title: NRAS mutation status is an independent prognostic factor in metastatic melanoma.
abstract: BACKGROUND
  There is a need for improved prognostic markers in melanoma. In this study, the authors tested the prognostic significance and clinicopathologic correlations of v-raf murine sarcoma viral oncogene homolog B1 (BRAF) and neuroblastoma RAS viral (v-ras) oncogene homolog (NRAS) mutations in patients with metastatic melanoma.
  
  
  METHODS
  Clinical and pathologic data were collected retrospectively on melanoma patients who were clinically tested for BRAF (exon 15) and NRAS (exons 1 and 2) mutations at The University of Texas M. D. Anderson Cancer Center. Analyses were performed to identify significant associations of mutations with tumor and patient characteristics and with survival from the diagnosis of stage IV disease.
  
  
  RESULTS
  The genotypes of the full cohort (n = 677) were 47% BRAF mutation, 20% NRAS mutation, and 32% wild-type for BRAF and NRAS ("WT"). Tumor mutation status was associated (P = .008) with the risk of central nervous system involvement at the diagnosis of stage IV disease, with a higher prevalence observed in BRAF-mutant (24%) and NRAS-mutant (23%) patients than in WT patients (12%). Among patients with nonuveal melanoma who underwent mutation testing within 6 months of stage IV diagnosis (n = 313), patients with NRAS mutations had a median survival of 8.2 months from stage IV diagnosis, which was shorter than the median survival of WT patients (15.1 months; P = .004). Multivariate analysis of this population incorporating age, sex, metastases (M1) category, serum lactate dehydrogenase level, and mutation status confirmed that NRAS mutations are associated independently with decreased overall survival (vs WT; P = .005; hazard ratio, 2.05).
  
  
  CONCLUSIONS
  Patients with BRAF or NRAS mutations were more likely than WT patients to have central nervous system involvement at the time they were diagnosed with distant metastatic disease. NRAS mutation status was identified as an independent predictor of shorter survival after a diagnosis of stage IV melanoma.
authors.affiliation: Department of Melanoma Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Jakob
authors.forename: Roland L
authors.initials: RL
authors.lastname: Bassett
authors.forename: Chaan S
authors.initials: CS
authors.lastname: Ng
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Curry
authors.forename: Richard W
authors.initials: RW
authors.lastname: Joseph
authors.forename: Gladys C
authors.initials: GC
authors.lastname: Alvarado
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Rohlfs
authors.forename: Jessie
authors.initials: J
authors.lastname: Richard
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Gershenwald
authors.forename: Kevin B
authors.initials: KB
authors.lastname: Kim
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Lazar
authors.forename: Patrick
authors.initials: P
authors.lastname: Hwu
authors.forename: Michael A
authors.initials: MA
authors.lastname: Davies
mesh_terms: D005260:Female; D005787:Gene Frequency; D011905:Genes, ras; D006801:Humans; D008545:Melanoma / Q000235:genetics* / Q000401:mortality / Q000473:pathology / Q000556:secondary; D008875:Middle Aged; D009154:Mutation; D009362:Neoplasm Metastasis; D011379:Prognosis; D048493:Proto-Oncogene Proteins B-raf / Q000235:genetics; D012878:Skin Neoplasms / Q000235:genetics* / Q000401:mortality / Q000473:pathology
chemical_list: C482119:BRAF protein, human; D048493:Proto-Oncogene Proteins B-raf