Impacts of microsatellite status, RAS and BRAF mutation on postoperative follow-up strategy in stage II( and III( colorectal cancer / 中华胃肠外科杂志

ABSTRACT

Colorectal cancer is the third tumor in the world, and nearly half of the stage II( and III( patients undergoing radical resection develop relapse. At present, the survival benefit of follow-up strategy is still unclear, partly due to the neglect of the risk of recurrence and the factors affecting prognosis. Studies found that microsatellite status, BRAF and RAS genotype had certain value for prognosis of colorectal cancer patients after radical resection, but there were differences in prediction among these three factors. Patients with high-frequency microsatellite instability in stage II( have good prognosis, so the follow-up strategy in this set of patients can be appropriately simplified. Locally advanced colorectal cancer patients with BRAF-V600E mutations usually have poor survival after recurrence, and survival benefit appears minimal by intensive follow-up strategy. Besides, standard follow-up strategy, or less intensive follow-up strategy seems an acceptable option for patients with this subtype. In contrast, for patients with wild-type BRAF and RAS in stage II( or III(, the prognosis is usually good after recurrence. Such patients are sensitive to both systemic treatment and local therapy. Therefore, for patients with wild-type BRAF and RAS, early detection of recurrence by intensive follow-up strategy can potentially increase the possibility of second radical resection and prolong survival. It is of clinical significance to explore the feasibility of individualized follow-up strategy for patients with different biological characteristics. In addition, the establishment of individual risk prediction model should take clinical, pathological and molecular features into consideration. Combination of TNM staging and molecular markers for more stratified management and establishment of individualized follow-up system are clinically meaningful in the future.