Genomic mutation and Clinicopathological features of KRAS wild-type tumors in Chinese cohort with pancreatic adenocarcinoma

This study aims to elucidate the genomic and clinicopathological characteristics of pancreatic ductal adenocarcinoma (PDAC) in Chinese patients with KRAS wild-type (WT) tumors. Analysis of 869 PDAC patients revealed that 164 tumors (19 %) were KRAS WT, with a predominance of TP53 mutations (32 %), followed by AHNAK (12 %), CTNNB1 (6 %), and BRAF (5 %). These tumors exhibited a higher prevalence of DNA damage response gene mutations, lower levels of tumor antigens CA-199, CA-125, and CEA, and with a similar trend in mutant-allele tumor heterogeneity and tumor mutational burden. Conversely, microsatellite instability was markedly elevated in these cases. Survival outcomes were superior for KRAS WT tumors, with a median overall survival of 36.5 months compared to 23.0 months for KRAS mutated tumors (P < 0.0001). These findings suggest that KRAS WT PDAC in Chinese patients presents a distinct genetic profile necessitating the development of specific therapeutic strategies.