Cancer Res Treat.  2020 Oct;52(4):1153-1161. 10.4143/crt.2020.173.

A Multi-cohort Study of the Prognostic Significance of Microsatellite Instability or Mismatch Repair Status after Recurrence of Resectable Gastric Cancer

• An JY
• Choi YY
• Lee J
• Hyung WJ
• Kim KM
• Noh SH
• Choi MG
• Cheong JH

• KMID: 2507941
• DOI: http://doi.org/10.4143/crt.2020.173

Abstract

Purpose
High microsatellite instability (MSI) is related to good prognosis in gastric cancer. We aimed to identify the prognostic factors of patients with recurrent gastric cancer and investigate the role of MSI as a prognostic and predictive biomarker of survival after tumor recurrence.
Materials and Methods
This retrospective cohort study enrolled patients treated for stage II/III gastric cancer who developed tumor recurrence and in whom the MSI status or mismatch repair (MMR) status of the tumor was known. MSI status and the expression of MMR proteins were evaluated using polymerase chain reaction and immunohistochemical analysis, respectively.
Results
Of the 790 patients included, 64 (8.1%) had high MSI status or MMR deficiency. The tumor-node-metastasis stage, type of recurrence, Lauren classification, chemotherapy after recurrence, and interval to recurrence were independently associated with survival after tumor recurrence. The MSI/MMR status and receiving adjuvant chemotherapy were not associated with survival after recurrence. In a subgroup analysis of patients with high MSI or MMR-deficient gastric cancer, those who did not receive adjuvant chemotherapy had better treatment response to chemotherapy after recurrence than those who received adjuvant chemotherapy.
Conclusion
Patients with high MSI/MMR-deficient gastric cancer should be spared from adjuvant chemotherapy after surgery, but aggressive chemotherapy after recurrence should be considered. Higher tumor-node-metastasis stage, Lauren classification, interval to recurrence, and type of recurrence are associated with survival after tumor recurrence and should thus be considered when establishing a treatment plan and designing clinical trials targeting recurrent gastric cancer.

Keyword

Stomach neoplasms; Recurrence; Microsatellite instability; Prognosis; Biomarker

Figure

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  Fig. 1. Kaplan-Meier curves for survival after recurrence according to receiving adjuvant chemotherapy and chemotherapy after recurrence. (A) Regardless of the MSI/MMR status. (B) MSS/pMMR tumor. (C) MSI-H/dMMR tumors in the overall cohort. MSI, microsatellite instability; MRR, mismatch repair; MSS, microsatellite stable; pMMR, proficient MMR; MSI-H, MSI-high; dMMR, deficient MMR; n, number of patients; Adj, adjuvant chemotherapy; CAR, chemotherapy after recurrence.

Reference

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