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RAS Mutation Status Predicts Survival and Patterns of Recurrence in Patients Undergoing Hepatectomy for Colorectal Liver Metastases

Vauthey, Jean-Nicolas MD*; Zimmitti, Giuseppe MD*; Kopetz, Scott E. MD; Shindoh, Junichi MD, PhD*; Chen, Su S. MD; Andreou, Andreas MD§; Curley, Steven A. MD*; Aloia, Thomas A. MD*; Maru, Dipen M. MD§

doi: 10.1097/SLA.0b013e3182a5025a
Papers of the 133rd ASA Annual Meeting

Objective: To determine the impact of RAS mutation status on survival and patterns of recurrence in patients undergoing curative resection of colorectal liver metastases (CLM) after preoperative modern chemotherapy.

Background: RAS mutation has been reported to be associated with aggressive tumor biology. However, the effect of RAS mutation on survival and patterns of recurrence after resection of CLM remains unclear.

Methods: Somatic mutations were analyzed using mass spectroscopy in 193 patients who underwent single-regimen modern chemotherapy before resection of CLM. The relationship between RAS mutation status and survival outcomes was investigated.

Results: Detected somatic mutations included RAS (KRAS/NRAS) in 34 (18%), PIK3CA in 13 (7%), and BRAF in 2 (1%) patients. At a median follow-up of 33 months, 3-year overall survival (OS) rates were 81% in patients with wild-type versus 52.2% in patients with mutant RAS (P = 0.002); 3-year recurrence-free survival (RFS) rates were 33.5% with wild-type versus 13.5% with mutant RAS (P = 0.001). Liver and lung recurrences were observed in 89 and 83 patients, respectively. Patients with RAS mutation had a lower 3-year lung RFS rate (34.6% vs 59.3%, P < 0.001) but not a lower 3-year liver RFS rate (43.8% vs 50.2%, P = 0.181). In multivariate analyses, RAS mutation predicted worse OS [hazard ratio (HR) = 2.3, P = 0.002), overall RFS (HR = 1.9, P = 0.005), and lung RFS (HR = 2.0, P = 0.01), but not liver RFS (P = 0.181).

Conclusions: RAS mutation predicts early lung recurrence and worse survival after curative resection of CLM. This information may be used to individualize systemic and local tumor-directed therapies and follow-up strategies.

Somatic mutations were analyzed using mass spectrometry in 193 patients who underwent single-regimen modern chemotherapy before resection of colorectal liver metastases (CLM). RAS mutation predicts early lung recurrence and worse survival after curative resection of CLM. This information may be used to individualize systemic and local tumor-directed therapies and follow-up strategies.

Departments of *Surgical Oncology

Gastrointestinal Medical Oncology

Hematopathology

§Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX.

Reprints: Jean-Nicolas Vauthey, MD, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1484, Houston, TX 77030. E-mail: jvauthey@mdanderson.org.

J.-N.V. and G.Z. contributed equally to this study.

Disclosure: This research was supported in part by the National Institutes of Health through MD Anderson's Cancer Center Support Grant, CA016672. The authors report no conflicts of interest relevant to this article.

© 2013 by Lippincott Williams & Wilkins.