Primary tumor location and survival in colorectal cancer: A retrospective cohort study

• 作者: Afsaneh Barzi David Lenis Himani Aggarwal Kristin M Sheffield Li Li Rachael Sorg Rebecca Miksad
• 来源期刊: 世界胃肠肿瘤学杂志:英文版(电子版)
• 学科: 医学
• 关键词: BEVACIZUMAB CETUXIMAB COHORT study Colorectal neoplasms Electronic health records Prognosis RETROSPECTIVE studies SURVIVAL
• 年，卷（期）: 2020,（4）
• 页码范围: 405-423
• 页数: 19页
• 分类号: R735.34

摘要

BACKGROUND Primary tumor location is a prognostic factor for metastatic colorectal cancer(m CRC).Post hoc analyses of m CRC clinical trials,including FIRE-3,CALGB/SWOG 80405,suggest that primary tumor location is also predictive of survival benefit with cetuximab or bevacizumab in combination with 5-fluorouracil-based chemotherapy.AIM Evaluate prognostic/predictive roles of primary tumor location in real-world m CRC patients treated with cetuximab or bevacizumab plus 5-fluorouracil-based chemotherapy.METHODS This retrospective cohort study selected patients with KRAS wild-type m CRC who initiated first-line therapy with cetuximab or bevacizumab in combination with 5-fluorouracil/leucovorin/irinotecan(FOLFIRI)or 5-fluorouracil/leucovorin/oxaliplatin(FOLFOX)between January 2013 and April 2017 from the Flatiron Health electronic health record-derived database of de-identified patientlevel data in the United States.Primary tumor location was abstracted from patients’charts.Left-sided primary tumor location(LPTL)was defined as tumors that originated in the splenic flexure,descending colon,sigmoid colon,or rectum;right-sided primary tumor location(RPTL)was defined as tumors that originated from the appendix,cecum,ascending colon,hepatic flexure,or transverse colon.Propensity score matching was used to balance the baseline demographic and clinical characteristics between patients treated with cetuximab and patientstreated with bevacizumab.Kaplan-Meier and Cox regression methods were used for survival analyses.RESULTS A total of 1312 patients met the selection criteria.Of 248 cetuximab plus FOLFIRI or FOLFOX patients,164 had LPTL and 84 had RPTL;of 1064 bevacizumab plus FOLFIRI or FOLFOX patients,679 had LPTL and 385 had RPTL.Cetuximab LPTL and RPTL patients were more likely to receive FOLFIRI vs bevacizumab patients(LPTL:64.0%vs 24.3%;RPTL:76.2%vs 24.9%,P<0.001).Stage at initial diagnosis was different between cetuximab RPTL vs bevacizumab RPTL patients(P<0.001);cetuximab RPTL patients were more likely to have stage I