Abstract
Although serum tumor markers (STMs), clinicopathological characteristics and the status of KRAS and MMR play an important role in optimizing the treatment and prognosis of colorectal cancer, their interrelationships remain largely unknown. A retrospective analysis of 2279 patients who tested for KRAS and MMR status, and STM measurements prior to treatment over the past four years was conducted. Of the 784 patients tested for KRAS and 2279 patients tested for MMR status, KRAS mutations and dMMR were identified in 276 patients (35.20%) and 177 patients (7.77%), respectively. Logistic regression analysis demonstrated that right colon, well and moderate differentiation and negative CA19-9 were independent predictors for KRAS mutations. The ROC curve yielded an AUC of 0.609 through the combination of these three factors. Age < 65 was an independent predictive factor for dMMR, along with tumor size > 4.6 cm, right colon, poor differentiation, harvested lymph nodes ≥ 22, no lymph node metastasis, no perineural invasion, negative CEA and positive CA72-4. When the nine criteria were used together, the AUC was 0.849. In summary, both STMs and clinicopathological characteristics were found to be significantly associated with the status of KRAS and MMR. The combination of these two factors possessed a strong predictive power for KRAS mutations and dMMR among CRC patients.
Highlights
Colorectal cancer (CRC) is the third most common type of cancer and the second leading cause of cancer-related death worldwide [1]
Of the 2279 patients tested for mismatch repair (MMR) status, dMMR were identified in 177 patients (7.77%)
Items were included in the multivariate analysis only when P value
Summary
Colorectal cancer (CRC) is the third most common type of cancer and the second leading cause of cancer-related death worldwide [1]. CRC imposes a substantial burden on the healthcare system, with the direct costs of CRC accounting for close to 10% and 12% of all direct cancer-related costs across the European Union [2] and the United States [3], respectively. It has been estimated that more than 20% of patients present with metastatic CRC (mCRC), and approximately half of patients with localized CRC will develop metastases [4]. In the majority of mCRC, tumor lesions tend to be unresectable, and chemotherapy is recommended to prolong survival and improve symptoms. Fluoropyrimidine-based chemotherapy regimens and monoclonal antibodies directed against epidermal growth factor receptor (EGFR) are approved for first-line treatment of the disease. Molecular testing for KRAS and mismatch repair (MMR) status are mandatory to optimize the choice and sequencing of therapy [5]
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