摘要
目的探讨基于精准医学与MDT模式在进展期或复发结直肠癌的临床治疗中的应用价值。方法收集进展期或复发的结直肠癌患者40例,采用免疫组化技术检测MLH1、MSH2表达水平,同时行RAS基因状态、BRAF基因状态检测,通过专科评估和多学科MDT模式并制定治疗治疗方案。结果40例患者中,MLH1、MSH2表达阳性者39例,MLH1、MSH2阴性者1例;MLH1、MSH2表达阳性两者之间具有较好的一致性,表达阳性率较高,占97.5%。在治疗上给予化疗联合靶向治疗,靶向治疗药物选择西妥昔抗或贝伐珠单抗;MSH1、MSH2表达缺失者联合免疫治疗和化疗。RAS基因野生型占29例,基因突变者11例;BRAF突变者3例,野生型占37例,RAS基因与BRAF基因状态不具有同步突变的概率。针对伴有基因突变的患者选择化疗联合贝伐珠单抗。针对精准医学检测及MDT会诊的结果,更改治疗方案有5例,占比12.5%;肿瘤的TNM分期及治疗策略均有所调整,但差异均无统计学意义(P>0.05)。结论进展期或复发结直肠癌进行精准医学检测和MDT协作,可提高肿瘤TNM分期的准确性及治疗方案的精准实施,应作为临床诊疗的参考要素。
Objective To explore the clinical study based on precision medicine and MDT model in advanced and/or recurrent colorectal cancer.Methods 40 cases with advanced or recurrent colorectal cancer were included.Results Among 40 patients,39 cases had positive MLH1 and MSH2 expression,and 1 case had negative MLH1 and MSH2 expression.MLH1 and MSH2 were positively expressed with a high positive rate,accounting for 97.5%.Chemotherapy combined with targeted therapy was given in the treatment which cetuximab or bevacizumab was selected as the targeted therapy drugs.MSH1 and MSH2 expression deficiency combined with immunotherapy and chemotherapy;RAS gene wild type accounted for 29 cases,gene mutation 11 cases,BRAF wild type accounted for 37 cases and mutation 3 cases,the positive rate was 7.5%.RAS gene and BRAF gene state did not have the probability of synchronous mutation.Chemotherapy combined with bevacizumab was selected for patients with genetic mutations.According to the results of precision medicine test and MDT consultation,5 cases(12.5%)changed their treatment plan.According to TNM staging of the tumor,and treatment strategies had been adjusted,and the differences were not statistically significant(P>0.05).Conclusion Accurate medical detection and MDT collaboration should be carried out for advanced or recurrent colorectal cancer,which can improve the precise implementation of treatment regimens and should be recommended as standard treatment in clinical practice.
作者
段训凰
李道生
曾祥胜
石春燕
邓建华
DUAN Xunhuang;LI Daosheng;ZENG Xiangsheng(The First People’s Hospital of Jiujiang,Jiujiang,332000)
出处
《实用癌症杂志》
2021年第5期844-846,共3页
The Practical Journal of Cancer
关键词
精准医学
MDT
结直肠癌
Precision medicine
MDT
Colorectal cancer
