TY - JOUR
T1 - Association between specific mutations in KRAS codon 12 and colorectal liver metastasis
AU - Margonis, Georgios Antonios
AU - Kim, Yuhree
AU - Spolverato, Gaya
AU - Ejaz, Aslam
AU - Gupta, Rohan
AU - Cosgrove, David
AU - Anders, Robert
AU - Karagkounis, Georgios
AU - Choti, Michael A.
AU - Pawlik, Timothy M.
N1 - Publisher Copyright:
© 2015 American Medical Association. All rights reserved.
PY - 2015/8/1
Y1 - 2015/8/1
N2 - IMPORTANCE Currently, one of the most commonly available biomarkers in the treatment of patients with colorectal liver metastases (CRLM) is the Kirsten rat sarcoma viral oncogene homolog (KRAS); however, the prognostic implications of specific mutations of the KRAS gene are still not well defined. OBJECTIVE To investigate the prognostic impact of specific KRAS mutations on patients undergoing liver resection for CRLM. DESIGN, SETTING, AND PARTICIPANTS This retrospective single-center studywas conducted from January 1, 2003, to December 31, 2013. Data about specific KRAS mutations for 331 patients who underwent hepatic resection for CRLM at Johns Hopkins Hospital between 2003 and 2013 were analyzed. Clinicopathological characteristics, perioperative details, and outcomes were stratified by specific KRAS mutation at codons 12 and 13. INTERVENTION Resection of CRLM. MAIN OUTCOMES AND MEASURES Overall survival (OS) and recurrence-free survival. RESULTS A mutated KRAS (mtKRAS) was identified in 91 patients (27.5%). At a median follow-up of 27.4 months, recurrence was observed in 48 patients (52.7%) with mtKRAS and 130 patients (54.2%) with wild-type KRAS (wtKRAS) (P =.82). Median and 5-year survival among patients with mtKRAS was 32.4 months and 32.7%, respectively, vs 58.5 months and 46.9%, respectively, for patients with wtKRAS (P =.02). Patients with KRAS codon 12 mutations had worse OS (hazard ratio [HR], 1.54; 95%CI, 1.05-2.27; P =.03) vs those with wtKRAS, whereas a KRAS codon 13 mutation was not associated with prognosis (HR, 1.47; 95%CI, 0.83-2.62; P =.19). Among the 6 most common mutations in codons 12 and 13, only G12V (HR, 1.78; 95%CI, 1.00-3.17; P =.05) and G12S (HR, 3.33; 95%CI, 1.22-9.10; P =.02) were associated with worse OS compared with patients with wtKRAS (both P <.05). Among patients who recurred, G12V (HR, 2.96; 95%CI, 1.32-6.61; P =.01), G12C (HR, 6.74; 95%CI, 2.05-22.2; P =.002), and G12S mutations (HR, 4.91; 95%CI, 1.52-15.8; P =.01) were associated with worse OS (both P <.05).
AB - IMPORTANCE Currently, one of the most commonly available biomarkers in the treatment of patients with colorectal liver metastases (CRLM) is the Kirsten rat sarcoma viral oncogene homolog (KRAS); however, the prognostic implications of specific mutations of the KRAS gene are still not well defined. OBJECTIVE To investigate the prognostic impact of specific KRAS mutations on patients undergoing liver resection for CRLM. DESIGN, SETTING, AND PARTICIPANTS This retrospective single-center studywas conducted from January 1, 2003, to December 31, 2013. Data about specific KRAS mutations for 331 patients who underwent hepatic resection for CRLM at Johns Hopkins Hospital between 2003 and 2013 were analyzed. Clinicopathological characteristics, perioperative details, and outcomes were stratified by specific KRAS mutation at codons 12 and 13. INTERVENTION Resection of CRLM. MAIN OUTCOMES AND MEASURES Overall survival (OS) and recurrence-free survival. RESULTS A mutated KRAS (mtKRAS) was identified in 91 patients (27.5%). At a median follow-up of 27.4 months, recurrence was observed in 48 patients (52.7%) with mtKRAS and 130 patients (54.2%) with wild-type KRAS (wtKRAS) (P =.82). Median and 5-year survival among patients with mtKRAS was 32.4 months and 32.7%, respectively, vs 58.5 months and 46.9%, respectively, for patients with wtKRAS (P =.02). Patients with KRAS codon 12 mutations had worse OS (hazard ratio [HR], 1.54; 95%CI, 1.05-2.27; P =.03) vs those with wtKRAS, whereas a KRAS codon 13 mutation was not associated with prognosis (HR, 1.47; 95%CI, 0.83-2.62; P =.19). Among the 6 most common mutations in codons 12 and 13, only G12V (HR, 1.78; 95%CI, 1.00-3.17; P =.05) and G12S (HR, 3.33; 95%CI, 1.22-9.10; P =.02) were associated with worse OS compared with patients with wtKRAS (both P <.05). Among patients who recurred, G12V (HR, 2.96; 95%CI, 1.32-6.61; P =.01), G12C (HR, 6.74; 95%CI, 2.05-22.2; P =.002), and G12S mutations (HR, 4.91; 95%CI, 1.52-15.8; P =.01) were associated with worse OS (both P <.05).
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U2 - 10.1001/jamasurg.2015.0313
DO - 10.1001/jamasurg.2015.0313
M3 - Article
C2 - 26038887
AN - SCOPUS:84939864100
SN - 2168-6254
VL - 150
SP - 722
EP - 729
JO - JAMA surgery
JF - JAMA surgery
IS - 8
ER -