Cancer Res Treat.  2020 Oct;52(4):1178-1187. 10.4143/crt.2020.313.

Adjuvant Chemotherapy in Microsatellite Instability–High Gastric Cancer

• Kim JW
• Cho SY
• Chae J
• Kim JW
• Kim TY
• Lee KW
• Oh DY
• Bang YJ
• Im SA

• KMID: 2507943
• DOI: http://doi.org/10.4143/crt.2020.313

Abstract

Purpose
Microsatellite instability (MSI) status may affect the efficacy of adjuvant chemotherapy in gastric cancer. In this study, the clinical characteristics of MSI-high (MSI-H) gastric cancer and the predictive value of MSI-H for adjuvant chemotherapy in large cohorts of gastric cancer patients were evaluated. Material and Methods This study consisted of two cohorts. Cohort 1 included gastric cancer patients who received curative resection with pathologic stage IB-IIIC. Cohort 2 included patients with MSI-H gastric cancer who received curative resection with pathologic stage II/III. MSI was examined using two mononucleotide markers and three dinucleotide markers.
Results
Of 359 patients (cohort 1), 41 patients (11.4%) had MSI-H. MSI-H tumors were more frequently identified in older patients (p < 0.001), other histology than poorly cohesive, signet ring cell type (p=0.005), intestinal type (p=0.028), lower third tumor location (p=0.005), and absent perineural invasion (p=0.027). MSI-H status has a tendency of better disease-free survival (DFS) and overall survival (OS) in multivariable analyses (hazard ratio [HR], 0.4; p=0.059 and HR, 0.4; p=0.063, respectively). In the analysis of 162 MSI-H patients (cohort 2), adjuvant chemotherapy showed a significant benefit with respect to longer DFS and OS (p=0.047 and p=0.043, respectively). In multivariable analysis, adjuvant chemotherapy improved DFS (HR, 0.4; p=0.040).
Conclusion
MSI-H gastric cancer had distinct clinicopathologic findings. Even in MSI-H gastric cancer of retrospective cohort, adjuvant chemotherapy could show a survival benefit, which was in contrast to previous prospective studies and should be investigated in a further prospective trial.

Keyword

Microsatellite instability; Adjuvant chemotherapy; Stomach neoplasms

Figure

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  Fig. 1. Disease-free survival (A) and overall survival (B) according to microsatellite instability (MSI) status. p-value calculated by a Kaplan-Meier method. MSI-H, MSI-high; MSI-L, MSI-low; MSS, microsatellite stable.

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  Fig. 2. Survival according to adjuvant chemotherapy in microsatellite instability–high gastric cancer. Bonferroni-corrected p-values, calculated by a Kaplan-Meier method. (A) Disease-free survival according to adjuvant chemotherapy. (B) Overall survival according to adjuvant chemotherapy. (C) Disease-free survival according to chemotherapy regimen. (D) Overall survival according to chemotherapy regimen.

Reference

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