Objective: To compare the treatment and prognosis of kirsten rat sarcoma viral oncogene (KRAS) mutant lung adenocarcinoma patients with different mutation states and molecular typing. Methods: The data of patients with advanced KRAS mutant lung adenocarcinoma who were diagnosed and received first-line therapy in the First Affiliated Hospital of Bengbu Medical College from April 2019 to April 2022 were collected. The co-mutation of TP53, molecular typing and the correlation of treatment prognosis were analyzed. Results: Follow-up to April 2022, the mPFS of patients with KRAS/TP53 co-mutation was significantly shorter than that of patients with KRAS single mutation (HR=0.613, 95%CI: 0.396-0.951, P=0.029), and the difference was statistically significant. The mPFS of chemotherapy combined with anti-angiogenesis therapy was significantly prolonger than that of chemotherapy alone (HR=0.593, 95%CI: 0.355-0.990, P=0.038). The mPFS of chemotherapy combined with immunotherapy group was significantly longer than that of chemotherapy alone (HR=0.426, 95%CI: 0.247-0.736, P=0.02). There was no significant difference in mPFS between chemotherapy combined with anti-angiogenesis therapy group and chemotherapy combined with immunotherapy group (HR=0.648, 95%CI: 0.371-1.130, P=0.126). Conclusion: TP53 is a poor prognostic factor in patients with advanced KRAS mutant lung adenocarcinoma. There is no significant difference in treatment and prognosis between different molecular subtypes of G12C and non-G12C. Chemotherapy combined with immunotherapy or anti-angiogenesis therapy can prolong PFS in patients with advanced lung adenocarcinoma compared with chemotherapy alone, but there is no significant difference in PFS between the combined treatment groups.
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