Hospital Pitié-Salpêtrière, Paris, France
Jean-Baptiste Bachet , Nathan Moreno-Lopez , Luca Viganò , Ugo Marchese , Maximiliano Gelli , Loic Raoux , Stephanie Truant , Christophe Laurent , Astrid Herrero , Bertrand Le Roy , Sophie Deguelte Lardiere , Guillaume Passot , Vincent Hautefeuille , Christelle De La Fouchardiere , Pascal Artru , Tchalla Ameto , Antoine Brouquet , Antonio Sa Cunha , Stéphane Benoist
Background: BRAF mutation is associated with poor prognosis in patients with metastatic colorectal cancer. In patients with resectable colorectal liver metastases (CRLM), the prognostic impact of BRAF mutation is unknown and the benefit of surgery is debated. This study aims to evaluate oncologic outcome of patients undergoing liver resection for BRAF-mutated CRLM. Methods: From 2012 to 2016, 66 patients underwent resection for BRAF-mutated LM in 24 centers. Case-matched comparison was made with 183 patients who underwent resection for BRAF wild-type CRLM during the same period. The matching criteria were: synchronous or metachronous CRLM, initially resectable or unresectable CRLM, uni- or bilobar distribution, and number (≤ or > 4) of CRLM. Patients with extra-hepatic disease were excluded. Results: Mean follow up was 28.7 ± 19.8 months after surgery. The 1- and 3-year disease-free survival (DFS) rates were 46.1% and 19.3% in BRAF-mutated and 55.4% and 27.8% in BRAF wild-type patients (p = 0.430). In multivariate analysis, BRAF mutation was not a predictor of worse DFS (p = 0.574, OR: 1.12 95%CI: 0.74-1.71). The 1- and 3-year overall survival rates after surgery were 93.5% and 54.3% in BRAF-mutated and 95.8% and 82.9% in BRAF wild-type patients (p = 0.004). The median survival after disease progression was 23.0 months (11-34.9) in BRAF-mutated and 44.3 months (35.9-52.6) in BRAF wild-type patients (p = 0.049). Multisite disease progression was more common in BRAF-mutated than in BRAF wild-type patients (48 vs 30%, p = 0.034) and was less likely to be surgically treated with curative intent (27% vs 42%, p = 0.085). Conclusions: Our results support the interest of surgical therapy of BRAF-mutated resectable CRLM as BRAF mutation by itself does not increase the risk of relapse after surgery. By analogy to non-metastatic CRC, BRAF mutation has a negative impact on survival in patients who relapse after resection of LM.
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