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

Adjuvant Chemotherapy in Microsatellite Instability–High Gastric Cancer

Affiliations
  • 1Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
  • 2Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
  • 3Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
  • 4Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea

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

  • 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.

  • 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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