Association of Prognostic Value of Primary Tumor Location in Stage III Colon Cancer With RAS and BRAF Mutational Status
Publikation: Beitrag in Fachzeitschrift › Forschungsartikel › Beigetragen › Begutachtung
Beitragende
- Arbeitsbereich Medizinische Biologie
- Medizinische Klinik und Poliklinik I
- Université Paris Cité
- Hôpital Ambroise Paré
- Fédération Francophone de Cancérologie Digestive (FFCD)
- Universität Paris Descartes 5
- Hospital Universitari Vall d'Hebron
- Università degli Studi di Firenze
- Universitätsklinikum Carl Gustav Carus Dresden
- Hôpital Erasme - Cliniques universitaires de Bruxelles
- CHU de Reims
- Université de Rouen
- DRK Kliniken Berlin Köpenick
- University College London
- Universitair Ziekenhuis (UZ) Leuven
- Institut d'Investigació Biomedica de Bellvitge (IDIBELL)
Abstract
IMPORTANCE: We know of no data on the prognostic value of primary tumor location (PTL) according to BRAF, RAS, and microsatellite instability (MSI) status in patients who have undergone resection for colon cancer (CC) and have been treated with current standard adjuvant chemotherapy.
OBJECTIVE: To determine the prognostic and predictive value of PTL according to BRAF, RAS, and MSI status in patients with stage III CC receiving adjuvant treatment with FOLFOX (folinic acid [leucovorin calcium], fluorouracil, and oxaliplatin) with or without cetuximab.
DESIGN, SETTING, AND PARTICIPANTS: This post hoc analysis included patients with available tumor blocks of resected stage III colon adenocarcinoma who participated in the Pan-European Trials in Alimentary Tract Cancer (PETACC)-8 phase 3 randomized trial. Among the 2559 patients who underwent randomization, 1900 were screened by next-generation sequencing, which showed that 1869 had full information concerning PTL. We categorized primary tumor site as located proximal (right) or distal (left) to the splenic flexure.
MAIN OUTCOMES AND MEASURES: The associations between PTL (right- vs left-sided) and disease-free survival (DFS), survival after relapse (SAR), and overall survival (OS) were assessed by Cox models and adjusted for clinical and pathological features, treatment, and MSI, BRAF, and RAS status.
RESULTS: Among the 1869 patients (1056 [57%] male; mean [SD] age, 59.4 [9.5] years) with full molecular data analyzed, 755 (40%) had a right-sided tumor, 164 (10%) had MSI, 942 (50%) had RAS mutations, and 212 (11%) had BRAF mutations. Right-sided tumor location was not prognostic for DFS in the whole population but was associated with a shorter SAR (hazard ratio [HR], 1.54; 95% CI, 1.23-1.93; P = .001) and OS (HR, 1.25; 95% CI, 1.02-1.54; P = .03). When looking at DFS in the different molecular subgroups, we found similar results for microsatellite-stable tumors and tumors with MSI; a better DFS in right-sided vs left-sided tumors in patients with RAS mutations (HR, 0.80; 95% CI, 0.64-1.00; P = .046); and a worse DFS in right-sided vs left-sided tumors in patients with RAS and BRAF double wild type (HR, 1.39; 95% CI, 1.01-1.92; P = .04). These results were found independently of the treatment received, and no beneficial effect of cetuximab on DFS or OS was observed in left-sided tumors.
CONCLUSIONS AND RELEVANCE: Although right-sided tumor location is associated with poor survival in patients with metastatic CC as previously reported, the association with disease recurrence appears to vary for patients with stage III CC and RAS or BRAF mutations vs those with double wild type.
Details
Originalsprache | Englisch |
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Seiten (von - bis) | e173695 |
Fachzeitschrift | JAMA oncology |
Jahrgang | 4 |
Ausgabenummer | 7 |
Publikationsstatus | Veröffentlicht - 12 Juli 2018 |
Peer-Review-Status | Ja |
Externe IDs
PubMedCentral | PMC6145739 |
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Scopus | 85048290429 |
ORCID | /0000-0002-9321-9911/work/142251973 |
Schlagworte
Ziele für nachhaltige Entwicklung
Schlagwörter
- Colonic Neoplasms/genetics, Disease-Free Survival, Female, Humans, Male, Mutation, Neoplasm Staging, Prognosis, Proto-Oncogene Proteins B-raf/genetics, Proto-Oncogene Proteins p21(ras)/genetics