Utilization of genetic biomarkers testing and its associated factors in advanced colorectal cancer patients in China: a nationwide multicenter clinical epidemiological study

Xi Zhang; Xue-Mei Lian; Xiao-Fen Gu; Yin Liu; Chang-Yan Feng; Li Li; Hui-Fang Xu; Jing-Chang Du; Yu-Qian Zhao; Li Ma; Yun-Yong Liu; Juan-Xiu Huang; Ji Cao; Xiao-Hui Wang; Ling-Bin Du; Shuang-Xia Duan; Wen-Jun Wang; Yan-Ping Fan; Yan-Qin Yu; Shao-Kai Zhang; Ji-Hai Shi; You-Lin Qiao; China Working Group on Colorectal Cancer Survey

doi:10.21037/atm-22-988

Utilization of genetic biomarkers testing and its associated factors in advanced colorectal cancer patients in China: a nationwide multicenter clinical epidemiological study

Ann Transl Med. 2022 Mar;10(6):324. doi: 10.21037/atm-22-988.

Authors

Xi Zhang¹, Xue-Mei Lian², Xiao-Fen Gu³, Yin Liu⁴, Chang-Yan Feng⁵, Li Li⁶, Hui-Fang Xu⁴, Jing-Chang Du⁷, Yu-Qian Zhao⁸, Li Ma⁹, Yun-Yong Liu¹⁰, Juan-Xiu Huang¹¹, Ji Cao¹², Xiao-Hui Wang¹³, Ling-Bin Du¹⁴, Shuang-Xia Duan¹⁵, Wen-Jun Wang¹⁶, Yan-Ping Fan¹⁷, Yan-Qin Yu¹⁸, Shao-Kai Zhang⁴, Ji-Hai Shi¹⁹, You-Lin Qiao^{4

20}; China Working Group on Colorectal Cancer Survey

Affiliations

¹ Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing Office for Cancer Prevention and Control, Peking University Cancer Hospital & Institute, Beijing, China.
² School of Public Health and Management, Chongqing Medical University, Chongqing, China.
³ Department of Student Affairs, Affiliated Tumor Hospital, Xinjiang Medical University, Ürümqi, China.
⁴ Department of Cancer Epidemiology, Affiliated Cancer Hospital of Zhengzhou University/Henan Cancer Hospital, Henan Engineering Research Center of Cancer Prevention and Control, Henan International Joint Laboratory of Cancer Prevention, Zhengzhou, China.
⁵ Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, China.
⁶ Department of Clinical Research, The First Affiliated Hospital, Jinan University, Guangzhou, China.
⁷ School of Public Health, Chengdu Medical College, Chengdu, China.
⁸ Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
⁹ Public Health School, Dalian Medical University, Dalian, China.
¹⁰ Liaoning Office for Cancer Control and Research, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China.
¹¹ Department of Gastroenterology, Wuzhou Red Cross Hospital, Wuzhou, China.
¹² Department of Cancer Prevention and Control Office, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
¹³ Department of Public Health, Gansu Provincial Cancer Hospital, Lanzhou, China.
¹⁴ Department of Cancer Prevention, The Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China.
¹⁵ Department of Preventive Health, Xinxiang Central Hospital, Xinxiang, China.
¹⁶ School of Nursing, Jining Medical University, Jining, China.
¹⁷ State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.
¹⁸ The Clinical Epidemiology of Research Center, Department of Public Health and Preventive Medicine, Baotou Medical College, Baotou, China.
¹⁹ The Clinical Epidemiology of Research Center, Department of Dermatology, The First Affiliated Hospital of Baotou Medical College, Baotou, China.
²⁰ Center for Global Health, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Abstract

Background: Biomarkers are a key tool in early detection, prognostication, survival, and predicting treatment response of colorectal cancer (CRC). However, little is known about biomarker testing for CRC patients in real-life clinical practice in China. This study aimed to address the usage of biomarker testing and analyze factors related to its acceptance among Chinese patients with advanced CRC.

Methods: A multicenter, cross-sectional, hospital-based clinical epidemiology study was conducted from March 2020 to March 2021. Nineteen hospitals were selected in seven geographical regions of China using stratified, multistage, nonrandomized cluster sampling. Data on demographics and clinical characteristics of each eligible CRC patient in stage III or IV diseases were recorded based on the patients' self-reporting and/or medical records. In addition, information on whether biomarker testing [RAS, BRAF, and microsatellite instability (MSI)] was performed, the results and timing for performing biomarker testing, and the reasons for refusing biomarker testing were also recorded. Univariate and multivariate logistic regression were conducted to explore the potential factors of biomarker testing.

Results: A total of 4,526 patients were enrolled in the study, of whom 41.4%, 36.1%, and 28.2% underwent RAS, BRAF, and MSI testing, respectively. RAS, BRAF, and high-level MSI (MSI-high) mutation rates in Chinese patients with advanced CRC were 37.0%, 9.9%, and 8.1%, respectively. The logistic regression analysis revealed that the treating hospital, age at diagnosis, education, family income, tumor site, history of chemotherapy and radiotherapy, and metastases were dependent factors affecting the utilization of biomarker testing in advanced CRC in China (P<0.005).

Conclusions: The biomarker testing rate, especially MSI testing, is less prevalent in clinical practice for patients with advanced CRC in China. Our findings may guide the formulation of biomarker testing of CRC strategies in China and other low-income countries.

Keywords: BRAF; Colorectal cancer (CRC); RAS; biomarker; microsatellite instability (MSI).