RAS Mutation Clinical Risk Score to Predict Survival After Resection of Colorectal Liver Metastases

Felice Giuliante, Francesco Ardito, Luigi Maria Larocca, Elena Panettieri, Kristoffer W. Brudvik, Robert P. Jones, Junichi Shindoh, Guillaume Passot, Michael H. Chung, Juhee Song, Liang Li, Vegar J. Dagenborg, Åsmund A. Fretland, Bård Røsok, Bjørn Edwin, Suguru Yamashita, Claudius Conrad, Thomas A. Aloia, Graeme J. Poston, Bjørn A. BjørnbethJean-Nicolas Vauthey

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77 Citations (Scopus)


OBJECTIVE:: To determine the impact of RAS mutation status on the traditional clinical score (t-CS) to predict survival after resection of colorectal liver metastases (CLM). BACKGROUND:: The 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. METHODS:: Patients 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. RESULTS:: A 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. CONCLUSIONS:: Modifying 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.
Original languageEnglish
Pages (from-to)120-126
Number of pages7
JournalAnnals of Surgery
Publication statusPublished - 2019


  • Surgery


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