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Microsatellite instability as a marker of prognosis: a systematic review and meta-analysis of endometrioid endometrial cancer survival data

  • Gynecologic Oncology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Introduction

To investigate whether microsatellite instability (MSI) is an important prognostic biomarker for endometrioid endometrial cancer (EEC).

Methods

The PubMed, EMBASE, and the Cochrane Cooperative Library databases were searched from inception to July 2021. Overall survival, disease-free survival, progression-free survival, EEC-specific survival, recurrence-free survival, and the recurrence rate were pooled to analyze the correlation between MSI and EEC. In addition, Egger’s regression analysis and Begg’s test were used to detect publication bias.

Results

17 studies met the inclusion criteria and were included in our meta-analysis with a sample size of 4723, and the included patients with endometrioid cancer (EC) all were EEC. The pooled hazard ratios (HR) in patients with EEC showed that MSI was significantly associated with shorter overall survival [HR = 1.37, 95% confidence interval (CI) (1.00–1.86), p = 0.048, I2 = 60.6%], shorter disease-free survival [HR = 1.99, 95% CI (1.31–3.01), p = 0.000, I2 = 67.2%], shorter EEC-specific survival [HR = 2.07, 95% CI (1.35–3.18), p = 0.001, I2 = 31.6%] and a higher recurrence rate [Odds ratios (OR) = 2.72, 95% CI (1.56–4.76), p = 0.000, I2 = 0.0%]. In the early-stage EEC subgroup, MSI was significantly associated with shorter overall survival [HR = 1.47, 95% CI (1.11–1.95), p = 0.07], shorter disease-free survival [HR = 4.17, 95% CI (2.37–7.41), p = 0.000], and shorter progression-free survival [HR = 2.41, 95% CI (1.05–5.54), p = 0.039]. No significant heterogeneity was observed in overall survival (I2 = 20.9%), disease-free survival (I2 = 0.0%), or progression-free survival (I2 = 0.0%) in patients with early-stage EEC. Meanwhile, publication bias was not observed, and the p-value for Egger’s test of overall survival, disease-free survival, and EEC-specific survival were p = 0.131, p = 0.068, and p = 0.987, respectively.

Conclusion

MSI is likely an important biomarker for poor prognosis in patients with EEC, and this correlation is even more certain in patients with early-stage EEC.

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Acknowledgements

With thanks to all participants in this study.

Funding

The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Pharmacy, The Third Hospital of Mianyang, Sichuan Mental Health Center, Sichuan, 621000, China

    Jing-ping Xiao & Ji-sheng Wang

  2. Department of Pathology, Sichuan Science City Hospital, Sichuan, 621000, China

    Yuan-yu Zhao & Yun-zi Wang

  3. Department of General Surgery, Sichuan Science City Hospital, Sichuan, 621000, China

    Jiang Du

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Contributions

JPX and YZW designed the study and wrote the manuscript. YYZ and JD developed the search strategy and completed the literature search. JSW developed the inclusion and exclusion criteria for the eligible studies. JPX, YZW, and JSW reviewed the eligible studies and extracted the data. JPX and YYZ did the methodological judgement. YYZ and JD performed the statistical analysis methods. JPX, YZW, and JD summarized the original data. Contributions to the interpretation of the data and review of the manuscript were made by all authors.

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Correspondence to Yun-zi Wang.

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Xiao, Jp., Wang, Js., Zhao, Yy. et al. Microsatellite instability as a marker of prognosis: a systematic review and meta-analysis of endometrioid endometrial cancer survival data. Arch Gynecol Obstet 307, 573–582 (2023). https://doi.org/10.1007/s00404-022-06636-8

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  • DOI: https://doi.org/10.1007/s00404-022-06636-8

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