中医干预化疗失败后晚期结直肠癌ctDNA状态及预后相关性研究

Study on traditional Chinese medicine in treating advanced colorectal cancer after chemotherapy failure ctDNA status and prognosis correlation

目的:通过对中医干预的化疗失败后晚期结直肠癌患者行ctDNA检测,探索ctDNA与预后的关系。方法:采用高通量二代基因测序(NGS)技术对血样进行检测。结果:在所有接受中医治疗的患者中,ctDNA低突变组较高突变组生存期较长(P=0.015)。KRAS突变者较KRAS野生型预后更差(P=0.015)。TP53基因突变,在左右半结肠中有显著差异(P=0.045),在是否合并肝转移方面具有显著差异(P=0.022),转移器官数目≥2的患者突变更多(P=0.049),脾肾两虚型TP53突变明显多于非脾肾两虚型(P=0.017)。APC基因在是否合并肝转移方面具有显著差异(P=0.025)。KRAS基因突变,有肝转移者更高(P=0.048),器官转移数目≥2的患者突变发生比例更高(P=0.006)。结论:ctDNA突变频率及KRAS基因状态可以预测中医治疗化疗失败后晚期肠癌的生存预后。

Objective:ctDNA was detected in patients with advanced colorectal cancer after chemotherapy failure who treated with prognosis,to explore the relationship between ctDNA and the efficacy of traditional Chinese medicine(TCM).Methods:Next-Generation Sequencing(NGS)was used to detect blood samples.Results:Among all patients receiving TCM treatment,the low-mutation ctDNA group had a longer survival compared with the high-mutation group(P=0.015).The prognosis of KRAS mutant patients was worse than that of wild type KRAS(P=0.015).TP53 gene was statistically significant in the left and right hemicolon(P=0.045).There were significant differences in the presence or absence of liver metastases(P=0.022).Patients with metastatic organ number≥2 had more mutations(P=0.049).The TP53 mutation of spleen-kidney deficiency type was significantly more than non-spleen-kidney deficiency type(P=0.017).There was a statistical difference between APC gene and liver metastasis(P=0.025).The number of patients with KRAS gene mutations and liver metastases was higher(P=0.048).Patients with metastatic organ number≥2 occured at a higher rate(P=0.006).Conclusion:ctDNA mutation frequency and KRAS gene status can predict the survival prognosis of advanced colorectal cancer after chemotherapy failure.