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Background Patients with metastatic colorectal cancer (mCRC) carrying  BRAF  (mut BRAF ) or  KRAS  mutation (mut KRAS ) have an inferior prognosis after liver or lung surgery, whereas the prognostic role in the context of peritoneal metastasis (PM) after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has been less investigated. Methods In total, 257 patients with non-appendiceal PM-CRC were included from the Norwegian National Unit for CRS-HIPEC. Results In total, 180 patients received CRS - HIPEC with Mitomycin C, 77 patients received palliative surgery only. In the CRS-HIPEC group, mut BRAF  was found in 24.7%, mut KRAS  33.9% and double wild-type 41.4% without differences in survival. MSI was found in 29.3% of mut BRAF  cases. Patients with mut BRAF/ MSI had superior 5-year survival compared to mut BRAF  with MSS (58.3% vs 25.2%,  P  = 0.022), and better 3-year disease-free survival (DFS) compared to mut KRAS  (48.6% vs 17.2%,  P  = 0.049). Peritoneal Cancer Index and the number of lymph node metastasis were prognostic for OS, and the same two, location and gender prognostic for DFS in multivariate analysis. Conclusions PM-CRC with CRS-HIPEC patients has a surprisingly high proportion of mut BRAF  (24.7%). Survival was similar comparing mut BRAF , mut KRAS  and double wild-type cases, whereas a small subgroup with mut BRAF  and MSI had better survival. Patients with mut BRAF  tumours and limited PM should be considered for CRS-HIPEC.

british journal of cancer

Impact of KRAS, BRAF and microsatellite instability status after cytoreductive surgery and HIPEC in a national cohort of colorectal peritoneal metastasis patients