Erschienen in:
01.03.2016 | Gastrointestinal Oncology
Strong Prognostic Value of Microsatellite Instability in Intestinal Type Non-cardia Gastric Cancer
verfasst von:
Daniele Marrelli, MD, Karol Polom, MD, Valeria Pascale, Carla Vindigni, MD, Riccardo Piagnerelli, MD, Lorenzo De Franco, MD, Francesco Ferrara, MD, Giandomenico Roviello, MD, Lorenzo Garosi, Roberto Petrioli, MD, Franco Roviello, MD
Erschienen in:
Annals of Surgical Oncology
|
Ausgabe 3/2016
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Abstract
Background
The clinical role of microsatellite instability (MSI) in gastric cancer (GC) is controversial. A large series of patients submitted to respective surgery for primary GC with a long follow-up time was evaluated.
Methods
472 patients with prospectively collected frozen samples of normal mucosa and tumor tissue stored in a biological tissue bank were included. Microsatellite analysis was evaluated using 5 quasi monomorphic mononucleotide repeats (BAT-26, BAT-25, NR-24, NR-21, and NR-27). The presence of MSI in 2 or more loci was classified as MSI-H, whereas all other cases were included in the microsatellite-stable (MSS) group.
Results
MSI-H phenotype was found in 111 of 472 patients (23.5 %). MSI-H status was related significantly with older age, female gender, non-cardia location, WHO histotype, non-cardia Lauren intestinal type, and less advanced stages. Cancer-related 5-year survival was significantly higher in MSI-H versus MSS group (67.6 % vs. 35 %, p < 0.001). Stratified analysis revealed a significant impact of MSI on prognosis in non-cardia tumors of intestinal type or tubular/poorly differentiated histology, particularly in stages II and III; multivariate Cox regression analysis confirmed MSS status as a strong predictor of poor prognosis (hazard ratio 2.65, 95 % CI 1.56–4.51, p < 0.001) in non-cardia intestinal type. No prognostic value of MSI in the diffuse-mixed type and signet-ring cell/mucinous histotypes was observed.
Conclusions
MSI was confirmed as a significant predictor of long term outcome in a large series of GC with a long follow-up time, but the prognostic value is limited to selected histotypes of non-cardia tumors.