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The Prognostic Impact of KRAS Mutation in Patients Having Curative Resection of Synchronous Colorectal Liver Metastases

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

m-KRAS has been recently reported to be a significant prognostic factor in patients undergoing resection of colorectal liver metastases. This is due to the lack of response to monoclonal epithelial growth factor receptor antibodies, and potentially as a result of a more aggressive tumor biology.

Methods

The National Cancer Database was queried to identify patients with known KRAS status presenting with colorectal cancer and liver metastases who underwent resection of the primary tumor and metastatic disease between 2010 and 2015.

Results

A total of 2655 patients were identified of which 1116 (42%) had m-KRAS. Tumor size, lymph node involvement rates, and margin status of the primary tumor were similar between patients with m-KRAS and wild-type KRAS (wt-KRAS). In the multivariable analysis, African-American race and right-sided colon cancers were independently associated with m-KRAS (both p < 0.001). m-KRAS patients had a significantly lower overall survival (OS) than those with wt-KRAS, with a 3- and 5-year OS of 51 vs. 64% and 31 vs. 42%, respectively (p < 0.001). After adjustment for available prognostic confounders, factors independently associated with worse OS were increasing age, receipt of monoagent chemotherapy, tumor size, positive lymph node, and resection margin status of the primary tumor, right-sided cancers, and m-KRAS.

Conclusions

m-KRAS is associated with worse OS in patients presenting with colorectal cancer and liver metastases undergoing resection of the primary tumor and metastatic disease. Right-sided lesions and African-American race were associated with m-KRAS. However, while right-sided remained an independent prognostic factor for OS, race did not.

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Authors and Affiliations

  1. Department of Surgery, University of Iowa Hospitals & Clinics, 200 Hawkins Drive, 1516 JCP, Iowa City, IA, 52242, USA

    Paolo Goffredo, Alan F. Utria, Anna C. Beck, James R. Howe, Ronald J. Weigel & Imran Hassan

  2. Department of Surgical Oncology, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA

    Yun Shin Chun & Jean-Nicolas Vauthey

Authors
  1. Paolo Goffredo
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  2. Alan F. Utria
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  3. Anna C. Beck
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  4. Yun Shin Chun
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  5. James R. Howe
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  6. Ronald J. Weigel
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  7. Jean-Nicolas Vauthey
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  8. Imran Hassan
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Contributions

Each author provided substantial contributions to the conception or design of the work or the acquisition, analysis, or interpretation of data for the work; drafted/revised the work critically for important intellectual content; approved the version to be published; and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Imran Hassan.

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Conflict of Interest

The authors declare that they have no conflict of interest.

Disclaimer

The data used in the study are derived from a de-identified NCDB file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data by the investigator.

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Goffredo, P., Utria, A.F., Beck, A.C. et al. The Prognostic Impact of KRAS Mutation in Patients Having Curative Resection of Synchronous Colorectal Liver Metastases. J Gastrointest Surg 23, 1957–1963 (2019). https://doi.org/10.1007/s11605-018-3978-4

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  • DOI: https://doi.org/10.1007/s11605-018-3978-4

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