Molecular profiling and survival outcomes in colorectal cancer in Egypt: Implications for precision oncology in real-world practice.

e15703 Background: Colorectal cancer (CRC) is a molecularly heterogeneous disease, and biomarker-guided treatment has become integral to modern management. However, in many low- and middle-income countries, including Egypt, access to molecular diagnostics and standardized testing strategies remains variable, and real-world survival data are limited. We aimed to describe the prevalence of key molecular alterations in Egyptian patients with CRC and to assess their association with overall survival (OS) in routine clinical practice. Methods: We conducted a retrospective cohort study of PCR-tested patients with CRC (stages I–IV) treated at a tertiary center in Egypt. Molecular alterations of interest included KRAS, NRAS, and BRAF mutations, as well as microsatellite instability (MSI) status. OS was calculated from the time of metastatic diagnosis when applicable. Results: A total of 111 patients with molecularly tested CRC were included. The mean age at diagnosis was 49.7 ± 13.6 years, and 58% were female. Any molecular alteration was detected in 34.2% of patients (38/111). KRAS mutations were the most frequent (30%, 27/90), followed by MSI-H (17.5%, 10/57), NRAS mutations (5.2%), and BRAF mutations (1.48%). No statistically significant difference in OS was observed between patients with and without any molecular alteration (median 32 vs 26 months, p = 0.06). In contrast, KRAS-mutant patients demonstrated significantly longer OS compared with KRAS wild-type patients (32 vs 26 months, p = 0.03). The prevalence of molecular alterations did not differ significantly according to age ( < 45 vs ≥45 years), sex, primary tumor location, initial stage, or nodal status. Conclusions: In this real-world Egyptian cohort, KRAS mutations were associated with unexpectedly longer overall survival, in contrast to conventional prognostic expectations derived from clinical trial populations. This finding likely reflects local real-world factors, including treatment selection patterns, limited access to biologic therapies, very low prevalence of poor-prognosis subtypes such as BRAF mutations, and a relatively short follow-up period. Together with the high prevalence of KRAS mutations and MSI-H, these results highlight the importance of expanding equitable access to molecular diagnostics and tailoring precision oncology strategies to the realities of routine clinical practice in resource-constrained settings.