D Tougeron1, G Sickersen2, G Mouillet3, A Zaanan4, I Trouilloud5, R Coriat6, T Aparicio7, G Des Guetz8, C Lecaille9, P Artru10, E Cauchin11, D Sefrioui12, T Boussaha13, A Ferru14, T Matysiak-Budnik11, C Silvain2, L Karayan-Tapon15, J C Pagès16, D Vernerey3, F Bonnetain3, P Michel12, J Taïeb4, T Lecomte17. 1. Department of Gastroenterology, Poitiers University Hospital, Poitiers, France. Electronic address: davidtougeron@hotmail.fr. 2. Department of Gastroenterology, Poitiers University Hospital, Poitiers, France. 3. Methodology and Quality of Life in Oncology Unit, Besançon University Hospital, Besançon, France. 4. Department of Gastroenterology, Georges Pompidou European Hospital, Paris, France. 5. Department of Gastroenterology, Ambroise Paré Hospital, Boulogne-Billancourt, France. 6. Paris Descartes University, Cochin Hospital, Paris, France. 7. Department of Gastroenterology, Avicenne Hospital, Bobigny, France. 8. Department of Medical Oncology, Avicenne Hospital, Bobigny, France. 9. Department of Gastroenterology, Bordeaux Nord Clinic, Bordeaux, France. 10. Department of Gastroenterology, Jean Mermoz Lyon Hospital, Lyon, France. 11. Department of Gastroenterology, Nantes University Hospital, Nantes, France. 12. Department of Gastroenterology, Rouen University Hospital, Rouen, France. 13. Department of Medical Oncology, Saint-Antoine Hospital, Paris, France. 14. Department of Medical Oncology, Poitiers University Hospital, Poitiers, France. 15. Department of Molecular Oncology, Poitiers University Hospital, Poitiers, France. 16. Department of Biochemistry, Tours University Hospital, Tours, France. 17. Department of Gastroenterology, Tours University Hospital, Tours, France.
Abstract
BACKGROUND: A microsatellite instability (MSI) phenotype is found in about 12% of colorectal cancers (CRCs) and is associated with a low recurrence rate after curative surgery. Several studies have identified clinical and pathological factors predictive of recurrence in resected CRC, but not in the MSI subgroup. PATIENTS AND METHODS: This multicentre retrospective study included patients with stage I, II or III MSI CRCs. Disease-free survival (DFS) was calculated with the Kaplan-Meier method. Factors associated with DFS were identified in univariate and multivariate Cox analyses. RESULTS: We studied 521 patients with MSI CRC. Respectively 11%, 51% and 38% of patients were at stage I, II and III. Mean age was 68.7years and 36% of the patients received adjuvant chemotherapy. Median follow-up was 32.8months. The disease recurrence rates were 6% and 21% in stage II and III patients, respectively. The 3-year DFS rate was 77%. In univariate analysis, age, bowel obstruction, lymph node invasion, stage T4, vascular emboli, lymphatic invasion and perinervous invasion were associated with poorer DFS (P<0.05). Three relevant independent predictors of poor DFS were identified in multivariate analysis, namely bowel obstruction (HR=2.46; 95%CI 1.31-4.62, P=0.005), vascular emboli (HR=2.79; 95%CI 1.74-4.47, P<0.001) and stage T4 (HR=2.16; 95%CI 1.31-3.56, P=0.002). CONCLUSIONS: Bowel obstruction, vascular emboli and stage T4 are independently associated with MSI CRC recurrence, suggesting that screening for vascular emboli in routine clinical practice may assist with adjuvant chemotherapy decision-making.
BACKGROUND: A microsatellite instability (MSI) phenotype is found in about 12% of colorectal cancers (CRCs) and is associated with a low recurrence rate after curative surgery. Several studies have identified clinical and pathological factors predictive of recurrence in resected CRC, but not in the MSI subgroup. PATIENTS AND METHODS: This multicentre retrospective study included patients with stage I, II or III MSI CRCs. Disease-free survival (DFS) was calculated with the Kaplan-Meier method. Factors associated with DFS were identified in univariate and multivariate Cox analyses. RESULTS: We studied 521 patients with MSI CRC. Respectively 11%, 51% and 38% of patients were at stage I, II and III. Mean age was 68.7years and 36% of the patients received adjuvant chemotherapy. Median follow-up was 32.8months. The disease recurrence rates were 6% and 21% in stage II and III patients, respectively. The 3-year DFS rate was 77%. In univariate analysis, age, bowel obstruction, lymph node invasion, stage T4, vascular emboli, lymphatic invasion and perinervous invasion were associated with poorer DFS (P<0.05). Three relevant independent predictors of poor DFS were identified in multivariate analysis, namely bowel obstruction (HR=2.46; 95%CI 1.31-4.62, P=0.005), vascular emboli (HR=2.79; 95%CI 1.74-4.47, P<0.001) and stage T4 (HR=2.16; 95%CI 1.31-3.56, P=0.002). CONCLUSIONS:Bowel obstruction, vascular emboli and stage T4 are independently associated with MSI CRC recurrence, suggesting that screening for vascular emboli in routine clinical practice may assist with adjuvant chemotherapy decision-making.