Microsatellite Instability (MSI) as an Independent Predictor of Pathologic Complete Response (PCR) in Locally Advanced Rectal Cancer: A National Cancer Database (NCDB) Analysis.
Microsatellite Instability (MSI) as an Independent Predictor of Pathologic Complete Response (PCR) in Locally Advanced Rectal Cancer: A National Cancer Database (NCDB) Analysis.
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DOI：
10.1097/sla.0000000000003051
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发表时间：
2020-04
影响因子：
9
通讯作者：
Kirichenko A
中科院分区：
文献类型：
--
作者：
Hasan S;Renz P;Wegner RE;Finley G;Raj M;Monga D;McCormick J;Kirichenko A
微卫星不稳定性（MSI）与直肠癌新辅助放化疗疗效之间的关系尚不清楚。我们利用美国国家癌症数据库（NCDB）调查MSI和病理完全缓解（pCR）之间的关联，在这个病人群体。我们分析了2010年至2015年间5086例局部晚期直肠癌患者，这些患者接受了MSI检测，并接受了明确的放化疗和手术治疗。主要比较组为4450例MSI阴性（−）和636例MSI阳性（+）患者。进行多变量回归分析，以确定预测pCR的人口统计学、治疗和临床特征。生存率采用考克斯比例风险比。所有患者均接受了明确的放化疗（中位剂量50.4戈伊），随后在4个月内切除。MSI（+）患者与诊断年代早、肿瘤分级高有关（P < 0.05）。总体pCR率为8.6%，其中MSI（-）肿瘤为8.9%，MSI（+）肿瘤为5.9%（P = 0.01）。多因素分析显示，MSI（+）病例与T分期较低的pCR率显著相关（比值比0.65，95%置信区间0.43-0.96）。pCR患者的5年生存率为93%，而无pCR患者的5年生存率为73%（<0.001）。在这项基于NCDB的分析中，微卫星不稳定性与局部进展期直肠癌新辅助放化疗后pCR降低独立相关。
The relationship between microsatellite instability (MSI) and response to neoadjuvant chemoradiation in rectal cancer is not well understood. We utilized the National Cancer Database (NCDB) to investigate the association between MSI and pathologic complete response (pCR) in this patient population. We analyzed 5086 patients between 2010 and 2015 with locally advanced rectal cancer who were tested for MSI and treated definitively with chemoradiation followed by surgery. Primary comparison groups were between 4450 MSI-negative(−) and 636 MSI-positive(+) patients. Multivariable regression analysis was conducted to identify demographic, therapeutic, and clinical characteristics predictive of pCR. Cox proportional-hazard ratios were used for survival. All patients were treated with definitive chemoradiation (median dose 50.4 Gy) followed by resection within 4 months. MSI(+) patients were associated with earlier year of diagnosis and higher-grade tumors (P < 0.05). The overall pCR rate was 8.6%, including 8.9% for MSI(−) and 5.9% for MSI(+) tumors (P = 0.01). Along with lower T stage, MSI(+) cases were significantly associated with a reduced pCR rate (odds ratio 0.65, 95% confidence interval 0.43–0.96) with multivariable analysis. The 5-year survival for patients with pCR was 93% compared with 73% without it (<0.001). Microsatellite instability was independently associated with a reduction in pCR for locally advanced rectal cancer after neoadjuvant chemoradiation in this NCDB-based analysis.