Prognostic value of mismatch repair deficiency in patients with advanced gastric cancer, treated by surgery and adjuvant 5-fluorouracil and leucovorin chemoradiotherapy
Prognostic value of mismatch repair deficiency in patients with advanced gastric cancer, treated by surgery and adjuvant 5-fluorouracil and leucovorin chemoradiotherapy
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DOI：
10.1016/j.ejso.2019.08.025
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发表时间：
2020-01-01
期刊：
影响因子：
3.8
通讯作者：
Kim, Sung
中科院分区：
文献类型：
--
作者：
Kim, Su Mi;An, Ji Yeong;Kim, Sung
目的：错配修复蛋白缺陷（MMRD）对胃癌放化疗结果的预测价值很少报道。本研究探讨了MMRD作为肿瘤复发的预后因素的临床意义，并作为对辅助放化疗的预测进展期胃癌patients.Methods：在1995年和2008年之间，881例接受根治性胃切除术的II期和111例胃癌的组织标本进行了分析。使用MLHI、PMS 2、MSH 2和MSH 6的免疫组织化学染色评估MMRD。根据辅助治疗将患者分为两组：5-氟尿嘧啶/亚叶酸（FL）辅助放化疗组和单纯手术组。比较两组患者的无病生存率（DFS）与MMRD的相关性。结果：881例胃癌患者中，88例（10.0%）出现MMRD，398例（45.2%）接受FL辅助放化疗。多因素分析显示MMRD是一个良好的独立预后因素（危险比，0.572，95%可信区间，0.370-0.883，P = 0.012）。对于III期胃癌显示错配修复蛋白水平（MMRP），术后辅助FL放化疗导致DFS优于单纯手术（P = 0.001）。在II期胃癌患者中，无论MMRD如何，辅助FL放化疗均未显示生存获益。结论：MMRD是晚期胃癌良好的独立预后因素。辅助FL放化疗对III期胃癌伴MMRP患者有益，但对MMRD患者无效。(C)2019 Elsevier Ltd，BASO -癌症外科协会和欧洲外科肿瘤学会。All rights reserved.
Objective: The predictive value of mismatch repair protein deficiency (MMRD) for chemoradiotherapeutic outcome has rarely been reported in gastric cancer. This study investigated the clinical significance of MMRD as a prognostic factor for tumor recurrence, and as a predictor of response to adjuvant chemoradiotherapy in advanced gastric cancer patients.Methods: Between 1995 and 2008, tissue specimens of 881 patients who underwent radical gastrectomy for stage II and 111 gastric cancer were analyzed. MMRD was assessed using immunohistochemical stains for MLHI, PMS2, MSH2, and MSH6. Patients were divided into two groups according to adjuvant treatment: a 5-fiuorouracil/leucovorin (FL) adjuvant chemoradiotherapy group and a surgery alone group. Disease-free survival (DFS) was compared between the two groups correlated to MMRD. Risk factors for tumor recurrence were analyzed using multivariate analysis.Results: Of the 881 gastric cancer patients, 88(10.0%) exhibited MMRD and 398(45.2%) patients received adjuvant FL chemoradiotherapy. The multivariate analysis revealed that MMRD was a good independent prognostic factor (hazard ratio, 0.572; 95% confidence interval, 0.370-0.883; P = 0.012). For stage Ill gastric cancer displaying mismatch repair protein proficiency (MMRP), adjuvant FL chemoradiotherapy after surgery resulted in better DFS than surgery alone (P = 0.001). Among the stage II gastric cancer patients, adjuvant FL chemoradiotherapy did not show survival benefit, regardless of MMRD.Conclusion: MMRD is a good independent prognostic factor in advanced gastric cancer. Adjuvant FL chemoradiotherapy was beneficial in patients with stage Ill gastric cancer with MMRP but not in those with MMRD. (C) 2019 Elsevier Ltd, BASO - The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.