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The prognostic value of KRAS mutation in locally advanced rectal cancer

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

The prognostic value of the KRAS proto-oncogene mutation in colorectal cancer has been debated. Herein, we analyzed the National Cancer Database (NCDB) to assess the role of KRAS mutation as a prognostic marker in patients with locally advanced rectal cancer (LARC).

Methods

We identified LARC patients treated with neoadjuvant chemoradiation from 2004–2015 excluding those with stage I/IV disease and unknown KRAS status. Multivariable logistic regression identified variables associated with KRAS positivity. Propensity adjusted univariable and multivariable analyses identified predictors of survival.

Results

Of the 784 eligible patients, 506 were KRAS-negative (KRAS −) and 278 were KRAS-positive (KRAS +). Median survival was 63.6 months and 76.3 months for KRAS + and KRAS − patients respectively, with propensity adjusted 3 and 5-year survival of 79.9% vs. 83.6% and 56.7% vs. 61.9% respectively (HR 1.56, p 1.074–2.272). Male sex, no insurance, and KRAS + disease were associated with poorer survival on unadjusted and propensity adjusted multivariable analyses.

Conclusions

Our analysis of KRAS + LARC suggest that KRAS + disease is associated with poorer overall survival. Given the inherent limitations of retrospective data, prospective validation is warranted.

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Data availability

Authors VB and RW had full access to all the data in the study. We take full responsibility for the integrity of the data and the accuracy of the analysis as well as sharing the data with any interested investigators.

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Authors and Affiliations

  1. Department of Internal Medicine, Allegheny Health Network, 320 E. North Avenue, Pittsburgh, PA, 15212, USA

    Palash Asawa

  2. Division of Medical Oncology, Allegheny Health Network Cancer Institute, 320 E. North Avenue, Pittsburgh, PA, 15212, USA

    Veli Bakalov, Pragnan Kancharla & Dulabh K. Monga

  3. Division of Radiation Oncology, Allegheny General Hospital, Allegheny Health Network Cancer Institute, Level 02, 320 E. North Avenue, Pittsburgh, PA, 15212, USA

    Stephen Abel, Alexander V. Kirichenko & Rodney E. Wegner

  4. Markey Cancer Center, University of Kentucky, 800 Rose St, Lexington, KY, 40536, USA

    Zena Chahine

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  1. Palash Asawa
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  4. Stephen Abel
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Contributions

Palash Asawa: conceptualization, methodology, writing—original draft. Veli Bakalov: conceptualization, methodology, formal analysis, investigation, writing—original draft, review and editing, visualization. Zena Chahine: conceptualization, methodology, writing—review and editing. Stephen Abel: conceptualization, methodology, writing—review and editing. Pragnan Kancharla: conceptualization, methodology, writing—review and editing. Dulabh K. Monga: conceptualization, methodology, writing—review and editing. Alexander V. Kirichenko: conceptualization, methodology, writing—review and editing. Rodney Wegner: conceptualization, methodology, formal analysis, investigation, software resources, writing—original draft, review and editing, visualization, project administration.

Corresponding author

Correspondence to Rodney E. Wegner.

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The authors declare no competing interests.

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Asawa, P., Bakalov, V., Kancharla, P. et al. The prognostic value of KRAS mutation in locally advanced rectal cancer. Int J Colorectal Dis 37, 1199–1207 (2022). https://doi.org/10.1007/s00384-022-04167-x

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  • DOI: https://doi.org/10.1007/s00384-022-04167-x

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