Zhenghao Cai1,2, Weiwei Rui3, Shuchun Li1,2, Abraham Fingerhut1,2,4, Jing Sun1,2, Junjun Ma1,2, Lu Zang1,2, Zhenggang Zhu1, Minhua Zheng1,2. 1. Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. 2. Shanghai Minimally Invasive Surgery Center, Shanghai, China. 3. Department of pathology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. 4. Section for Surgical Research, Department of Surgery, Medical University of Graz, Graz, Austria.
Abstract
BACKGROUND: We assessed the association between microsatellite instability-high (MSI-H) and tumor response to neoadjuvant chemotherapy (NAC) as well as its prognostic relevance in patients with clinical stage III gastric cancer (cStage III GC). MATERIALS AND METHODS: The NAC + surgery and the control cohorts consisted of 177 and 513 cStage III GC patients, respectively. The clinical and pathological features were compared between patients with MSI-H [n=57 (8.3%)] and microsatellite stability or microsatellite instability-low (MSS/MSI-L) [n=633 (91.7%)]. Radiological and histological response to NAC were evaluated based on response evaluation criteria in solid tumors (RECIST) and tumor regression grade (TRG) systems, respectively. The log-rank test and Cox analysis were used to determine the survival associated with MSI status as well as tumor regression between the two groups in both NAC + surgery and the control cohorts. RESULTS: A statistically significant association was found between MSI-H and poor histological response to NAC (p=0.038). Significant survival priority of responders over poor-responders could only be observed in MSS/MSI-L but not in MSI-H tumors. However, patients with MSI-H had statistically significantly better survival compared to patients with MSS/MSI-L in both the NAC + surgery (hazard ratio=0.125, 95% CI, 0.017-0.897, p=0.037 ) and the control cohort (hazard ratio=0.479, 95% CI, 0.268-0.856, p=0.013). CONCLUSION: MSI-H was associated with poorer regression and better survival after NAC for cStage III GC. TRG evaluation had prognostic significance in MSS/MSI-L but not in MSI-H. Further studies are needed to assess the value of NAC for cStage III GC patients with MSI-H phenotype.
BACKGROUND: We assessed the association between microsatellite instability-high (MSI-H) and tumor response to neoadjuvant chemotherapy (NAC) as well as its prognostic relevance in patients with clinical stage III gastric cancer (cStage III GC). MATERIALS AND METHODS: The NAC + surgery and the control cohorts consisted of 177 and 513 cStage III GC patients, respectively. The clinical and pathological features were compared between patients with MSI-H [n=57 (8.3%)] and microsatellite stability or microsatellite instability-low (MSS/MSI-L) [n=633 (91.7%)]. Radiological and histological response to NAC were evaluated based on response evaluation criteria in solid tumors (RECIST) and tumor regression grade (TRG) systems, respectively. The log-rank test and Cox analysis were used to determine the survival associated with MSI status as well as tumor regression between the two groups in both NAC + surgery and the control cohorts. RESULTS: A statistically significant association was found between MSI-H and poor histological response to NAC (p=0.038). Significant survival priority of responders over poor-responders could only be observed in MSS/MSI-L but not in MSI-H tumors. However, patients with MSI-H had statistically significantly better survival compared to patients with MSS/MSI-L in both the NAC + surgery (hazard ratio=0.125, 95% CI, 0.017-0.897, p=0.037 ) and the control cohort (hazard ratio=0.479, 95% CI, 0.268-0.856, p=0.013). CONCLUSION: MSI-H was associated with poorer regression and better survival after NAC for cStage III GC. TRG evaluation had prognostic significance in MSS/MSI-L but not in MSI-H. Further studies are needed to assess the value of NAC for cStage III GC patients with MSI-H phenotype.
Authors: Karen Becker; Rupert Langer; Daniel Reim; Alexander Novotny; Christian Meyer zum Buschenfelde; Jutta Engel; Helmut Friess; Heinz Hofler Journal: Ann Surg Date: 2011-05 Impact factor: 12.969
Authors: Yoon Young Choi; Hyunki Kim; Su-Jin Shin; Ha Yan Kim; Jinae Lee; Han-Kwang Yang; Woo Ho Kim; Young-Woo Kim; Myeong-Cherl Kook; Young Kyu Park; Hyung-Ho Kim; Hye Seung Lee; Kyung Hee Lee; Mi Jin Gu; Seung Ho Choi; SoonWon Hong; Jong Won Kim; Woo Jin Hyung; Sung Hoon Noh; Jae-Ho Cheong Journal: Ann Surg Date: 2019-08 Impact factor: 12.969
Authors: Pietro Achilli; Paolo De Martini; Marco Ceresoli; Giulio M Mari; Andrea Costanzi; Dario Maggioni; Raffaele Pugliese; Giovanni Ferrari Journal: J Gastrointest Oncol Date: 2017-12