Yonsei Med J.  2015 Jan;56(1):175-181. 10.3349/ymj.2015.56.1.175.

Clinical Implications of Microsatellite Instability in T1 Colorectal Cancer

• Kang J
• Lee HW
• Kim IK
• Kim NK
• Sohn SK
• Lee KY

• KMID: 2352804
• DOI: http://doi.org/10.3349/ymj.2015.56.1.175

Abstract

PURPOSE
The estimation of regional lymph node metastasis (LNM) risk in T1 colorectal cancer is based on histologic examination and imaging of the primary tumor. High-frequency microsatellite instability (MSI-H) is likely to decrease the possibility of metastasis to either regional lymph nodes or distant organs in colorectal cancers. This study evaluated the clinical implications of MSI in T1 colorectal cancer with emphasis on the usefulness of MSI as a predictive factor for regional LNM.
MATERIALS AND METHODS
A total of 133 patients who underwent radical resection for T1 colorectal cancer were included. Genomic DNA was extracted from normal and tumor tissues and amplified by polymerase chain reaction (PCR). Five microsatellite markers, BAT-25, BAT-26, D2S123, D5S346, and D17S250, were used. MSI and clinicopathological parameters were evaluated as potential predictors of LNM using univariate and multivariate analyses.
RESULTS
Among 133 T1 colorectal cancer patients, MSI-H, low-frequency microsatellite instability (MSI-L), and microsatellite stable (MSS) colorectal cancers accounted for 7.5%, 6%, and 86.5%, respectively. MSI-H tumors showed a female predominance, a proximal location and more retrieved lymph nodes. Twenty-two patients (16.5%) had regional LNM. Lymphovascular invasion and depth of invasion were significantly associated with LNM. There was no LNM in 10 MSI-H patients; however, MSI status was not significantly correlated with LNM. Disease-free survival did not differ between patients with MSI-H and those with MSI-L/MSS.
CONCLUSION
MSI status could serve as a negative predictive factor in estimating LNM in T1 colorectal cancer, given that LNM was not detected in MSI-H patients. However, validation of our result in a different cohort is necessary.

Keyword

Microsatellite instability; lymph node metastasis; early colorectal cancer; T1; prognosis

MeSH Terms

Adult
Aged
Aged, 80 and over
Colorectal Neoplasms/*genetics/*pathology
Female
Humans
Lymph Nodes/pathology
Lymphatic Metastasis/pathology
Male
*Microsatellite Instability
Microsatellite Repeats/genetics
Middle Aged
Neoplasm Staging
Risk Factors
Survival Analysis

Figure

• 

  Fig. 1 Comparison of survival between MSI-H group and MSI-L/MSS group. There was no difference of survival outcomes between "MSI-H group" and "MSI-L/MSS group" (mean follow-up periods: 31 months). DFS, disease-free survival; MSI-H, high-frequency microsatellite instability; MSI-L, low-frequency microsatellite instability; MSS, microsatellite stable.

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