【摘要】 目的 KRAS基因突变是抗表皮生长因子受体(EGFR)治疗抵抗的重要预测因子,本文系统评价比较配对的转移性结直肠癌(mCRC)原发灶和转移灶KRAS基因状态以指导临床实践。方法通过PubMed和CNKI数据库检索所有符合检索条件的文献,末次检索日期为2010年5月30日,根据纳入和排除标准进一步筛选。采用Meta分析方法比较mCRC原发灶和转移灶中KRAS基因突变之间的差异。结果 11篇文献纳入Meta分析,553例患者配对有原发灶和非淋巴结转移灶。原发灶中KRAS基因的突变频率与转移灶相比差异无统计学意义(35.62%vs.37.25%,OR=0.93,95%CI0.73～1.19,P=0.57)。原发灶和转移灶KRAS基因突变不一致率为7%(0～14%)。结论 mCRC患者原发灶和转移灶中KRAS基因突变具有高度一致性,无论原发灶或非淋巴结转移灶KRAS基因突变都可作为EGFR单克隆抗体治疗选择靶标的组织来源。由于转移淋巴结KRAS突变的高度异质性,转移淋巴结并不适合用作突变检测分析。更多还原

【Abstract】 Objective KRAS mutations in primary colorectal cancer(CRC)are predictive of nonresponse to anti-epidermal growth factor receptor(EGFR)antibodies in patients with metastatic colorectal cancer(mCRC).The aim of our study was to perform a systematic review to compare the mutational status of KRAS in primary CRC and metastases,and further to guide clinical practice.Methods Systematic computerized searches of the PubMed and Medline databases(up to May 30,2010)meeting specified search criteria were performed,followed by a further screening according to inclusive and exclusive criteria.Results A total of 553 matched primary CRC and non-lymph node metastases were available for the analysis of the KRAS status from 11 articles.There was no statically significant difference in mutation frequency of KRAS between primary CRC and metastases,[35.62% vs.37.25%,odds radio(OR)=0.93(95% CI 0.73-1.19),P=0.57].The discordant rate of KRAS mutations in primary and metastatic tumor was 7%(0~14%).Conclusions The systematic analysis showed a high concordance of the KRAS mutation status in primary CRC and corresponding metastases.Either the primary CRC or the metastases seem to be appropriate for the routine analysis of the KRAS status before anti-EGFR antibody therapy.Due to the high rates of heterogeneity,lymph node metastases are not suitable for diagnostic mutation analysis.更多还原