Microsatellite instability in gastric cancer is associated with better prognosis in only stage II cancers
Microsatellite instability in gastric cancer is associated with better prognosis in only stage II cancers
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DOI：
10.1016/j.surg.2005.08.021
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发表时间：
2006-03-01
期刊：
影响因子：
3.8
通讯作者：
Moore, PS
中科院分区：
文献类型：
--
作者：
Beghelli, S;de Manzoni, G;Moore, PS
背景微卫星不稳定性（MSI）的评估尚未纳入胃癌患者的常规评估中，因为其预后价值存在争议。我们使用单核苷酸标记物BAT 25和BAT 26确定了510例散发性胃癌中MSI的临床意义。将结果与错配修复蛋白Mlh 1和Msh 2的免疫组化表达进行比较。结果。MSI存在于83例（16%）癌症中，与更好的生存率相关（P < .001）。多因素分析显示MSI表型是一个独立因素（P = 0.005），并增加了TNM分期、部位和年龄的预后信息。MSI癌症患者的相对死亡风险为0.6（95%置信区间[CI]，0.4-0.8）。此外，当根据分期分组时，只有II期癌症显示MSI状态对生存率有显著影响（P = 0.011;风险比= 0.3; 95%CI，0.1-0.8）。MSI还与年龄较大（P = 0.002）、女性（P <0.001）、肠道组织类型（P = 0.011）、T分期较低（P = 0.018）和淋巴结受累较少（P <0.001）相关。最后，将错配修复蛋白Mlh 1和Msh 2的免疫组化表达结果与微卫星分析结果进行比较，结果显示95%的肿瘤结果一致，敏感性为82%，特异性为98%。胃癌的微卫星分析在判断预后方面具有临床实用性，但应在常规临床环境中仅在H期肿瘤中确定。免疫组化可能被认为是足够的，虽然微卫星分析是优选的。
Background. The assessment of microsatellite instability (MSI) is not included yet in the routine evaluation of patients with gastric cancer, as controversial data exist regarding its prognostic value.Methods. We determined the clinical significance of MSI in 510 sporadic gastric cancers, using the mononucleotide markers BAT25 and BAT26. The results were compared with the immunohistochemical expression, of the mismatch repair proteins Mlh1 and Msh2.Results. MSI was present in 83 (16%) cancers and correlated with better survival (P < .001). Multivariate analysis showed that the MSI phenotype was an independent factor (P = .005) and added prognostic information to TNM stage, location, and age. The relative risk of death for MSI cancer patients was 0.6 (95% confidence interval [CI], 0.4-0.8). Moreover, when grouped according to stage, only stage II cancers showed a significant effect of MSI status on survival (P = .011; hazard ratio = 0.3; 95% CI, 0.1-0.8). MSI also correlated with older age (P = .002), female gender (P < .001), intestinal histotype (P = .011), lower T stage (P = .018), and less lymph node involvement (P < .001). Finally, comparison of the results of immunohistochemical expression of the mismatch repair proteins Mlh1 and Msh2 with microsatellite analysis showed concordant results in 95% of neoplasms, with a sensitivity of 82% and specificity of 98%.Conclusions. Microsatellite analysis of gastric cancer has clinical utility in determination of prognosis, but should be determined in only stage H neoplasms in a routine clinical setting. Immunohistochemistry may be considered sufficient, although microsatellite analysis is preferable.