Background: To investigate the prognostic value of RAS mutation status and subtypes in colorectal lung metastases (CRLM) patients undergoing image-guided thermal ablation (IGTA), and to evaluate survival outcomes under different systemic therapy regimens. Materials and Methods: In this multicenter retrospective–prospective cohort study, 387 patients with CRLM who received percutaneous IGTA between March 2014 and December 2022 were included. Patients were stratified by RAS genotype (KRAS/NRAS wild-type vs mutant). Survival outcomes including local tumor progression-free survival (LTPFS), progression-free survival (PFS), and overall survival (OS) were analyzed using Cox regression. Subgroup analyses were conducted based on chemotherapy regimens and targeted agents. Results: The 3-year LTP rate was significantly higher in KRAS-mutant patients (25.0%) than wild-type (15.0%). KRAS mutation, lesion diameter ≥20 mm, and elevated CEA were independent risk factors for LTP. Median PFS was 16.0 months; KRAS mutations predicted inferior PFS (13.3% vs 32.8% at 3 years). Median OS was significantly reduced in both KRAS (17.9 vs 56.8 months) and NRAS-mutant patients (22.1 vs 53.8 months). Among KRAS-mutant patients, FOLFOX plus bevacizumab yielded better OS than cetuximab. Conclusion: RAS mutations are independent predictors of poor local control and survival after IGTA in CRLM. Evaluate interactions between RAS genotype and commonly used targeted agents in the peri-ablative setting. These integrated, real-world insights support the development of genotype-guided ablation planning and peri-ablative systemic therapy strategies.
Fan et al. (Tue,) studied this question.