Impact of KRAS Mutation on Recurrence-Free Survival in Colon Cancer Patients Undergoing Cytoreduction with...

Introduction: For colon cancer (CC), KRAS mutations are associated with worse outcomes. Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) for advanced-stage CC may proffer some survival benefits for select patients. We sought to evaluate postoperative morbidity and mortality among mutant and wildtype KRAS patients undergoing CRS/HIPEC for advanced CC. Methods: We identified 80 patients with CC from an institutional HIPEC database. Patients were categorized based on the presence (mutKRAS) or absence (wildtype) of KRAS mutations. Patient characteristics, tumor factors, treatment, and clinical outcomes were compared between groups. Postoperative morbidity was measured by Clavien-Dindo Classification (CDC). Kaplan-Meier survival analysis evaluated recurrence-free survival (RFS). Results: Overall, 52 (65%) mutKRAS were identified. Patient and tumor characteristics were similar among groups. While not significant, the wildtype group had a lower median (IQR) preoperative PCI score of 7 (3, 12) than the mutKRAS group, whose score was 11 (5, 21) (p = 0.057). The mutKRAS group had a higher rate of CDC grade 3 or more (23.1%) compared to the wildtype group (7.1%) (p = 0.015). Despite this, there were no significant differences in length of stay. Moreover, RFS between the mutKRAS and wildtype groups did not differ significantly (p = 0.47). Conclusions: Contrary to the typical association of KRAS mutations with poorer survival in CC, our findings suggest that patients with this mutation have an RFS comparable to those without it when treated with CRS/HIPEC. This may imply that CRS/HIPEC offers therapeutic benefits for KRAS-mutant CC patients, potentially mitigating the usually adverse prognosis associated with this mutation.