2009ASCO结肠癌进展.ppt

2009ASCO结肠癌进展 南昌大学第一附属医院肿瘤科 黎军和 分子指标预测Ⅱ期结肠癌高危复发 大型研究结果 Ceteximab疗效的预测 结肠癌辅助化疗终点 Oxaliplatin相关 synchronous stage IV colorectal cancer 化疗策略和方案的调整 其它 分子指标预测结肠癌高危复发及指导化疗 Abr4000 高通量 Abr4001MSI Abr 4002 Abr 4012 18q LOH Background: NSABP C-01/C-02 、CCF 、 C-04 、C-06 48 genes significantly associated with recurrence risk and 66 genes predictive of 5FU/LV benefit . Multivariate analysis yielded 18 genes (7 prognostic genes, 6 predictive genes, 5 reference genes) and separate prognostic recurrence score (RS) and predictive treatment score (TS) algorithms. Methods: Gene expression was quantitated by RT-PCR . Recurrence-free interval (RFI), disease-free survival (DFS), and overall survival (OS) were analyzed using Cox regression Results: In the QUASAR validation study the RS predicted recurrence risk (p=0.004). The RS also predicted DFS (p=0.01) and OS (p=0.04). Recurrence risk increased monotonically with increasing RS. In multivariate analyses, RS retained prognostic significance (p=0.008) independent of mismatch repair (MMR), T stage, nodes examined, grade, and lymphovascular invasion. MMR deficiency (p0.001) and T4 stage (p=0.005). However, TS was not validated as a predictor of 5FU/LV benefit Conclusions:RS is a validated, independent predictor of individualized recurrence risk for stage II colon cancer To investigate the incidence of MSI-H in stage II (n=395) and stage III (n=859) COC, its association with histopathological variables and its prognostic and predictive impact 。 Patients：PETACC 3-EORTC 40993-SAKK 60/00 trial Results：MSI H was present in 22% (85) of Stage II and 12% (103)of Stage III colon cancer.Microsatellite instability is a strong prognostic factor for RFS and OS when considering Stage II and Stage III COC. Subgroup analysis suggests a stronger effect in Stage II than in Stage III. There is no evidence for an effect of the addition of IRI.  Object:To compare the incidence of molecular markers in stage II (SII) and III (SIII) colon cancer a