Abstract：
BRAF V600E mutant-metastatic colorectal cancer (mCRC) is characterized by its short survival time. Treatment approaches vary depending on whether or not the metastases are initially resectable. The benefit of metastasectomy remains unclear, and the optimal first-line treatment is controversial. This study aimed to describe the prognosis of BRAF V600E mutant-mCRC, analyze the recurrence pattern in resectable patients, and explore the optimal first-line treatment for unresectable patients.
Patients diagnosed with BRAF V600E mutant-mCRC between February 2014 and January 2022 in five hospitals were enrolled. Date on clinical and pathological characteristics, treatment features, and survival outcomes were collected.
Of the 220 included patients, 64 initially resectable patients had a significantly longer overall survival (OS) (37.07 vs. 20.20 months, P < 0.001) than initially unresectable patients. Of 156 unresectable patients, 54 received doublet (FOLFOX, XELOX or FOLFIRI) or triplet (FOLFOXIRI) chemotherapies (Chemo), 55 received Chemo plus Bevacizumab (Chemo+Bev), and 33 received vemurafenib plus cetuximab and irinotecan (VIC). The VIC regimen had a better progression-free survival (PFS) (12.70 months) than the Chemo (6.70 months, P < 0.001) and Chemo+Bev (8.8 months, P = 0.044) regimens. Patients treated with VIC had the best overall response rate (60.16%, P < 0.001), disease control rate (93.94%, P < 0.001) and conversional resection rate (24.24%, P = 0.003).
Metastasectomy is beneficial to the survival of patients with BRAF V600E mutant-mCRC. For initially unresectable patients, VIC as first-line therapy is associated with a better prognosis and efficacy than doublet and triplet chemotherapy with or without bevacizumab.
Patients diagnosed with BRAF V600E mutant-mCRC between February 2014 and January 2022 in five hospitals were enrolled. Date on clinical and pathological characteristics, treatment features, and survival outcomes were collected.
Of the 220 included patients, 64 initially resectable patients had a significantly longer overall survival (OS) (37.07 vs. 20.20 months, P < 0.001) than initially unresectable patients. Of 156 unresectable patients, 54 received doublet (FOLFOX, XELOX or FOLFIRI) or triplet (FOLFOXIRI) chemotherapies (Chemo), 55 received Chemo plus Bevacizumab (Chemo+Bev), and 33 received vemurafenib plus cetuximab and irinotecan (VIC). The VIC regimen had a better progression-free survival (PFS) (12.70 months) than the Chemo (6.70 months, P < 0.001) and Chemo+Bev (8.8 months, P = 0.044) regimens. Patients treated with VIC had the best overall response rate (60.16%, P < 0.001), disease control rate (93.94%, P < 0.001) and conversional resection rate (24.24%, P = 0.003).
Metastasectomy is beneficial to the survival of patients with BRAF V600E mutant-mCRC. For initially unresectable patients, VIC as first-line therapy is associated with a better prognosis and efficacy than doublet and triplet chemotherapy with or without bevacizumab.
摘要：
背景：BRAFV600E突变型转移性结直肠癌（mCRC）的特点是生存时间短。治疗方法取决于转移最初是否可切除。转移瘤切除术的益处尚不清楚，最佳的一线治疗方法是有争议的。本研究旨在描述BRAFV600E突变-mCRC的预后，分析可切除患者的复发模式，探索不可切除患者的最佳一线治疗方案。
方法：纳入2014年2月至2022年1月在5家医院诊断为BRAFV600E突变-mCRC的患者。临床和病理特征日期，治疗特点,并收集生存结果。
结果：在纳入的220名患者中，64例最初可切除的患者的总生存期（OS）明显更长（37.07vs.20.20个月，P<0.001）比最初不可切除的患者。在156名无法切除的患者中，54收到双打（FOLFOX，XELOX或FOLFIRI）或三联（FOLFOXIRI）化疗（化疗），55例接受化疗加贝伐单抗（化疗+贝夫），33人接受了维罗非尼联合西妥昔单抗和伊立替康（VIC）。VIC方案的无进展生存期（PFS）（12.70个月）优于化疗（6.70个月，P<0.001)和化疗+Bev(8.8个月，P=0.044）方案。接受VIC治疗的患者总体反应率最好（60.16％，P<0.001)，疾病控制率（93.94%，P<0.001）和转化切除率（24.24％，P=0.003)。
结论：转移切除术有利于BRAFV600E突变-mCRC患者的生存。对于最初无法切除的患者，VIC作为一线治疗比有或没有贝伐单抗的双联和三联化疗具有更好的预后和疗效。
方法：纳入2014年2月至2022年1月在5家医院诊断为BRAFV600E突变-mCRC的患者。临床和病理特征日期，治疗特点,并收集生存结果。
结果：在纳入的220名患者中，64例最初可切除的患者的总生存期（OS）明显更长（37.07vs.20.20个月，P<0.001）比最初不可切除的患者。在156名无法切除的患者中，54收到双打（FOLFOX，XELOX或FOLFIRI）或三联（FOLFOXIRI）化疗（化疗），55例接受化疗加贝伐单抗（化疗+贝夫），33人接受了维罗非尼联合西妥昔单抗和伊立替康（VIC）。VIC方案的无进展生存期（PFS）（12.70个月）优于化疗（6.70个月，P<0.001)和化疗+Bev(8.8个月，P=0.044）方案。接受VIC治疗的患者总体反应率最好（60.16％，P<0.001)，疾病控制率（93.94%，P<0.001）和转化切除率（24.24％，P=0.003)。
结论：转移切除术有利于BRAFV600E突变-mCRC患者的生存。对于最初无法切除的患者，VIC作为一线治疗比有或没有贝伐单抗的双联和三联化疗具有更好的预后和疗效。
