The prognostic value of KRAS mutation in locally advanced rectal cancer

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...

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Bibliographic Details
Published in:International journal of colorectal disease 2022-05, Vol.37 (5), p.1199-1207
Main Authors: Asawa, Palash, Bakalov, Veli, Kancharla, Pragnan, Abel, Stephen, Chahine, Zena, Monga, Dulabh K., Kirichenko, Alexander V., Wegner, Rodney E.
Format: Article
Language:English
Subjects:
Analysis
Cancer
Cancer patients
Care and treatment
Colorectal cancer
Gastroenterology
Genetic aspects
Hepatology
Humans
Internal Medicine
Male
Medicine
Medicine & Public Health
Mutation - genetics
Original Article
Proctology
Prognosis
Proto-Oncogene Proteins p21(ras) - genetics
Rectal Neoplasms - genetics
Rectal Neoplasms - therapy
Retrospective Studies
Surgery
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Summary: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.
ISSN:1432-1262
0179-1958
1432-1262
DOI:10.1007/s00384-022-04167-x