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Histopathological Predictors of Microsatellite Instability in Colorectal Cancer—a Tertiary Care Center Experience

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Abstract

Microsatellite instability (MSI) has a therapeutic and prognostic implication in colorectal carcinomas (CRCs). It can be detected either by immunohistochemistry (IHC) or molecular studies. In developing countries, a significant proportion of the patients experience financial constraints limiting the utilization of healthcare facilities. We aimed to identify the possible clinicopathological variables which can be used as predictors of microsatellite instability in such patients. CRC cases received for MSI detection by IHC (for 1 and 1/2 years) were included. A panel of four IHC markers (anti-MLH1, anti-PMS2, anti-MSH2, and anti-MSH6) was used. Confirmation by the molecular study was recommended in all the IHC-proven MSI cases. Various clinicopathological parameters were evaluated as predictors of MSI. Microsatellite instability was detected in 40.6% (30/74) cases with MLH1 and PMS2 dual loss in 27% cases, MSH2 and MSH6 dual loss in 6.8%, loss of all four MMR proteins in 2.7%, and isolated PMS2 loss in 4.1%. MSI-H expression was shown by 36.5% cases with only 4.1% cases showing MSI-L expression. The age cut-off value to differentiate both the study groups (MSI vs MSS) was 63 years with a sensitivity of 47.7% and specificity of 86.7%. ROC curve showed an area under the curve of 0.65 (95% CI, 0.515–0.776; p-value = 0.03). On univariate analysis, age < 63 years, colon site, and absence of nodal metastasis were significantly higher in the MSI group. However, on multivariate analysis, only the age < 63 years was found to be significantly higher in the MSI group. Confirmation was molecular study could only be obtained in 12 cases and was completely concordant with MSI detection by IHC. MSI detection can be performed either by IHC or by molecular study. In this study, no histological parameter appeared to be the independent predictor of MSI status. The age < 63 years might predict the microsatellite instability, yet larger studies are needed for its validation. Thus, we recommend that IHC testing should be performed in all CRC cases.

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Authors and Affiliations

  1. Department of Pathology, Dayanand Medical College & Hospital, Tagore Nagar, Ludhiana, Punjab, 141001, India

    Singh Aminder, Jindal Saveena, Soni Ankita, Kaur Harpreet, Narang Vikram, Grover Sumit, Garg Bhavna & Kaur Ramneek

  2. Department of Medical Oncology, Dayanand Medical College & Hospital, Ludhiana, Punjab, India

    Jain Kunal

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Contributions

Aminder Singh: Concept and manuscript editing.

Saveena Jindal: Data acquisition and manuscript review.

Ankita Soni (corresponding author and guarantor): Literature search and manuscript preparation.

Harpreet Kaur: Manuscript review.

Kunal Jain: Data acquisition and manuscript editing.

Vikram Narang: Data acquisition and manuscript review.

Sumit Grover: Manuscript review.

Bhavna Garg: Manuscript editing.

Ramneek kaur: Data acquisition.

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Correspondence to Soni Ankita.

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Aminder, S., Saveena, J., Ankita, S. et al. Histopathological Predictors of Microsatellite Instability in Colorectal Cancer—a Tertiary Care Center Experience. Indian J Surg Oncol 14, 137–143 (2023). https://doi.org/10.1007/s13193-022-01633-4

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