THE IMPACT OF LIVER SURGERY AND MARGIN STATUS ON SURVIVAL ACCORDING TO KRAS MUTATIONAL STATUS IN COLORECTAL LIVER METASTASES

Authors

  • Mariana Peyroteo Surgical Oncology Department, Instituto Português de Oncologia do Porto, Portugal
  • Rita Canotilho Surgical Oncology Department, Instituto Português de Oncologia do Porto, Portugal
  • Alexandre Sousa Surgical Oncology Department, Instituto Português de Oncologia do Porto, Portugal
  • Fernanda Sousa Surgical Oncology Department, Instituto Português de Oncologia do Porto, Portugal
  • Manuel Fernandes Surgical Oncology Department, Instituto Português de Oncologia do Porto, Portugal
  • Belarmino Gonçalves
  • José Flávio Videira Surgical Oncology Department, Instituto Português de Oncologia do Porto, Portugal
  • Maria Fragoso Medical Oncology Department, Instituto Português de Oncologia do Porto, Portugal
  • Lúcio Lara Santos Surgical Oncology Department, Instituto Português de Oncologia do Porto, Portugal; Experimental Pathology and Therapeutics Group, Instituto Português de Oncologia do Porto Francisco Gentil, EPE, Porto, Portugal
  • Joaquim Abreu de Sousa Surgical Oncology Department, Instituto Português de Oncologia do Porto, Portugal

DOI:

https://doi.org/10.34635/rpc.815

Keywords:

colorectal liver metastasis, KRAS status, liver margin, recurrence free survival

Abstract

Introduction: The impact of kirsten rat sarcoma viral oncogene homolog (KRAS) mutational status on surgery planning for colorectal liver metastases (CRLM) remains unknown. The aim of the study was to evaluate the impact of type of liver surgery and margin status in recurrence free survival (RFS) of patients with CRLM, according to KRAS mutational status.

Materials and methods: Retrospective review of all patients consecutively submitted to CLRM surgery between January 2011 and December 2016 with KRAS determination. Exclusion criteria were 2-stage hepatectomy strategy, loss to follow up and non-anatomical and anatomical resections performed simultaneously.

Results: 114 patients were included, with a median age of 61 [31-80] years old. 67.5% of patients were male. KRAS mutation was present in 46.5% of patients, 58.8% had non-anatomical resections and R0 surgery was obtained in 69.3%. With a median follow up of 43 [4-105] months, recurrence rate was 86.8%, median overall survival and RFS were 53 and 11 months, respectively. In the mutated KRAS (mKRAS) group, the detection of R1 margins was the only predictor of worse RFS (31 versus 13 months, p=0.022). In the wild-type KRAS (wtKRAS) group a similar difference was not observed (24 versus 19 months, p=0.310). The most common form of recurrence after R1 resections in the mKRAS group was extra-hepatic, while in the wtKRAS was isolated hepatic recurrence.

Conclusion: In patients with mKRAS, R1 resection was associated with a decreased RFS, mainly due to extra-hepatic recurrence. These findings were not replicated in the wtKRAS group. KRAS mutational status should be considered while planning liver resection for CRLM, namely when deciding optimal margin width. 

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Published

2020-09-30

Issue

No. 48 (2020): Number 48 - September 2020

Section

Original Papers

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