ArticleJournal of gastrointestinal oncology2026
KRAS mutation subtypes refine prognostic stratification in colorectal cancer: a retrospective cohort study.
Article in Journal of gastrointestinal oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Colorectal cancer (CRC) remains a leading cause of cancer-related mortality worldwide, with Kirsten rat sarcoma viral oncogene homolog (KRAS) mutations occurring in approximately 40% of cases and playing a critical role in tumor progression and treatment resistance. However, the prognostic impact of specific KRAS mutation subtypes remains incompletely understood. This study aims to elucidate the distinctions in clinical and pathological features and prognostic outcomes among various KRAS mutation subtypes in CRC patients. Methods: We conducted a retrospective analysis of 343 stage I-IV CRC patients who underwent genetic testing at the Department of Oncology Surgery, The First Affiliated Hospital of Kunming Medical University, from January 2017 to October 2023. Clinical data were meticulously collected and analyzed to determine the impact of KRAS mutations on the prognosis of CRC patients. Results: The overall KRAS mutation rate was 67.3%, with the most common subtypes being G12D, G13D, and G12V. KRAS mutations showed significant associations with gender, microsatellite stability, and initial carcinoembryonic antigen (CEA) levels. Multivariate analysis identified poor tumor differentiation, tumor-node-metastasis (TNM) stage IV, and exon 2 mutations of KRAS as independent risk factors for poor prognosis, while curative surgical resection emerged as a protective factor (all P<0.05). Specifically, patients with G12A and K117N mutations of KRAS had the worst overall survival (OS) outcomes. Conclusions: KRAS mutations-particularly exon 2 alterations-are associated with inferior OS in CRC. Among KRAS-mutant subtypes, G12A and K117N confer the poorest prognosis, supporting the clinical value of subtype-level risk stratification.
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