Association between mutational subgroups, Warburg-subtypes, and survival in patients with colorectal cancer

Previous research suggests that Warburg-subtypes are related to potentially important survival differences in colorectal cancer (CRC) patients. In the present study, we investigated whether mutational subgroups based on somatic mutations in RAS, BRAF, PIK3CA, and MET, which are known to promote the Warburg-effect, as well as mismatch repair (MMR) status, hold prognostic value in CRC. In addition, we investigated whether Warburg-subtypes provide additional prognostic information, independent of known prognostic factors like TNM stage.

CRC patients (n = 2344) from the prospective Netherlands Cohort Study (NLCS) were classified into eight mutually exclusive mutational subgroups, based on observed mutations in RAS, BRAF, PIK3CA, and MET, and MMR status: All-wild-type + MMR_proficient , KRAS_mut  + MMR_proficient , KRAS_mut  + PIK3CA_mut  + MMR_proficient , PIK3CA_mut  + MMR_proficient , BRAF_mut  + MMR_proficient , BRAF_mut  + MMR_deficient , other + MMR_proficient , and other + MMR_deficient . Kaplan-Meier curves and Cox regression models were used to investigate associations between mutational subgroups and survival, as well as associations between our previously established Warburg-subtypes and survival within these mutational subgroups.

Compared to patients with all-wild-type + MMR_proficient CRC, patients with KRAS_mut  + MMR_proficient , KRAS_mut  + PIK3CA_mut  + MMR_proficient , BRAF_mut  + MMR_proficient , or other + MMR_proficient CRC had a statistically significant worse survival (HR_CRC-specific ranged from 1.29 to 1.88). In contrast, patients with other + MMR_deficient CRC had the most favorable survival (HR_CRC-specific 0.48). No statistically significant survival differences were observed for the Warburg-subtypes within mutational subgroups.

Our results highlight the prognostic potential of mutational subgroups in CRC. Warburg-subtypes did not provide additional prognostic information within these mutational subgroups. Future larger-scale prospective studies are necessary to validate our findings and to examine the potential clinical utility of CRC subtyping based on mutational subgroups.