KRAS as a predictor of poor prognosis and benefit from postoperative FOLFOX chemotherapy in patients with stage II and III colorectal cancer. Issue 7 (27th March 2015)

• Record Type: Journal Article
• Authors: Deng, Yanhong; Wang, Li; Tan, Shuyun; Kim, George P.; Dou, Ruoxu; Chen, Dianke; Cai, Yue; Fu, Xinhui; Wang, Lei; Zhu, Jun; Wang, Jianping
• Is Part Of: Molecular oncology. Volume 9:Issue 7(2015:Aug.)
• Page Start: 1341
• Page End: 1347
• Publication Date: 2015-03-27
• Subjects: KRAS -- Adjuvant chemotherapy -- Colorectal cancer -- FOLFOX; Cancer -- Molecular aspects -- Periodicals; 616.994005
• DOI: 10.1016/j.molonc.2015.03.006
• Languages: English
• ISSNs: 1574-7891

Abstract

Abstract : Purpose: The KRAS gene frequently mutates in colorectal cancer (CRC). Here we investigated the prognostic and predictive role of KRAS mutation in patients with stage II or III CRC. Experimental design: A consecutive cohort of patients with stage II or III CRC from a single center database was studied. The association between KRAS status, adjuvant FOLFOX therapy, and 3‐year disease‐free survival (3‐y DFS) was analyzed. Results: Of our 433 patients, 166 (38.3%) exhibited the KRAS mutation. Among the 190 patients who did not receive adjuvant therapy, those with KRAS mutation tumors had a worse 3‐y DFS (hazard ratio [HR], 1.924; 95% confidence interval [CI], 1.078–3.435; P = 0.027). Among patients who received adjuvant chemotherapy, KRAS mutation was not correlated with worse 3‐y DFS (HR, 1.083; 95% CI, 0.618–1.899; P = 0.781). Adjuvant chemotherapy improved 3‐y DFS only among patients with KRAS mutant tumors (78.0% vs 69.2%) on multivariate analysis adjusted for age, stage, grade, site, vessel invasion, and carcinoembryonic antigen level (HR, 0.454; 95% CI, 0.229–0.901; P = 0.024). In contrast, there was no benefit of adjuvant chemotherapy in the KRAS wild‐type group (84.3% vs 82.0%). Conclusions: KRAS mutation indicates poor prognosis. FOLFOX adjuvant chemotherapy benefits patients with stage II or III colorectal cancer with KRAS mutant tumors and is worth further investigation. Highlights: The results showed patients with KRAS mutant tumors have poorer survival than those with KRAS wild type tumors, but after adjuvant FOLFOX chemotherapy, the patients' prognosis gets improved. Only patients with KRAS mutant tumors benefit from adjuvant chemotherapy in colorectal cancer. It indicated that patients with KRAS mutant tumors, oxaliplatin‐based adjuvant therapy must be guaranteed.