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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 1/2020

Open Access 01-01-2020 | Metastasis | Peritoneal Surface Malignancy

Prognostic Impact of BRAF and KRAS Mutation in Patients with Colorectal and Appendiceal Peritoneal Metastases Scheduled for CRS and HIPEC

Authors: Wilhelm Graf, MD, PhD, Peter H. Cashin, MD, PhD, Lana Ghanipour, MD, PhD, Malin Enblad, MD, PhD, Johan Botling, MD, PhD, Alexei Terman, MD, PhD, Helgi Birgisson, MD, PhD

Published in: Annals of Surgical Oncology | Issue 1/2020

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Abstract

Background

KRAS and BRAF mutations are prognostic and predictive tools in metastatic colorectal cancer, but little is known about their prognostic value in patients scheduled for cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Therefore, we analyzed the prognostic impact of KRAS and BRAF mutations in patients with peritoneal metastases scheduled for CRS and HIPEC.

Patients and Methods

In a consecutive series of 399 patients scheduled for CRS and HIPEC between 2009 and 2017, 111 subjects with peritoneal metastases from primaries of the appendix, colon, or rectum were analyzed for KRAS mutation and 92 for BRAF mutation.

Results

Mutation in KRAS was present in 51/111 (46%), and mutated BRAF was found in 10/92 (11%). There was no difference in overall survival between KRAS mutation tumors and KRAS wild type, whereas BRAF mutation was associated with short survival. No subject with BRAF mutation survived 2 years. On multivariate analysis, completeness of cytoreduction score (CCS, p = 0.000001), presence of signet cell differentiation (p = 0.000001), and BRAF mutation (p = 0.0021) were linked with poor prognosis.

Conclusions

BRAF mutation is a marker of poor prognosis in patients with appendiceal and colorectal peritoneal metastases scheduled for CRS and HIPEC, whereas survival outcome in subjects with mutated KRAS does not differ from wild-type KRAS. This finding suggests that those with BRAF mutation should be considered for alternative treatment options.
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Metadata
Title
Prognostic Impact of BRAF and KRAS Mutation in Patients with Colorectal and Appendiceal Peritoneal Metastases Scheduled for CRS and HIPEC
Authors
Wilhelm Graf, MD, PhD
Peter H. Cashin, MD, PhD
Lana Ghanipour, MD, PhD
Malin Enblad, MD, PhD
Johan Botling, MD, PhD
Alexei Terman, MD, PhD
Helgi Birgisson, MD, PhD
Publication date
01-01-2020
Publisher
Springer International Publishing
Keyword
Metastasis
Published in
Annals of Surgical Oncology / Issue 1/2020
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-019-07452-2

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