诊断时循环瘤DNA的预后值及其在晚期上皮卵巢卵巢癌患者新辅助化疗一周期后的早期下降. 对CHIVA第二阶段GINECO试验的辅助分析
Henri Azaïs1, Camille Brochard2, Valérie Taly3
1AP-HP (Assistance Publique des Hôpitaux de Paris), Department of Gynaecological Oncological and Breast Surgery, Hôpital Européen Georges-Pompidou, Paris, France; Université de Paris Cité, Paris CARPEM Cancer Institute, Paris, France; INSERM UMR-S 1147, University of Paris Cité, Centre de Recherche des Cordeliers, Paris, France.
Gynecologic oncology
|December 13, 2024
概括
在晚期卵巢癌中,在化疗后早期检测循环瘤DNA (ctDNA) 减少预测了更好的生存率. 这一发现使得患者获得更准确的信息,并为细胞还原性手术 (CRS) 进行准备.
科学领域:
- 在瘤学瘤学.
- 分子诊断学 分子诊断
- 基因组学就是基因组学.
背景情况:
- 先进的上皮卵巢癌 (EOC) 带来了重大的治疗挑战.
- 新辅助化疗 (NACT) 是高级EOC的标准治疗方法.
- 预后标记对于指导治疗决策和患者管理至关重要.
研究的目的:
- 在诊断时 (T0) 评估循环瘤DNA (ctDNA) 检测的预后价值.
- 评估NACT (T1) 一个周期后早期ctDNA水平下降对患者结局的影响.
- 为了将ctDNA动力学与晚期EOC中无进展生存率 (PFS) 和总生存率 (OS) 相关联.
主要方法:
- 在CHIVA试验中,从高级EOC患者的T0和T1收集的血液样本.
- 使用下一代测序进行ctDNA检测.
- 多变量分析和Cox生存模型来确定PFS和OS的预后因素.
主要成果:
- 168名患者中有107名 (63.7%) 在T0.0时具有可检测的ctDNA.
- 160名患者中有137名 (85.6%) 呈现出负ctDNA或在T1.0下降>80%.
- 早期ctDNA下降与改善的PFS (p=0.0017) 和OS (p=0.0036) 显著相关.
- 有利的ctDNA动力学预测了成功的细胞还原性手术 (CRS) 的更高可能性 (OR:3.94).
结论:
- 在NACT后ctDNA比率的早期降低在先进的EOC中提供了重要的预后信息.
- ctDNA动力学可以指导早期患者管理,并为有关预后的讨论提供信息.
- 这种标志物有助于及时为CRS做好准备,可能改善手术结果.
相关概念视频
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02:07Tumor Progression
Tumor progression is a phenomenon where the pre-formed tumor acquires successive mutations to become clinically more aggressive and malignant. In the 1950s, Foulds first described the stepwise progression of cancer cells through successive stages.
Colon cancer is one of the best-documented examples of tumor progression. Early mutation in the APC gene in colon cells causes a small growth on the colon wall called a polyp. With time, this polyp grows into a benign, pre-cancerous tumor. Further...
Colon cancer is one of the best-documented examples of tumor progression. Early mutation in the APC gene in colon cells causes a small growth on the colon wall called a polyp. With time, this polyp grows into a benign, pre-cancerous tumor. Further...