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. 2022 May;37(5):1199-1207.
doi: 10.1007/s00384-022-04167-x. Epub 2022 Apr 29.

The prognostic value of KRAS mutation in locally advanced rectal cancer

Palash Asawa  1 , Veli Bakalov  2 , Pragnan Kancharla  2 , Stephen Abel  3 , Zena Chahine  4 , Dulabh K Monga  2 , Alexander V Kirichenko  3 , Rodney E Wegner  5
Affiliations

The prognostic value of KRAS mutation in locally advanced rectal cancer

Palash Asawa et al. Int J Colorectal Dis. 2022 May.

Abstract

Background: The prognostic value of the KRAS proto-oncogene mutation in colorectal cancer has been debated. Herein, we analyzed the National Cancer Database (NCDB) to assess the role of KRAS mutation as a prognostic marker in patients with locally advanced rectal cancer (LARC).

Methods: We identified LARC patients treated with neoadjuvant chemoradiation from 2004-2015 excluding those with stage I/IV disease and unknown KRAS status. Multivariable logistic regression identified variables associated with KRAS positivity. Propensity adjusted univariable and multivariable analyses identified predictors of survival.

Results: Of the 784 eligible patients, 506 were KRAS-negative (KRAS -) and 278 were KRAS-positive (KRAS +). Median survival was 63.6 months and 76.3 months for KRAS + and KRAS - patients respectively, with propensity adjusted 3 and 5-year survival of 79.9% vs. 83.6% and 56.7% vs. 61.9% respectively (HR 1.56, p 1.074-2.272). Male sex, no insurance, and KRAS + disease were associated with poorer survival on unadjusted and propensity adjusted multivariable analyses.

Conclusions: Our analysis of KRAS + LARC suggest that KRAS + disease is associated with poorer overall survival. Given the inherent limitations of retrospective data, prospective validation is warranted.

Keywords: Colorectal cancers; Gene mutations; KRAS mutation; Locally advanced rectal cancer; Prognostic value.

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