Şahin LAÇİN, Muhammet Ali KAPLAN, Hüseyin BÜYÜKBAYRAM, Nadiye AKDENİZ, Abdurrahman IŞIKDOĞAN, Mehmet KÜÇÜKÖNER, Yasin SEZGİN, Oğur KARHAN, Erkan BİLEN, Senar EBİNÇ, Zuhat URAKÇI

RAS mutant metastatik kolorektal kanserde primer tümör yerleşiminin prognostik önemi

Amaç: RAS wild metastatik kolorektak kanser (KRK) tanılı hastalarda tümör lokalizasyonun prognostik önemi hakkında çok sayıda çalışma bildirilmiştir. Ancak RAS mutant hastalar ile ilgili yeterli sayıda çalışma bulunmamaktadır. Bu çalışmada RAS mutant metastatik KRK tanılı hastalarda tümör yerleşim yerinin prognostik önemini belirlemeyi amaçladık. Yöntemler: Bu retrospektif çalışmaya hastanemizde 2011 ve 2017 yılları arasında tanı alan RAS mutant metastatik KRK tanılı 57 hasta dahil edildi. Hasta özellikleri hastane kayıt sistemindeki verilerden elde edildi. KRAS veya NRAS mutasyonu saptanan hastalar dahil edildi. Bulgular: Hastalardan 29 ’u (%50,9) kadın olup ortanca yaş 52 (18-80) idi. Primer tümör, hastaların 40’ında (%70,2) sol kolon ve 17’sinde (%29,8) sağ kolonda yerleşim göstermekteydi. Yirmi beş (%43,9) hasta oxaliplatin temelli ve 32 (%56,1) hasta da irinotekan temelli kemoterapi almıştı. Primer tümör lokalizasyonuna göre progresyonsuz sağkalım (PSK) ve genel sağkalım (GSK) süreleri arasında istatiksel anlamlı fark saptanmadı (PSK sol kolonda 10.9 ay, sağ kolonda 8.1 ay, p=0.400 ve GSK sol kolonda 20.9 ay, sağ kolonda 20.8 ay, p=0.930). Oxaliplatin temelli tedavi alan hastaların irinotekan temelli tedavi alanlara göre GSK ’larının daha iyi olduğu görüldü (28.7 ay,16.3 ay, sırası ile p=0.017). Sonuç: Çalışmamızda metastatik KRK hastalarında primer tümör yerleşim yerine göre guruplar arasında PSK ve GSK açısından fark saptanmadı. Ancak, bulgularımız bu hasta alt gurubu için standart yaklaşımın belirlenmesi için daha büyük hasta popülasyonları ve alt grup analizleri ile potansiyel prognostik ve moleküler özelliklerin değerlendirildiği çalışmalara olan ihtiyacın altını çizmektedir.

Prognostic importance of primary tumor location in RAS mutant metastatic colorectal cancer

Objective: The prognostic value of tumor location in patients with metastatic colorectal cancer (mCRC) was reportedby recent analyses in RAS wild-type patients. However, there is no enough specific data regarding prognostic value ofprimary tumor location in RAS mutated mCRC patients. We aimed to find if there is any relation between tumorprognosis and primary tumor location in patients with RAS mutated mCRC.Method: This retrospective study included 57 patients with mCRC who were diagnosed and treated in our hospitalbetween January 2011 and December 2017. Characteristics features of the patients were obtained from ourinstitution patient medical records. Patients were included to the present study if KRAS or NRAS mutation wasdetected in tumor tissues. Results: Twenty-nine (50.9%) of patients were female and the median age of all patients was 52 (18-80) years. Forty(70.2%) of 57 patients were defined as left side (LS) and 17 (29.8%) of patients were located in the right side (RS). Asfirst line systemic treatment, twenty-five (43.9%) patients had received oxaliplatin-based chemotherapy while 32(56.1%) patients had received irinotecan-based chemotherapy. Tumor sidedness did not affect on progression-freesurvival (PFS) (mPFS, 10.9 months for LS vs 8.1 months for RS, p=0.400) and overall survival (OS) (mOS, 20.9 monthsfor LS vs 20.8 months for RS, p=0.930).The patients who had oxaliplatin based chemotherapy regimens showedbetter OS rate than irinotecan based regimens (28.7months vs16.3 months, p=0.017, respectively).Conclusion: Our study results support the thought that claims the sidedness of primary CRC in metastatic setting doesnot have effect on PFS and OS in patients with RAS mutant mCRC. However, our findings also underline the necessityof studies with larger patient populations and subgroup analyzes to evaluate potential prognostic and molecularfeatures to determine the standart approach to this specific subgroup of the disease.

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