Association KRAS G13D and Anastomotic Recurrence

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Association KRAS G13D and Anastomotic Recurrence

Postby I_will_fight » Fri Jan 12, 2024 2:12 am

In a nutshell: Patients with mutation KRAS G13D appear to be more likely to suffer Anastomotic recurrences.
This seems to be the case for all mutations of the A->D type (i.e. G12D and G13D)
What is more. Patients that suffer Anastomotic Recurrence show worse prognosis if they have KRAS G13D mutation

I guess patients with KRAS G12D and KRAS G13D mutations should insist on more frequent colonoscopies

Source :
Received September 26, 2022; Accepted February 28, 2023
DOI: 10.3892/ol.2023.13778

Patients. The present study assessed 21 patients who underwent curative resection for CRC at the Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, (Tokyo, Japan) between January 2005 and December 2019, and were diagnosed with AR and matched to a control group of Non Anastomotic Local Recurrence (NALR)

Prevalence of KRASg13D in the AR group was 33% while in the NALR group was 4.8%

Most AR occured in the first year and 100% by the 3rd year after initial surgery for KRAS G13D.

After AR resection all G13D patients recurred within two years

Abstract. The genetic risk factors for anastomotic recurrence (AR) after curative surgery for colorectal cancer (CRC) are unclear. The present study is a single‑center retrospective observational study that aimed to elucidate the association between the KRAS G13D mutation and AR in CRC. The present study included 21 patients with AR and 67 patients with non‑anastomotic local recurrence (NALR) following curative surgery for CRC between January 2005 and December 2019. KRAS G13D mutation status was examined by droplet digital polymerase chain reaction. Data of clinicopathological findings and oncological outcomes were analyzed and compared between the AR group and the matched NALR group. The prevalence of the KRAS G13D mutation was significantly higher in the AR group (AR vs. NALR, 33.3 vs. 4.8%; P=0.047). Comparing the KRAS G13D mutation‑positive and KRAS G13D mutation‑negative patients in the AR group, there was no significant difference in the time from initial surgery to AR or resection rate of AR; however, all patients with KRAS G13D mutation who underwent resection of AR had subsequent recurrence within 2 years after resection, and overall survival was poor (3‑year survival rate: Positive vs. negative, 68.6 vs. 90.9%; P=0.02). The prevalence of the KRAS G13D mutation was significantly higher in patients with AR, and KRAS G13D‑mutant patients with AR had a poorer prognosis than those that were negative for the KRAS G13D mutation. In conclusion, postoperative surveillance and treatment strategies should be considered with attention to the possibility of AR and subsequent recurrence in KRAS G13D‑mutant patients.

analyzing the 17 cases who underwent surgical resection of AR, even though there was no significant difference in recurrence‑free survival (RFS) after resection (2‑year RFS after resection: KRAS G13D+ 0% vs. KRAS G13D‑ 33.3%; P=0.10), all KRAS G13D+ patients experienced subsequent recurrence within 2 years (Fig. 2B). Notably, KRAS G13D+ patients had a significantly poorer overall survival (OS) (3‑year OS: KRAS G13D+ 68.6% vs. KRAS G13D‑ 90.9%; P=0.02) (Fig. 2C). The rate of synchronous recurrence at the diagnosis of AR was 28.6% (2/7) in KRAS G13D+ patients and 42.9% (6/14) in KRAS G13D‑ patients. There was no significant difference in the synchronous recurrence patterns between patients with and without the KRAS G13D mutation (Table IV)."

Of note:

Few reports have suggested that the KRAS G13D mutation differs from other KRAS subtypes and may benefit from treatment with the anti‑EGFR antibody cetuximab (25,26), but this has been doubted by some reports (27) and no conclusion has been reached. The therapeutic efficacy of anti‑EGFR antibody therapy in KRAS G13D+ requires further study.
46 yo male Spain
06/2020 - 6cm T3N0M0 CC splenic flex
3 and 4 mm lung ground glass
lymp 0/37
KRAS mt G13D
V/LNI absent
PNI present
07/20 - hemicol surg, optimistic surgeon.
11/20 - 4 x CAPOX completed.
12/20 - Clear colonoscopy
02/21 - MRI liver lesion unchanged.
11/21 - Clear CT
02/22- Colonoscopy: Sessil polyp 3mm
05/22- Clear CT
06/22- Negative Signatera
12/22- Negative Signatera
01/23- Clear CT
07/23- Clear CT, normal markers.
09/23 - Negative Signatera
01/24 - Clear CT

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