Jiang BB, Wang JC, Yan K, Zhang ZY, Wang S, Wu W, Yang W. Differential effects of the KRAS gene on recurrence in right- vs left-sided colorectal liver metastases undergoing radiofrequency ablation. World J Gastrointest Surg 2025; 17(8): 108418 [DOI: 10.4240/wjgs.v17.i8.108418]
Corresponding Author of This Article
Kun Yan, MD, Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing 100142, China. ydbz@vip.sina.com
Research Domain of This Article
Medicine, Research & Experimental
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Aug 27, 2025; 17(8): 108418 Published online Aug 27, 2025. doi: 10.4240/wjgs.v17.i8.108418
Differential effects of the KRAS gene on recurrence in right- vs left-sided colorectal liver metastases undergoing radiofrequency ablation
Bin-Bin Jiang, Ji-Chen Wang, Kun Yan, Zhong-Yi Zhang, Song Wang, Wei Wu, Wei Yang
Bin-Bin Jiang, Ji-Chen Wang, Kun Yan, Zhong-Yi Zhang, Song Wang, Wei Wu, Wei Yang, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing 100142, China
Ji-Chen Wang, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing 102218, China
Co-first authors: Bin-Bin Jiang and Ji-Chen Wang.
Author contributions: Jiang BB, Wang JC, Yan K, Wu W, and Yang W were responsible for the conception and design of the study; Jiang BB, Wang JC, Zhang ZY, and Wang S prepared the initial manuscript draft. All the authors critically reviewed the manuscript. Jiang BB and Wang JC contributed equally to this work.
Supported by Capital Health Development Research Project, No. 2020-2-2152; and National Natural Science Foundation of China, No. 82472002.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of the Beijing Cancer Hospital (Approval No. 2020KT64).
Informed consent statement: Since this was a retrospective study with the inability to access to the patients, the Ethics Committee granted a waiver for the requirement of informed consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kun Yan, MD, Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing 100142, China. ydbz@vip.sina.com
Received: April 14, 2025 Revised: May 20, 2025 Accepted: June 16, 2025 Published online: August 27, 2025 Processing time: 133 Days and 5 Hours
Abstract
BACKGROUND
KRAS mutation status and primary tumor location serve as critical prognostic factors for colorectal liver metastases (CLMs). Emerging evidence suggests a potential interaction between these two variables that may influence clinical outcomes.
AIM
To investigate the association of KRAS mutations with recurrence in patients with CLM who underwent radiofrequency ablation (RFA) according to the primary tumor location.
METHODS
This retrospective study analyzed 164 patients with KRAS-determined CLM treated with percutaneous RFA between January 2012 and December 2018. The clinicopathological characteristics, recurrence patterns, and survival outcomes were systematically evaluated.
RESULTS
A total of 164 patients (mean age: 58.0 ± 9.8 years, range: 34-83 years) who underwent percutaneous RFA of 325 CLMs (mean size: 2.2 ± 1.0 cm, range: 0.7-5.0 cm) were included in the study. Eighty-nine (54.3%) patients had wild-type KRAS, and 75 (45.7%) patients had mutated KRAS. Compared with wild-type patients, patients with KRAS mutations presented significantly higher local tumor progression rates (30.7% vs 14.6%, P = 0.013). Among 126 patients (76.8%) who experienced post-RFA recurrence, 61.6% developed intrahepatic metastases, and 53.7% developed extrahepatic metastases. Primary tumor location significantly modified KRAS-related outcomes: Compared with wild-type patients, left-sided colorectal cancer (CRC) patients with KRAS mutations presented higher intrahepatic recurrence rates (77.2% vs 52.5%, P = 0.003) and shorter median intrahepatic recurrence-free survival (15 vs 25 months, P = 0.007). No significant differences in KRAS expression were detected in right-sided tumors.
CONCLUSION
KRAS mutation status predicts differential recurrence patterns after CLM ablation, with significant prognostic implications, specifically in left-sided CRCs. These findings underscore the importance of integrating molecular profiling and primary tumor characteristics in therapeutic decision-making for patients with metastatic CRC.
Core Tip: The mutation status of the KRAS differentially impacts intrahepatic recurrence after radiofrequency ablation (RFA) for colorectal liver metastases (CLMs) based on primary tumor location. Patients with left-sided colorectal cancer harboring KRAS mutations have significantly worse intrahepatic recurrence-free survival post-RFA, whereas no such association exists in right-sided patients. KRAS status was not correlated with extrahepatic recurrence, regardless of tumor origin. These findings highlight the clinical value of incorporating both primary tumor location and KRAS genotyping to optimize post-RFA management strategies, enabling personalized approaches to reduce recurrence risk and improve long-term outcomes in CLM patients.
