KRAS Status as an Independent Prognostic Factor for Survival after Yttrium-90 Radioembolization Therapy for Unresectable Colorectal Cancer Liver Metastases

Abstract Purpose To evaluate Kirsten rat sarcoma viral oncogene homolog ( KRAS ) mutation status as a prognostic factor for survival after yttrium-90 ( 90 Y) radioembolization for colorectal cancer (CRC) liver metastases. Materials and Methods Consecutive patients with unresectable CRC liver metastases and documented KRAS mutation status who were treated with 90 Y radioembolization during the period 2007–2014 were investigated. Patient demographics, disease characteristics, therapy regimens, and overall survival (OS) from first 90 Y radioembolization were compared between patients with KRAS wild-type (wt) and mutant status. Kaplan-Meier estimation and Cox regression were used for survival analysis and to assess independent prognostic factors for OS. Results Of 186 patients, 104 underwent KRAS mutation analysis before 90 Y radioembolization, with 45 (43.3%) identified as mutant. The wt and mutant groups were similar in demographics, liver status, overall performance status, and tumor characteristics (all P > .05). Mean time from liver metastasis to 90 Y radioembolization was greater in patients with KRAS wt status ( P = .033). A greater percentage of wt patients received anti–epidermal growth factor receptor therapies before 90 Y radioembolization (66.1% vs 8.9%; P 90 Y radioembolization was significantly greater in KRAS wt patients (9.5 mo vs 4.8 mo; P = .041). Univariate analysis identified Child-Pugh class, carcinoembryonic antigen (CEA), chemotherapy after 90 Y radioembolization, KRAS status, and treatment-induced toxicity as prognostic factors for OS. Multivariate Cox regression analysis demonstrated Child-Pugh class, CEA, and KRAS status to be independent prognostic factors for OS, even when correcting for the effect of chemotherapy after 90 Y radioembolization. Conclusions Patients with CRC and KRAS wt may derive greater survival benefit from 90 Y radioembolization therapy than patients with KRAS mutant.