• Kristoffer W Brudvik, Robert P Jones, Felice Giuliante, Junichi Shindoh, Guillaume Passot, Michael H Chung, Juhee Song, Liang Li, Vegar J Dagenborg, Åsmund A Fretland, Bård Røsok, Agostino M De Rose, Francesco Ardito, Bjørn Edwin, Elena Panettieri, Luigi M Larocca, Suguru Yamashita, Claudius Conrad, Thomas A Aloia, Graeme J Poston, Bjørn A Bjørnbeth, and Jean-Nicolas Vauthey.
• Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
• Ann. Surg. 2019 Jan 1; 269 (1): 120-126.

ObjectiveTo determine the impact of RAS mutation status on the traditional clinical score (t-CS) to predict survival after resection of colorectal liver metastases (CLM).BackgroundThe t-CS relies on the following factors: primary tumor nodal status, disease-free interval, number and size of CLM, and carcinoembryonic antigen level. We hypothesized that the addition of RAS mutation status could create a modified clinical score (m-CS) that would outperform the t-CS.MethodsPatients who underwent resection of CLM from 2005 through 2013 and had RAS mutation status and t-CS factors available were included. Multivariate analysis was used to identify prognostic factors to include in the m-CS. Log-rank survival analyses were used to compare the t-CS and the m-CS. The m-CS was validated in an international multicenter cohort of 608 patients.ResultsA total of 564 patients were eligible for analysis. RAS mutation was detected in 205 (36.3%) of patients. On multivariate analysis, RAS mutation was associated with poor overall survival, as were positive primary tumor lymph node status and diameter of the largest liver metastasis >50 mm. Each factor was assigned 1 point to produce a m-CS. The m-CS accurately stratified patients by overall and recurrence-free survival in both the initial patient series and validation cohort, whereas the t-CS did not.ConclusionsModifying the t-CS by replacing disease-free interval, number of metastases, and CEA level with RAS mutation status produced an m-CS that outperformed the t-CS. The m-CS is therefore a simple validated tool that predicts survival after resection of CLM.

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