Differential Radiographic Appearance of BRAF V600E–Mutant Metastatic Colorectal Cancer in Patients Matched by Primary Tumor Location
Open accessAbstract
BACKGROUND: BRAF-mutant metastatic colorectal cancers (mCRCs) share many clinicopathologic features with right-sided colon tumors, including frequent peritoneal involvement. Because of the poorer outcomes associated with BRAF mutations, early enrollment in clinical trials has been encouraged. However, the use of standard eligibility and assessment criteria, such as measurable disease, has anecdotally impeded patient accrual and restricted appraisal of treatment response. We investigated whether the presence of a BRAF V600E mutation is differentially associated with sites and appearance of metastatic disease in patients matched by primary tumor location. METHODS: A total of 40 patients with BRAF-mutant mCRC were matched to 80 patients with BRAF wild-type mCRC by location of primary tumor (right or left colon; rectum), sex, and age. Associations between BRAF mutation status and clinicopathologic characteristics and metastatic sites were analyzed using proportion tests. Survival was summarized with Kaplan-Meier and Cox regression methods. RESULTS: The distribution of primary tumor locations was: 60% right colon, 30% left colon, and 10% rectum. Compared with BRAF wild-type tumors, BRAF-mutant tumors more commonly associated with peritoneal metastases (50% vs 31%; P=.045) and ascites (50% vs 24%; P=.0038). In patients with left colon primaries, BRAF mutations were associated with more frequent ascites (58% vs 12%; P=.0038) and less frequent liver metastases (42% vs 79%; P=.024). Among patients with right colon primaries, no significant difference in sites of disease by BRAF mutation status was observed. Disease was not measurable by RECIST 1.1 in 24% of patients with right-sided primary tumors, irrespective of BRAF mutation status. In the BRAF-mutated cohort, ascites correlated unfavorably with survival (hazard ratio, 2.35; 95% CI, 1.14, 4.83; P=.02). CONCLUSIONS: Greater frequency of ascites and peritoneal metastases, which pose challenges for RECIST 1.1 interpretation of therapeutic outcomes, are seen with BRAF-mutant mCRC, even when patients are matched for primary tumor location.
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Although a higher percentage of men enrolled compared to most prior mindfulness interventions for integrative cancer care, the evaluable study sample included a greater proportion of younger (age <50), female, White and Latino or Hispanic patients relative to the underlying population.
“Although a higher percentage of men enrolled compared to most prior mindfulness interventions for integrative cancer care [34], the evaluable study sample included a greater proportion of younger (age <50), female, White and Latino or Hispanic patients relative to the underlying population [44, 53].”
From Being present: A single-arm feasibility study of audio-based mindfulness meditation for colorectal cancer patients and caregivers (2018) · cites this paper as [53]
The Results (Clinicopathologic Characteristics; page not provided) describe age and sex in a cohort of patients with BRAF-mutant metastatic colorectal cancer, not the evaluable mindfulness-study sample. The Background discusses demographic associations with BRAF mutations, but our copy does not compare that mindfulness sample with an underlying population or report its White and Latino or Hispanic proportions. Searched for those demographic terms and the claimed sample comparison. (LLM, conf=0.78)
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References 40 · Cited by 21
- Authors
- Atreya, C. E., Greene, C., McWhirter, R. M., Ikram, N. S., Allen, I. E., Van Loon, K., Venook, A. P., Yeh, B. M., & Behr, S. C.
- Affiliations
- University of California, San Francisco (US)
- Venue
- Journal of the National Comprehensive Cancer Network
- Publisher
- Harborside Press, LLC
- Published
- 2016-12
- Volume
- 14
- Issue
- 12
- Pages
- 1536-1543
- ISSN
- 1540-1405 (ISSN-L)
- 1540-1413
- PMC
- PMC5551390
- OpenAlex
- W2563122469
- Cited by
- 21
- References
- 40
- Citations by year
- 2024: 3 · 2023: 6 · 2021: 3 · 2020: 3 · 2018: 4 · 2017: 2
- FWCI
- 1.08
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the National Comprehensive Cancer Network (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institutes of Health
- National Cancer Institute (K08CA127143, K08CA175153)
- Topics
- Health Sciences › Medicine › Oncology › Colorectal Cancer Treatments and Studies
- Health Sciences › Medicine › Oncology › Colorectal Cancer Surgical Treatments
- Health Sciences › Medicine › Pathology and Forensic Medicine › Genetic factors in colorectal cancer
- Keywords
- BRAF V600E mutation, metastatic colorectal cancer, right-sided colon cancer, left-sided colon cancer, rectal cancer, peritoneal carcinomatosis, ascites, liver metastasis, RECIST 1.1, radiographic appearance, measurable disease, survival
- MeSH terms
- Adult, Aged, Aged, 80 and over, Ascites, Female, Humans, Liver Neoplasms, Male, Middle Aged, Mutation, Peritoneal Neoplasms, Prognosis, Retrospective Studies, Tomography, X-Ray Computed, Biomarkers, Tumor, Colorectal Neoplasms, Incidence, Proportional Hazards Models, Treatment Outcome, Proto-Oncogene Proteins B-raf, Kaplan-Meier Estimate, Young Adult
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