Impacto clínico del estado de mutación del homólogo del oncogén viral del sarcoma de la rata de Kirsten (KRAS) en los patrones de recidiva y en la eficacia del tratamiento local tras una hepatectomía por metástasis hepáticas colorrectales.

The Kirsten rat sarcoma viral oncogene homolog (KRAS) is defined as frequently mutated oncogenes in colorectal cancer. We aimed to clarify the clinical impact of KRAS mutation status on recurrence patterns, the surgical management of recurrent lesions, and prognostic outcomes after curative hepatectomy for colorectal liver metastases (CRLM). The subjects of this retrospective study were 190 patients who underwent curative (macroscopic R0 resection) hepatectomy for CRLM and had wild-type (62.1%) or mutant (37.9%) KRAS status. KRAS mutations were associated with significantly worse overall survival (OS) and recurrence-free survival (RFS), as well as more aggressive recurrence patterns.

Multivariate analysis identified KRAS mutation as an independent predictor of poor OS and RFS, whereas CEA ≥ 5 ng/mL was independently associated with OS but not RFS.

Notably, patients from the mutant KRAS and wild-type KRAS groups who underwent local therapy (as repeat resection or ablation) for local recurrence had comparable OS. Conversely, among the patients who did not receive local therapy, those from the mutant KRAS group had significantly worse OS than those from the wild-type KRAS group. KRAS mutations are associated with aggressive recurrence patterns and a poor prognosis for patients with CRLM.

However, survival following local therapy for recurrence appeared less pronounced regardless of KRAS status.