Adjuvant Hepatic Artery Infusion Chemotherapy is Associated with Improved Survival Regardless of KRAS Mutation Status in Patients with Resected Colorectal Liver Metastases: A Retrospective Analysis of 674 Patients

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Abstract

Objective:To investigate the impact of adjuvant hepatic artery infusion (HAI) in relation to KRAS mutational status in patients with resected colorectal cancer liver metastases (CRLM).Background:Patients with KRAS-mutated CRLM have worse outcomes after resection. Adjuvant HAI chemotherapy improves overall survival after liver resection.Methods:Patients with resected CRLM treated at MSKCC with and without adjuvant HAI who had available KRAS status (wild-Type, WT; mutated, MUT) were reviewed from a prospectively maintained institutional database. Correlations between KRAS status, adjuvant HAI, clinical factors, and outcomes were analyzed. Cox proportional hazard model was used to adjust for confounders.Results:Between 1993 and 2012, 674 patients (418 KRAS-WT, 256 MUT) with a median follow up of 6.5 years after resection were evaluated. Fifty-four percent received adjuvant HAI. Tumor characteristics (synchronous disease, number of lesions, clinical-risk score, 2-stage hepatectomy) were significantly worse in the HAI group; however, there were more patients with resected extrahepatic metastases in the no-HAI group. In KRAS-WT tumors, 5-year survival was 78% for patients treated with HAI versus 57% for patients without HAI [hazard ratio (HR) 0.51, P < 0.001]. In KRAS-MUT tumors, 5-year survival was 59% for patients treated with HAI versus 40% for patients without HAI (HR 0.56, P < 0.001). On multivariate analysis, HAI remained associated with improved OS (HR 0.53, P < 0.002) independent of KRAS status and other clinicopathologic factors.Conclusion:Adjuvant HAI after resection of CRLM is independently associated with improved outcomes regardless of KRAS mutational status. Adjuvant HAI may mitigate the worse outcomes seen in patients with resectable KRAS-MUT CRLM.

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Gholami, S., Kemeny, N. E., Boucher, T. M., Gönen, M., Cercek, A., Kingham, T. P., … D’Angelica, M. (2020). Adjuvant Hepatic Artery Infusion Chemotherapy is Associated with Improved Survival Regardless of KRAS Mutation Status in Patients with Resected Colorectal Liver Metastases: A Retrospective Analysis of 674 Patients. Annals of Surgery, 272(2), 352–356. https://doi.org/10.1097/SLA.0000000000003248

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