Karol Polom1, Christine Böger2, Elizabeth Smyth3, Daniele Marrelli4, Hans-Michael Behrens2, Luigi Marano5, Thomas Becker6, Florian Lordick7, Christoph Röcken2, Franco Roviello4. 1. General Surgery and Surgical Oncology Department, University of Siena, Italy viale Bracci 16, 53100, Siena, Italy; Department of Surgical Oncology, Medical University of Gdansk, Gdansk, Poland. Electronic address: polom.karol@gmail.com. 2. Department of Pathology, Christian-Albrechts-University, Kiel, Germany. 3. Department of Gastrointestinal Oncology and Lymphoma, Royal Marsden Hospital, London and Sutton, United Kingdom. 4. General Surgery and Surgical Oncology Department, University of Siena, Italy viale Bracci 16, 53100, Siena, Italy. 5. General, Minimally Invasive and Robotic Surgery, Department of Surgery, "San Matteo degli Infermi Hospital"-ASL Umbria 2, 06049, Spoleto, Italy. 6. Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, Christian-Albrechts-University, Kiel, Germany. 7. University Cancer Center Leipzig (UCCL), University Medicine Leipzig, 04103 Leipzig, Germany.
Abstract
BACKGROUND: Current guidelines recommend that metastatic gastric cancer should not be treated with surgery unless this is required for symptom control. We hypothesized that patients with mismatch repair deficiency (MMRd) gastric cancer and metastatic disease detected at the timepoint of surgical resection would have superior survival compared to patients with MMRd cancers in the same setting. METHODS: Clinicopathological details and survival data were collected from prospective databases at two large European centers on patients who had undergone surgery and were diagnosed with synchronous stage IV gastric cancer (distant lymph nodes, positive peritoneal cytology, peritoneal, and distant metastases) at the timepoint of surgery. Resection specimens were tested for the presence of microsatellite instability using a standard 5 mononucleotide repeat panel. RESULTS: One hundred and seventy six patients with resected stage IV gastric cancer were identified. 14/176 (8.0%) had MSI-H (high) disease. There was no significant difference between the clinical and pathological characteristics of MSI and microsatellite stable (MSS) patients. No differences in the type of metastases were observed between MSI and MSS groups. Patients who were MSI-H had superior OS compared to MSS patients (median OS 15.9 vs. 8 months, p = 0.023). However, in Cox regression multivariate analysis only liver and peritoneal metastases were independent predictors of survival. CONCLUSIONS: Surgically treated patients with MSI-H stage IV gastric cancer have a better survival than patients with MSS gastric cancer. Further analysis of the role of surgery in MSI stage IV GC is required.
BACKGROUND: Current guidelines recommend that metastatic gastric cancer should not be treated with surgery unless this is required for symptom control. We hypothesized that patients with mismatch repair deficiency (MMRd) gastric cancer and metastatic disease detected at the timepoint of surgical resection would have superior survival compared to patients with MMRd cancers in the same setting. METHODS: Clinicopathological details and survival data were collected from prospective databases at two large European centers on patients who had undergone surgery and were diagnosed with synchronous stage IV gastric cancer (distant lymph nodes, positive peritoneal cytology, peritoneal, and distant metastases) at the timepoint of surgery. Resection specimens were tested for the presence of microsatellite instability using a standard 5 mononucleotide repeat panel. RESULTS: One hundred and seventy six patients with resected stage IV gastric cancer were identified. 14/176 (8.0%) had MSI-H (high) disease. There was no significant difference between the clinical and pathological characteristics of MSI and microsatellite stable (MSS) patients. No differences in the type of metastases were observed between MSI and MSS groups. Patients who were MSI-H had superior OS compared to MSS patients (median OS 15.9 vs. 8 months, p = 0.023). However, in Cox regression multivariate analysis only liver and peritoneal metastases were independent predictors of survival. CONCLUSIONS: Surgically treated patients with MSI-H stage IV gastric cancer have a better survival than patients with MSS gastric cancer. Further analysis of the role of surgery in MSI stage IV GC is required.
Authors: Stefan Mereiter; Karol Polom; Coralie Williams; Antonio Polonia; Mariana Guergova-Kuras; Niclas G Karlsson; Franco Roviello; Ana Magalhães; Celso A Reis Journal: J Clin Med Date: 2018-09-05 Impact factor: 4.241
Authors: Alexander Quaas; Jan Rehkaemper; Josef Rueschoff; Aylin Pamuk; Thomas Zander; Axel Hillmer; Janna Siemanowski; Jana Wittig; Reinhard Buettner; Patrick Plum; Felix Popp; Florian Gebauer; Christiane Josephine Bruns; Heike Loeser; Hakan Alakus; Birgid Schoemig-Markiefka Journal: Front Oncol Date: 2021-07-22 Impact factor: 6.244