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Multicenter Study
. 2025 Jun;49(6):1573-1582.
doi: 10.1002/wjs.12616. Epub 2025 May 8.

The Impact of KRAS Status on Long-Term Outcomes After Thermal Ablation and Hepatic Resection for Liver-Only Colorectal Metastases: A New Clue for Tailoring Surgical Strategy on Tumor Biology?

Fabio Giannone  1   2   3 , Federico Sangiuolo  1 , Gianluca Cassese  1   3   4 , Marco Palucci  1   3 , Celeste Del Basso  1 , Alfonso Lapergola  2 , Giorgio Badessi  5 , Reza Kianmanesh  5 , Patrick Pessaux  2   6 , Rami Rhaiem  5 , Fabrizio Panaro  1   3   4
Affiliations
Multicenter Study

The Impact of KRAS Status on Long-Term Outcomes After Thermal Ablation and Hepatic Resection for Liver-Only Colorectal Metastases: A New Clue for Tailoring Surgical Strategy on Tumor Biology?

Fabio Giannone et al. World J Surg. 2025 Jun.

Abstract

Introduction: KRAS mutation is a negative prognostic factor for colorectal liver metastases (CRLM). Thermal ablation (TA) is considered a valid alternative to liver resection (LR) for CRLM in selected cases. This study aims to investigate the influence of KRAS status on long-term outcomes of TA during LR.

Materials and methods: This is a retrospective analysis of patients undergoing surgery for CRLM in two hepatobiliary centers. Patients were divided into two groups: LR or LR + TA, and long-term results were investigated according to KRAS status.

Results: 220 patients were included, of whom 74 (33.6%) were KRAS mutated. TA was performed in association with LR in 42 mutated (mKRAS) tumors (56.7%). Multivariate analysis in mKRAS patients showed that synchronous disease (p = 0.014), performing TA (p = 0.044), performing two or more TA (p = 0.032), and N2 status (p < 0.001) were independently associated with DFS. TA was more frequently associated with a liver-only recurrence, both in mutated and wt tumors, but with a higher risk in mKRAS (p = 0.013 vs. p = 0.048).

Conclusion: CRLM surgical treatment should be tailored to KRAS status because TA may potentially be less effective in mutated patients during surgical resection. This is even more important in the case of multiple ablations.

Keywords: colorectal liver metastases; liver resection; outcomes; thermal ablation.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Kaplan–Meier curves of DFS (A) and DSS (B) comparing patients with or without a KRAS mutation.
FIGURE 2
FIGURE 2
Kaplan–Meier curves of DFS (A) and DSS (B) comparing the two groups (liver resection alone vs. liver resection + thermal ablation) in mKRAS patients. LR: liver resection, TA: thermal ablation.
See this image and copyright information in PMC

References

    1. Bray F., Laversanne M., Sung H., et al., “Global Cancer Statistics 2022: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries,” CA: A Cancer Journal for Clinicians 74, no. 3 (2024): 229–263, 10.3322/caac.21834. - DOI - PubMed
    1. Imai K., Adam R., and Baba H., “How to Increase the Resectability of Initially Unresectable Colorectal Liver Metastases: A Surgical Perspective,” Annals of Gastroenterological Surgery 3, no. 5 (2019): 476–486, 10.1002/ags3.12276. - DOI - PMC - PubMed
    1. Osterlund P., Salminen T., Soveri L.‐M., et al., “Repeated Centralized Multidisciplinary Team Assessment of Resectability, Clinical Behavior, and Outcomes in 1086 Finnish Metastatic Colorectal Cancer Patients (RAXO): A Nationwide Prospective Intervention Study,” Lancet Regional Health ‐ Europe 3 (2021): 100049, 10.1016/j.lanepe.2021.100049. - DOI - PMC - PubMed
    1. Cervantes A., Adam R., Roselló S., et al., “Metastatic Colorectal Cancer: ESMO Clinical Practice Guideline for Diagnosis, Treatment and Follow‐Up,” Annals of Oncology 34 (2023): 10–32, 10.1016/j.annonc.2022.10.003. - DOI - PubMed
    1. Benson Al B., Venook A. P., Adam M., et al., “Colon Cancer, Version 3.2024, NCCN Clinical Practice Guidelines in Oncology,” Journal of the National Comprehensive Cancer Network JNCCN 22, no. 2D (2024): e240029, 10.6004/jnccn.2024.0029. - DOI - PubMed

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