RAS変異の影響：化学療法と熱焼灼術による大腸癌肺転移との闘い

Hongjie Fan^1,2,3, Tao Xu^1,2,3, Yulan Zeng⁴

¹Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

International journal of surgery (London, England)

|February 24, 2026

要旨

Background:

To investigate the prognostic value of RAS mutation status and subtypes in colorectal lung metastases (CRLM) patients undergoing image-guided thermal ablation (IGTA), and to evaluate survival outcomes under different systemic therapy regimens.

Materials And Methods:

In this multicenter retrospective-prospective cohort study, 387 patients with CRLM who received percutaneous IGTA between March 2014 and December 2022 were included. Patients were stratified by RAS genotype (KRAS/NRAS wild-type vs mutant). Survival outcomes including local tumor progression-free survival (LTPFS), progression-free survival (PFS), and overall survival (OS) were analyzed using Cox regression. Subgroup analyses were conducted based on chemotherapy regimens and targeted agents.

Results:

The 3-year LTP rate was significantly higher in KRAS-mutant patients (25.0%) than wild-type (15.0%). KRAS mutation, lesion diameter ≥20 mm, and elevated CEA were independent risk factors for LTP. Median PFS was 16.0 months; KRAS mutations predicted inferior PFS (13.3% vs 32.8% at 3 years). Median OS was significantly reduced in both KRAS (17.9 vs 56.8 months) and NRAS-mutant patients (22.1 vs 53.8 months). Among KRAS-mutant patients, FOLFOX plus bevacizumab yielded better OS than cetuximab.

Conclusion:

RAS mutations are independent predictors of poor local control and survival after IGTA in CRLM. Evaluate interactions between RAS genotype and commonly used targeted agents in the peri-ablative setting. These integrated, real-world insights support the development of genotype-guided ablation planning and peri-ablative systemic therapy strategies.

キーワード:

RAS 化学療法大腸癌肺転移画像誘導熱焼灼術標的療法

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