Shindoh Junichi, Nishioka Yujiro, Yoshioka Ryuji, Sugawara Toshitaka, Sakamoto Yoshihiro, Hasegawa Kiyoshi, Hashimoto Masaji, Kokudo Norihiro
Hepatobiliary-Pancreatic, Surgery Division, Department of Digestive Surgery, Toranomon Hospital, Tokyo, Japan.
Okinaka Memorial Institute for Medical Disease, Tokyo, Japan.
Ann Surg Oncol. 2016 Jun;23(6):1890-6. doi: 10.1245/s10434-016-5087-5. Epub 2016 Jan 19.
The KRAS mutation status is reportedly correlated with poor survival outcome in patients with colorectal liver metastases (CLM); however, its true prognostic impact and the reason for the poor prognosis remain unclear.
Data on 163 patients with a known KRAS mutation status who underwent curative resection for CLM were retrospectively reviewed. The long-term survival and site-specific incidence of recurrence were then compared between patients with a KRAS mutation (mtKRAS) and those without a mutation (wtKRAS).
The mtKRAS group had a poorer 3-year disease-specific survival (DSS) rate (59.8 vs. 83.6 %, p = 0.016), 3-year recurrence-free survival (RFS) rate (0 vs. 20.2 %, p = 0.069), and median time to surgical failure (TSF) [18.8 vs. 39.7 months, p = 0.001] than the wtKRAS group. The cumulative incidences of liver recurrence and lung recurrence at 3 years were also higher in the mtKRAS group (76.2 vs. 54.7 %, p = 0.060; and 71.9 vs. 37.3 %, p < 0.001, respectively). A multivariate analysis confirmed that an mtKRAS status had a significant effect on the DSS rate (hazard ratio [HR] 2.9, p = 0.006), RFS (HR 2.0, p = 0.004), TSF (HR 2.4, p < 0.001), liver recurrence (HR 1.7, p < 0.001), and lung recurrence (HR 2.6, p < 0.001). Lung-related unresectable recurrences were more frequent (41 vs. 18 %, p = 0.048) and were associated with an earlier TSF (9.6 vs. 14.0 months, p = 0.14) in the mtKRAS group, regardless of the location of the primary lesions.
mtKRAS is associated with poor survival outcome after CLM resection because of a relatively high incidence of lung recurrence and a relatively short TSF.
据报道，KRAS突变状态与结直肠癌肝转移（CLM）患者的不良生存结果相关；然而，其真正的预后影响以及预后不良的原因仍不清楚。
回顾性分析163例行CLM根治性切除且已知KRAS突变状态患者的数据。然后比较KRAS突变患者（mtKRAS）和无突变患者（wtKRAS）的长期生存率和部位特异性复发率。
mtKRAS组的3年疾病特异性生存率（DSS）（59.8%对83.6%，p = 0.016）、3年无复发生存率（RFS）（0对20.2%，p = 0.069）和手术失败中位时间（TSF）[18.8个月对39.7个月，p = 0.001]均低于wtKRAS组。mtKRAS组3年时肝复发和肺复发的累积发生率也更高（分别为76.2%对54.7%，p = 0.060；71.9%对37.3%，p < 0.001）。多因素分析证实，mtKRAS状态对DSS率（风险比[HR] 2.9，p = 0.006）、RFS（HR 2.0，p = 0.004）、TSF（HR 2.4，p < 0.001）、肝复发（HR 1.7，p < 0.001）和肺复发（HR 2.6，p < 0.001）有显著影响。无论原发灶位置如何，mtKRAS组与肺相关的不可切除复发更频繁（41%对18%，p = 0.048），且与更早的TSF相关（9.6个月对14.0个月，p = 0.14）。
mtKRAS与CLM切除术后的不良生存结果相关，原因是肺复发发生率相对较高且TSF相对较短。
