2637a407b676f1e9f968f91f4204aa20 healthcare_a2022v10n3p472.pdf 3554e3642f3ddd562288bd208dd062119621cfd9 healthcare_a2022v10n3p472.pdf 83798f1c7cd19318720bfad6ed0fc439869342d1437cfe958a153da29ed5e2c3 healthcare_a2022v10n3p472.pdf Title: KRAS Assessment Following ESMO Recommendations for Colorectal Liver Metastases. Is It Always Worth It? Subject: Background: Genetic evaluation is essential in assessing colorectal cancer (CRC) and colorectal liver metastasis (CRLM). The aim of this study was to determine the pragmatic value of KRAS on oncological outcomes after CRLM according to the ESMO recommendations and to query whether it is necessary to request KRAS testing in each situation. Methods: A retrospective cohort of 126 patients who underwent surgery for hepatic resection for CRLM between 2009 and 2020 were reviewed. The patients were divided into three categories: wild-type KRAS, mutated KRAS and impractical KRAS according to their oncological variables. The impractical (not tested) KRAS group included patients with metachronous tumours and negative lymph nodes harvested. Disease-free survival (DFS), overall survival (OS) and hepatic recurrence-free survival (HRFS) were calculated by the Kaplan–Meier method, and a multivariable analysis was conducted using the Cox proportional hazards regression model. Results: Of the 108 patients identified, 35 cases had KRAS wild-type, 50 cases had a KRAS mutation and the remaining 23 were classified as impractical KRAS. Significantly longer medians for OS, HRFS and DFS were found in the impractical KRAS group. In the multivariable analyses, the KRAS mutational gene was the only variable that was maintained through OS, HRFS and DFS. For HRFS (HR: 13.63; 95% confidence interval (CI): 1.35–100.62; p = 0.010 for KRAS), for DFS (HR: 10.06; 95% CI: 2.40–42.17; p = 0.002 for KRAS) and for OS (HR: 4.55%; 95% CI: 1.37–15.10; p = 0.013). Conclusion: Our study considers the possibility of unnecessary KRAS testing in patients with metachronous tumours and negative lymph nodes harvested. Combining the genetic mutational profile (i.e., KRAS in specific cases) with tumour characteristics helps patient selection and achieves the best prognosis after CRLM resection. Keywords: KRAS oncogene; colorectal liver metastases; tumour burden score; synchronic tumours Author: Olga Morató, Maria Villamonte, Patricia Sánchez-Velázquez, Eva Pueyo-Périz, Luís Grande, Benedetto Ielpo, Eduoardo Rosso, Alessandro Anselmo and Fernando Burdío Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Mon Mar 7 06:53:57 2022 CET ModDate: Mon Mar 7 06:59:29 2022 CET Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 11 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 2731318 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- JYPLJJ+VnURWPalladioL-Bold Type 1 Custom yes yes no 10 0 EROCFA+VnURWPalladioL Type 1 Custom yes yes no 15 0 EKUCRW+URWPalladioL-Bold Type 1 Custom yes yes no 19 0 BTARMZ+URWPalladioL-Roma Type 1 Custom yes yes no 24 0 WLITKQ+URWPalladioL-Ital Type 1 Custom yes yes no 28 0 ADUMBL+URWPalladioL-BoldItal Type 1 Custom yes yes no 32 0 MCBCCI+SourceSansRoman-Regular Type 1C Custom yes yes no 40 0 MCBCCM+SourceSansRoman.613wght Type 1C Custom yes yes no 44 0 MCBCCO+SourceSansRoman-Bold Type 1C Custom yes yes no 48 0 XAOEUN+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 60 0 FXXUVH+CMSY10 Type 1 Builtin yes yes no 86 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2024-05-07 04:39:42 CEST RepresentationInformation: healthcare_a2022v10n3p472.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2022-03-16 11:59:57 CET Size: 2731318 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 287 FreeObjects: 5 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Methods Destination: section.2 Children: Item: Title: Study Design Destination: subsection.2.1 Item: Title: Parameters Studied Destination: subsection.2.2 Item: Title: Calculation of Tumour Burden Score Destination: subsection.2.3 Item: Title: Statistical Analysis Destination: subsection.2.4 Item: Title: Results Destination: section.3 Children: Item: Title: Patient Characteristics Destination: subsection.3.1 Item: Title: Cumulative Incidence of Recurrence and Survival According to Different KRAS Expression Destination: subsection.3.2 Item: Title: Uni-Multivariable Analysis among DFS, HRFS and OS Destination: subsection.3.3 Item: Title: Discussion Destination: section.4 Item: Title: Conclusions Destination: section.5 Item: Title: References Destination: section.5 Info: Title: KRAS Assessment Following ESMO Recommendations for Colorectal Liver Metastases. Is It Always Worth It? Author: Olga Morató, Maria Villamonte, Patricia Sánchez-Velázquez, Eva Pueyo-Périz, Luís Grande, Benedetto Ielpo, Eduoardo Rosso, Alessandro Anselmo and Fernando Burdío Subject: Background: Genetic evaluation is essential in assessing colorectal cancer (CRC) and colorectal liver metastasis (CRLM). The aim of this study was to determine the pragmatic value of KRAS on oncological outcomes after CRLM according to the ESMO recommendations and to query whether it is necessary to request KRAS testing in each situation. Methods: A retrospective cohort of 126 patients who underwent surgery for hepatic resection for CRLM between 2009 and 2020 were reviewed. The patients were divided into three categories: wild-type KRAS, mutated KRAS and impractical KRAS according to their oncological variables. The impractical (not tested) KRAS group included patients with metachronous tumours and negative lymph nodes harvested. Disease-free survival (DFS), overall survival (OS) and hepatic recurrence-free survival (HRFS) were calculated by the Kaplan Meier method, and a multivariable analysis was conducted using the Cox proportional hazards regression model. Results: Of the 108 patients identified, 35 cases had KRAS wild-type, 50 cases had a KRAS mutation and the remaining 23 were classified as impractical KRAS. Significantly longer medians for OS, HRFS and DFS were found in the impractical KRAS group. In the multivariable analyses, the KRAS mutational gene was the only variable that was maintained through OS, HRFS and DFS. For HRFS (HR: 13.63; 95% confidence interval (CI): 1.35 100.62; p = 0.010 for KRAS), for DFS (HR: 10.06; 95% CI: 2.40 42.17; p = 0.002 for KRAS) and for OS (HR: 4.55%; 95% CI: 1.37 15.10; p = 0.013). Conclusion: Our study considers the possibility of unnecessary KRAS testing in patients with metachronous tumours and negative lymph nodes harvested. Combining the genetic mutational profile (i.e., KRAS in specific cases) with tumour characteristics helps patient selection and achieves the best prognosis after CRLM resection. Keywords: KRAS oncogene; colorectal liver metastases; tumour burden score; synchronic tumours Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Mon Mar 07 06:53:57 CET 2022 ModDate: Mon Mar 07 06:59:29 CET 2022 ID: 0x2752490dc08097490709673d1a36df34, 0x2752490dc08097490709673d1a36df34 Filters: FilterPipeline: FlateDecode Fonts: Type1: Font: BaseFont: ADUMBL+URWPalladioL-BoldItal FontSubset: true FirstChar: 65 LastChar: 112 FontDescriptor: FontName: ADUMBL+URWPalladioL-BoldItal Flags: Symbolic FontBBox: -170, -300, 1073, 935 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: EKUCRW+URWPalladioL-Bold FontSubset: true FirstChar: 3 LastChar: 122 FontDescriptor: FontName: EKUCRW+URWPalladioL-Bold Flags: Symbolic FontBBox: -152, -301, 1000, 935 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: FXXUVH+CMSY10 FontSubset: true FirstChar: 0 LastChar: 0 FontDescriptor: FontName: FXXUVH+CMSY10 Flags: Symbolic FontBBox: -29, -960, 1116, 775 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