Abstract

Objective: To evaluate survival outcomes and prognostic factors in stage IV non-small cell lung cancer (NSCLC) patients harboring KRAS mutations treated at K Hospital.

Methods: A combined retrospective–prospective descriptive study enrolled 124 stage IV KRAS-mutant NSCLC patients treated between January 2020 and December 2024. Clinical characteristics, treatment patterns and responses were recorded. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan–Meier method; independent prognostic factors were identified through Cox regression.

Results: First-line regimens comprised platinum-based doublet chemotherapy (73.4%), chemo-immunotherapy (8.9%), single-agent immunotherapy (3.2%) and single-agent chemotherapy (14.5%). Partial response, stable disease and progressive disease rates were 41.9%, 33.1% and 25%, respectively (disease-control rate 75%). After a median follow-up of 13.2 months, median PFS was 6.8 months and median OS 15.3 months. Poor performance status (PS ≥ 2) and adrenal metastasis independently predicted shorter PFS and OS; pleural, hepatic and skeletal metastases correlated with shorter PFS, whereas PD-L1 positivity correlated with longer OS.

Conclusions: Stage IV KRAS-mutant NSCLC carries limited survival. Performance status, adrenal metastasis and PD-L1 expression are key determinants for prognostication and individualized treatment planning.