结肠癌组织和转移灶中KRAS基因突变的临床意义.docVIP

结肠癌组织和转移灶中KRAS基因突变的临床意义 　　[摘要] 目的 研究晚期结肠癌组织与转移灶中KRAS基因突变对临床治疗和用药的意义。方法 整群收集该院 2014年1-12月手术的68例原发晚期结肠癌组织和转移灶。用直接测序法检测KRAS基因突变情况。结果 ①癌组织中KRAS基因突变率60.29%（41/68），转移灶为55.88%（38/68），癌组织的突变率高，二者差异无统计学意义（P0.05）。②肝转移KRAS基因突变率58.62%（34/58）较肺转移26.67%（4/15）患者高，差异有统计学意义（P0.05）；③癌组织与转移灶的KRAS基因突变同时存在的有36例，一致率为89.71%（61/68），一致性较高（Kappa=0.89）。结论 结直肠癌患者中，癌组织KRAS基因突变率高于转移灶，一致率为89.71%。KRAS基因突变提示侵袭转移风险高，易耐药复发预后不良。建议原发灶和转移灶同时检测。 　　[Abstract] Objective To research the significance of KRAS mutation in the colon cancer tissue and metastasis in late stage for the clinical treatment and mediation. Methods 68 cases of primary colon cancer tissues and metastases receiving operation in our hospital from January 2014 to December 2014 were collected and the KRAS mutation condition was detected by direct sequencing method. Results ①The KRAS mutation rate in the cancer tissues was higher than that in the metastases， 60.29%[41/68 vs 55.88%（38/68）]， the difference was not statistically significance （P0.05）.②the KRAS mutation rate in the liver metastasis was higher than that in the pulmonary metastasis， the difference was statistically significant （P0.05）.③The KRAS mutation in the cancer tissues and the KRAS mutation in the metastases coexisted in 36 cases， the consistency rate was 89.71%（61/68）， and the consistency was high （Kappa=0.89）. Conclusion The KRAS mutation rate in the cancer tissues is higher than that in the metastases for patients with colon cancer， the consistency rate is 89.71%， the KRAS mutation reminds that the risk of invasion and metastasis is high， and it is prone to drug resistant and recurrence and the prognosis is not good， it is suggested that the primary lesion and metastasis are detected at the same time. 　　[Key words] Colon cancer； KRAS mutation； Metastasis 　　随着对CRC发病分子机制和信号传导通路的深入研究，证明RAS信号通路激活与恶性肿瘤的发病、进展和恶性程度密切相关[1]。野生型KRAS基因可抑制癌细胞生长，一旦突变就会持续刺激细胞生长导致肿瘤发生。KRAS检测是目前筛选抗EGFR靶向药物治疗最有效直接的方法[2]。靶向药物耐药是恶性肿瘤存在的普遍现象，其耐药机制复杂为多种基因共同参与的结果。相关临床试验证实KRAS、BRAF突变型的患者出现耐药不能从抗EGFR治疗中获益