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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 11/2016

01-10-2016 | Hepatobiliary Tumors

Prognostic Implication of KRAS Status after Hepatectomy for Colorectal Liver Metastases Varies According to Primary Colorectal Tumor Location

Authors: Kazunari Sasaki, MD, Georgios A. Margonis, MD, PhD, Ana Wilson, DO, Yuhree Kim, MD, MPH, Stefan Buettner, B.Sc, Nikolaos Andreatos, MD, Faiz Gani, MD, Neda Amini, MD, Gaya Spolverato, MD, Timothy M. Pawlik, MD, MPH, PhD, FACS

Published in: Annals of Surgical Oncology | Issue 11/2016

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ABSTRACT

Background

Right-sided and left-sided colorectal cancer (CRC) is known to differ in their molecular carcinogenic pathways. We sought to investigate the variable prognostic implication of KRAS mutation after hepatectomy for colorectal liver metastases (CRLM) according to the site of primary CRC.

Methods

A total of 426 patients who underwent a curative-intent hepatic resection and whose KRAS status was available were identified. Clinicopathologic characteristics and long-term outcomes were stratified by KRAS status (wild type vs. mutant type) and primary tumor location (right-sided vs. left-sided). Cecum, right and transverse colon were defined as right-sided, whereas left colon and rectum were defined as left-sided.

Results

Among patients with a right-sided CRC, 5-year recurrence-free survival (RFS) and overall survival (OS) were not correlated with KRAS status (wild type: 30.8 and 47.2 % vs. mutant type: 38.5 and 49.1 %, respectively) (both P > 0.05). Specifically, mutant-type KRAS was not associated with either RFS or OS on multivariable analysis (hazard ratio [HR] 1.51, 95 % confidence interval [CI] 0.73–3.14, P = 0.23 and HR 1.03, 95 % CI 0.51–2.08, P = 0.95, respectively). In contrast, among patients who underwent resection of CRLM from a left-sided primary CRC, 5-year RFS and OS were worse among patients with mutant-type KRAS (wild type: 23.7 and 57.2 % vs. mutant type: 19.6 and 38.2 %, respectively) (both P < 0.05). On multivariable analysis, mutant-type KRAS remained independently associated with worse RFS and OS among patients with a left-sided primary CRC (HR 1.57, 95 % CI 1.01–2.44, P = 0.04 and HR 1.81, 95 % CI 1.11–2.96, P = 0.02, respectively).

Conclusions

KRAS status has a variable prognostic impact after hepatic resection for CRLM depending on the site of the primary CRC. Future studies examining the impact of KRAS status on prognosis after hepatectomy should take into account the primary CRC tumor site.
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Metadata
Title
Prognostic Implication of KRAS Status after Hepatectomy for Colorectal Liver Metastases Varies According to Primary Colorectal Tumor Location
Authors
Kazunari Sasaki, MD
Georgios A. Margonis, MD, PhD
Ana Wilson, DO
Yuhree Kim, MD, MPH
Stefan Buettner, B.Sc
Nikolaos Andreatos, MD
Faiz Gani, MD
Neda Amini, MD
Gaya Spolverato, MD
Timothy M. Pawlik, MD, MPH, PhD, FACS
Publication date
01-10-2016
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 11/2016
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-016-5361-6

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