TY - JOUR
T1 - Demystifying BRAF Mutation Status in Colorectal Liver Metastases
T2 - A Multi-institutional, Collaborative Approach to 6 Open Clinical Questions
AU - Margonis, Georgios A.
AU - Boerner, Thomas
AU - Bachet, Jean Baptiste
AU - Buettner, Stefan
AU - Moretto, Roberto
AU - Andreatos, Nikolaos
AU - Sartore-Bianchi, Andrea
AU - Wang, Jane
AU - Kamphues, Carsten
AU - Gagniere, Johan
AU - Lonardi, Sara
AU - Løes, Inger M.
AU - Wagner, Doris
AU - Spallanzani, Andrea
AU - Sasaki, Kazunari
AU - Burkhart, Richard
AU - Pietrantonio, Filippo
AU - Pikoulis, Emmanouil
AU - Pawlik, Timothy M.
AU - Truant, Stéphanie
AU - Orlandi, Armando
AU - Pikouli, Anastasia
AU - Pella, Nicoletta
AU - Beyer, Katharina
AU - Poultsides, George
AU - Seeliger, Hendrik
AU - Aucejo, Federico N.
AU - Kornprat, Peter
AU - Kaczirek, Klaus
AU - Lønning, Per E.
AU - Kreis, Martin E.
AU - Wolfgang, Christopher L.
AU - Weiss, Matthew J.
AU - Cremolini, Chiara
AU - Benoist, Stéphane
AU - D'Angelica, Michael
N1 - Publisher Copyright:
© 2023 Lippincott Williams and Wilkins. All rights reserved.
PY - 2023/9/1
Y1 - 2023/9/1
N2 - Objective: To investigate the clinical implications of BRAF-mutated (mutBRAF) colorectal liver metastases (CRLMs). Background: The clinical implications of mutBRAF status in CRLMs are largely unknown. Methods: Patients undergoing resection for mutBRAF CRLM were identified from prospectively maintained registries of the collaborating institutions. Overall survival (OS) and recurrence-free survival (RFS) were compared among patients with V600E versus non-V600E mutations, KRAS/BRAF comutation versus mutBRAF alone, microsatellite stability status (Microsatellite Stable (MSS) vs instable (MSI-high)), upfront resectable versus converted tumors, extrahepatic versus liver-limited disease, and intrahepatic recurrence treated with repeat hepatectomy versus nonoperative management. Results: A total of 240 patients harboring BRAF-mutated tumors were included. BRAF V600E mutation was associated with shorter OS (30.6 vs 144 mo, P=0.004), but not RFS compared with non-V600E mutations. KRAS/BRAF comutation did not affect outcomes. MSS tumors were associated with shorter RFS (9.1 vs 26 mo, P<0.001) but not OS (33.5 vs 41 mo, P=0.3) compared with MSI-high tumors, whereas patients with resected converted disease had slightly worse RFS (8 vs 11 mo, P=0.01) and similar OS (30 vs 40 mo, P=0.4) compared with those with upfront resectable disease. Patients with extrahepatic disease had worse OS compared with those with liver-limited disease (8.8 vs 40 mo, P<0.001). Repeat hepatectomy after intrahepatic recurrence was associated with improved OS compared with nonoperative management (41 vs 18.7 mo, P=0.004). All results continued to hold true in the multivariable OS analysis. Conclusions: Although surgery may be futile in patients with BRAF-mutated CRLM and concurrent extrahepatic disease, resection of converted disease resulted in encouraging survival in the absence of extrahepatic spread. Importantly, second hepatectomy in select patients with recurrence was associated with improved outcomes. Finally, MSI-high status identifies a better prognostic group, with regard to RFS while patients with non-V600E mutations have excellent prognosis.
AB - Objective: To investigate the clinical implications of BRAF-mutated (mutBRAF) colorectal liver metastases (CRLMs). Background: The clinical implications of mutBRAF status in CRLMs are largely unknown. Methods: Patients undergoing resection for mutBRAF CRLM were identified from prospectively maintained registries of the collaborating institutions. Overall survival (OS) and recurrence-free survival (RFS) were compared among patients with V600E versus non-V600E mutations, KRAS/BRAF comutation versus mutBRAF alone, microsatellite stability status (Microsatellite Stable (MSS) vs instable (MSI-high)), upfront resectable versus converted tumors, extrahepatic versus liver-limited disease, and intrahepatic recurrence treated with repeat hepatectomy versus nonoperative management. Results: A total of 240 patients harboring BRAF-mutated tumors were included. BRAF V600E mutation was associated with shorter OS (30.6 vs 144 mo, P=0.004), but not RFS compared with non-V600E mutations. KRAS/BRAF comutation did not affect outcomes. MSS tumors were associated with shorter RFS (9.1 vs 26 mo, P<0.001) but not OS (33.5 vs 41 mo, P=0.3) compared with MSI-high tumors, whereas patients with resected converted disease had slightly worse RFS (8 vs 11 mo, P=0.01) and similar OS (30 vs 40 mo, P=0.4) compared with those with upfront resectable disease. Patients with extrahepatic disease had worse OS compared with those with liver-limited disease (8.8 vs 40 mo, P<0.001). Repeat hepatectomy after intrahepatic recurrence was associated with improved OS compared with nonoperative management (41 vs 18.7 mo, P=0.004). All results continued to hold true in the multivariable OS analysis. Conclusions: Although surgery may be futile in patients with BRAF-mutated CRLM and concurrent extrahepatic disease, resection of converted disease resulted in encouraging survival in the absence of extrahepatic spread. Importantly, second hepatectomy in select patients with recurrence was associated with improved outcomes. Finally, MSI-high status identifies a better prognostic group, with regard to RFS while patients with non-V600E mutations have excellent prognosis.
KW - BRAF
KW - CRLM
KW - MSI
UR - http://www.scopus.com/inward/record.url?scp=85164259266&partnerID=8YFLogxK
U2 - 10.1097/SLA.0000000000005771
DO - 10.1097/SLA.0000000000005771
M3 - Article
C2 - 36453261
AN - SCOPUS:85164259266
SN - 0003-4932
VL - 278
SP - E540-E548
JO - Annals of surgery
JF - Annals of surgery
IS - 3
ER -