Τίτλος:
KRAS Mutation Status Dictates Optimal Surgical Margin Width in Patients Undergoing Resection of Colorectal Liver Metastases
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Background: The optimal tumor-free margin width remains controversial and may be inappropriate to investigate without considering differences in the underlying tumor biology. Methods: R1 resection was defined as margin clearance less than 1 mm. R0 resection was further divided into 3 groups: 1–4, 5–9, and ≥10 mm. The impact of margin width on overall survival (OS) relative to KRAS status [wild type (wtKRAS) vs. mutated (mutKRAS)] was assessed. Results: A total of 411 patients met inclusion criteria. Median patient age was 58 years (interquartile range, 49.7–66.7); most patients were male (n = 250; 60.8 %). With a median follow-up of 28.3 months, median and 5-year OS were 69.8 months and 55.1 %. Among patients with wtKRAS tumors, although margin clearance of 1–4 mm or more was associated with improved OS compared to R1 (all P < 0.05), no difference in OS was observed when comparing margin clearance of 1–4 mm to the 5–9 mm and the ≥10 mm groups (all P > 0.05). In contrast, among patients with mutKRAS tumors, all three groups of margin clearance (1–4, 5–9, and ≥10 mm) fared no better in terms of 5-year survival compared to R1 resection (all P > 0.05). Conclusions: While a 1–4 mm margin clearance in patients with wtKRAS tumors was associated with improved survival, wider resection width did not confer an additional survival benefit. In contrast, margin status—including a 1 cm margin—did not improve survival among patients with mutKRAS tumors. © 2016, Society of Surgical Oncology.
Συγγραφείς:
Margonis, G.A.
Sasaki, K.
Andreatos, N.
Kim, Y.
Merath, K.
Wagner, D.
Wilson, A.
Buettner, S.
Amini, N.
Antoniou, E.
Pawlik, T.M.
Περιοδικό:
Annals of Surgical Oncology
Εκδότης:
Springer New York LLC
Λέξεις-κλειδιά:
fluorouracil; irinotecan; oxaliplatin; KRAS protein, human; protein p21, adult; Article; cancer chemotherapy; cancer patient; cancer surgery; colorectal liver metastasis; female; gene mutation; human; liver resection; major clinical study; male; oncogene K ras; outcome assessment; overall survival; post treatment survival; surgical margin; aged; colorectal tumor; genetics; liver resection; liver tumor; middle aged; mutation; pathology; prognosis; secondary; surgical margin; survival rate, Aged; Colorectal Neoplasms; Female; Hepatectomy; Humans; Liver Neoplasms; Male; Margins of Excision; Middle Aged; Mutation; Prognosis; Proto-Oncogene Proteins p21(ras); Survival Rate
DOI:
10.1245/s10434-016-5609-1
