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Clinical significance of microsatellite instability in colorectal cancer

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Abstract

Introduction

Colorectal cancer is a heterogeneous tumor type with regard to molecular pathogenesis and genetic instability. The majority of colorectal cancers display chromosomal instability and follow the classical adenoma-carcinoma sequence of tumor progression. A subset of about 15 % of colorectal cancers, however, displays DNA mismatch repair (MMR) deficiency and the high-level microsatellite instability (MSI-H) phenotype. MSI-H colorectal cancers can occur as sporadic tumors or in the context of hereditary non-polyposis colorectal cancer (HNPCC) or Lynch syndrome.

Clinical relevance

The MSI-H phenotype is a hallmark of Lynch syndrome-associated cancers, which is of diagnostic relevance for the identification of Lynch syndrome mutation carriers. MSI-H colorectal cancers are characterized by a distinct clinical behavior, which results from their particular molecular pathogenesis and gives microsatellite instability testing its clinical significance. The MSI-H phenotype shows association with proximal tumor localization, a dense local lymphocyte infiltration, and a low frequency of distant organ metastasis. Moreover, MSI-H colorectal cancers have a better prognosis than their microsatellite-stable counterparts. A distinct responsiveness of MSI-H colorectal cancer patients towards chemotherapy has been shown in several studies.

Conclusions

The clinical characteristics of MSI-H cancers are closely linked to their molecular pathogenesis, and research on the molecular alteration characteristic of MSI-H cancers may provide the basis for novel diagnostic or therapeutic approaches.

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Acknowledgments

Work in the authors’ lab has been funded by grants of the Deutsche Krebshilfe (DKH, German Cancer Aid) and the Deutsche Forschungsgemeinschaft (DFG, German Cancer Research Foundation).

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Authors and Affiliations

  1. Department of Applied Tumor Biology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany

    Matthias Kloor, Laura Staffa, Aysel Ahadova & Magnus von Knebel Doeberitz

  2. Clinical Cooperation Unit Applied Tumor Biology, German Cancer Research Center (DKFZ), Heidelberg, Germany

    Matthias Kloor, Laura Staffa, Aysel Ahadova & Magnus von Knebel Doeberitz

  3. Molecular Medicine Partnership Unit (MMPU), EMBL, Heidelberg, Germany

    Matthias Kloor, Laura Staffa, Aysel Ahadova & Magnus von Knebel Doeberitz

  4. Abteilung für Angewandte Tumorbiologie Institut für Pathologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany

    Matthias Kloor

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Kloor, M., Staffa, L., Ahadova, A. et al. Clinical significance of microsatellite instability in colorectal cancer. Langenbecks Arch Surg 399, 23–31 (2014). https://doi.org/10.1007/s00423-013-1112-3

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