Synapse - Adjuvant hepatic artery infusion chemotherapy is associated with improved survival regardless of KRAS mutation status in patients with resected colorectal liver metastases: A retrospective analysis of 674 patients

Adjuvant hepatic artery infusion chemotherapy is associated with improved survival regardless of KRAS mutation status in patients with resected colorectal liver metastases: A retrospective analysis of 674 patients Journal Article

Authors:	Gholami, S.; Kemeny, N. E.; Boucher, T. M.; Gönen, M.; Cercek, A.; Kingham, T. P.; Balachandran, V.; Allen, P.; DeMatteo, R.; Drebin, J.; Jarnagin, W.; D'Angelica, M.
Article Title:	Adjuvant hepatic artery infusion chemotherapy is associated with improved survival regardless of KRAS mutation status in patients with resected colorectal liver metastases: A retrospective analysis of 674 patients
Abstract:	Objective: To investigate the impact of adjuvant hepatic artery infusion (HAI) in relation to KRAS mutational status in patients with resected colorectal cancer liver metastases (CRLM). Background: Patients with KRAS-mutated CRLM have worse outcomes after resection. Adjuvant HAI chemotherapy improves overall survival after liver resection. Methods: Patients with resected CRLM treated at MSKCC with and without adjuvant HAI who had available KRAS status (wild-type, WT; mutated, MUT) were reviewed from a prospectively maintained institutional database. Correlations between KRAS status, adjuvant HAI, clinical factors, and outcomes were analyzed. Cox proportional hazard model was used to adjust for confounders. Results: Between 1993 and 2012, 674 patients (418 KRAS-WT, 256 MUT) with a median follow up of 6.5 years after resection were evaluated. Fifty-four percent received adjuvant HAI. Tumor characteristics (synchronous disease, number of lesions, clinical-risk score, 2-stage hepatectomy) were significantly worse in the HAI group; however, there were more patients with resected extrahepatic metastases in the no-HAI group. In KRAS-WT tumors, 5-year survival was 78% for patients treated with HAI versus 57% for patients without HAI [hazard ratio (HR) 0.51,P< 0.001]. In KRAS-MUT tumors, 5-year survival was 59% for patients treated with HAI versus 40% for patients without HAI (HR 0.56,P< 0.001). On multivariate analysis, HAI remained associated with improved OS (HR 0.53,P< 0.002) independent of KRAS status and other clinicopathologic factors. Conclusion: Adjuvant HAI after resection of CRLM is independently associated with improved outcomes regardless of KRAS mutational status. Adjuvant HAI may mitigate the worse outcomes seen in patients with resectable KRAS-MUT CRLM.
Keywords:	chemotherapy; recurrence; surgery; kras; metastases; patterns; colorectal liver; score; cancer; ras mutation; adjuvant hepatic artery infusion; liver-directed
Journal Title:	Annals of Surgery
Volume:	272
Issue:	2
ISSN:	0003-4932
Publisher:	Lippincott Williams & Wilkins
Date Published:	2020-08-01
Start Page:	352
End Page:	356
Language:	English
ACCESSION:	WOS:000562697800069
DOI:	10.1097/sla.0000000000003248
PROVIDER:	wos
PUBMED:	32675549
PMCID:	PMC8477796
Notes:	Article -- Source: Wos