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Background  The relationship between  KRAS  mutational status and timing of colorectal liver metastasis (CRLM) remains unclear. This study evaluated the relationship between  KRAS  mutational status and long-term survival in patients with synchronous CRLM.    Methods  Of the 255 patients who underwent initial hepatic resection for CRLM between January 2001 and December 2018, the  KRAS  mutational status was examined in 101 patients. Medical records of these patients were reviewed to evaluate recurrence and survival outcomes.    Results   KRAS  mutant status was identified in 38 patients (37.6%). The overall survival (OS) was significantly better in patients with wild-type  KRAS  than in those with mutant  KRAS  status. In patients with synchronous metastases, the OS of patients with wild-type  KRAS  was significantly better than those with mutant  KRAS . Multivariate analyses indicated shorter OS to be independently associated with positive primary lymph node, and large tumor size and R1 resection in patients with metachronous metastasis, whereas to be independently associated with mutant  KRAS  status in patients with synchronous metastasis. Furthermore, in the subgroup of patients with synchronous metastases, the repeat resection rate for hepatic recurrence was significantly high in those with wild type  KRAS  than in those with mutant  KRAS .    Conclusion   KRAS  mutation is an independent prognostic factor in patients with synchronous CRLM, but not in patients with metachronous CRLM.

Differential effects of KRAS mutational status on long-term survival according to the timing of colorectal liver metastases