基于FOLFOX的辅助化疗 (联盟N0147) 的第三阶段试验中的组织自由循环瘤DNA检测和患者结果
Frank A Sinicrope1,2, Diana Segovia3, Nalin Sharma2
1Department of Oncology, Mayo Clinic, Rochester, MN.
概括
在第三阶段结肠癌 (CC) 手术后检测循环瘤DNA (ctDNA) 可以准确预测复发和存活率. 这种分子残留疾病检测为指导辅助治疗决策提供了有价值的预后信息.
科学领域:
- 在瘤学瘤学.
- 分子诊断学 分子诊断学
- 基因组学就是基因组学.
背景情况:
- 循环瘤DNA (ctDNA) 检测正在成为评估分子残留疾病的工具.
- 术后风险分层和辅助治疗指导在第三阶段结肠癌 (CC) 中至关重要.
研究的目的:
- 为了评估一个无组织的预后价值,表观基因组ctDNA测定在III期CC.患者.
- 评估ctDNA与无病存活率 (DFS),复发时间 (TTR) 和整体存活率 (OS) 的关联.
主要方法:
- 在辅助化疗前,从2,260名手术后患者收集了血样本.
- 使用无组织ctDNA测定进行分析,在ctDNA阳性病例中量化瘤分数 (TF) 和基因型.
- 多变量考克斯模型评估了与生存结果的关联.
主要成果:
- ctDNA阳性 (20.4%) 与较短的TTR,DFS和OS (所有P < .0001) 独立相关.
- 在ctDNA阳性 (27.7%) 与ctDNA阴性 (77.1%) 患者中,5年DFS显着较低.
- 在ctDNA阳性患者中,较高的TF和特定突变 (例如FLT1,PREX2) 与较差的结果相关.
结论:
- 无组织ctDNA测定在切除的III期CC中提供了强大的预后价值.
- ctDNA负担,dMMR状态和特定突变确定了高风险患者群体.
- ctDNA评估可以完善风险分层,并为辅助治疗策略提供信息.
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