KRAS-mutation status in relation to colorectal cancer survival: The joint impact of correlated tumour markers

A. I. Phipps, D. D. Buchanan, K. W. Makar, A. K. Win, J. A. Baron, N. M. Lindor, J. D. Potter, P. A. Newcomb

Research output: Contribution to journalArticlepeer-review

149 Scopus citations


Background: Mutations in the Kirsten Ras (KRAS) oncogene are common in colorectal cancer (CRC). The role of KRAS-mutation status as a prognostic factor, however, is unclear. We evaluated the relationship between KRAS-mutation status and CRC survival, considering heterogeneity in this association by tumour and patient characteristics.Methods:The population-based study included individuals diagnosed with CRC between 1998-2007 in Western Washington State. Tumour specimens were tested for KRAS exon 2 mutations, the BRAF p.V600E mutation, and microsatellite instability (MSI). We used Cox regression to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between KRAS-mutation status and disease-specific and overall survival. Stratified analyses were conducted by age, sex, tumour site, stage, and MSI. We conducted additional analyses combining KRAS-mutation, BRAF-mutation, and MSI status.Results:Among 1989 cases, 31% had KRAS-mutated CRC. Kirsten Ras (KRAS)-mutated CRC was associated with poorer disease-specific survival (HR=1.37, 95% CI: 1.13-1.66). This association was not evident in cases who presented with distant-stage CRC. Cases with KRAS-wild-type/BRAF-wild-type/ MSI-high CRC had the most favourable prognosis; those with CRC exhibiting a KRAS-or BRAF-mutation and no MSI had the poorest prognosis. Patterns were similar for overall survival.Conclusion:Kirsten Ras (KRAS)-mutated CRC was associated with statistically significantly poorer survival after diagnosis than KRAS-wild-type CRC.

Original languageEnglish (US)
Pages (from-to)1757-1764
Number of pages8
JournalBritish journal of cancer
Issue number8
StatePublished - Apr 30 2013

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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