of good efficacy of cetuximab-containing regimen in the treatment of patients with metastatic colorectal cancer. Patients with K-ras wt could benefit from cetuximab in combination with chemotherapy.