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Evaluation of Long-Term Outcomes of Microsatellite Instability Status in an Asian Cohort of Sporadic Colorectal Cancers

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Abstract

Purpose

Microsatellite instability in colorectal cancer (CRC) and its long-term outcomes remains poorly studied in Asians. We investigate the prognostic significance of microsatellite instability in an Asian population and assess its clinical impact in patients who undergo adjuvant chemotherapy.

Methods

Six hundred fifty-four consecutive CRC patients who underwent surgical resection between January 2010 and December 2012 were recruited. Survival was estimated using the Kaplan-Meier approach. Univariate Cox proportional hazard models were used to estimate the hazard ratios for variables associated with survival. A subgroup analyses was performed for stage III patients who underwent chemotherapy to evaluate the prognostic significance of microsatellite instability in this group.

Results

Five hundred ninety-one (90.4%) patients were microsatellite stable (MSS) while 63 (9.6%) were microsatellite instable (MSI). Three years recurrence-free survival (RFS) and disease-specific survival (DSS) were 83.7 versus 73.7% (p = 0.295) and 87.1 versus 91.2% (p = 0.307) in MSS and MSI tumors, respectively. Among stage III patients who received adjuvant therapy, MSI status was found to be an adverse prognostic factor for RFS (HR 2.74 (95% CI 1.43–5.26), p = 0.002). This remained significant on multivariate analysis (HR 2.38 (95% CI 1.15–4.93), p = 0.018). Adjuvant chemotherapy was associated with survival benefit for patients with MSS tumors (HR 0.35, 95% CI 0.17–0.69, p = 0.002) but not MSI tumors (HR 0.67, 95% CI 0.08–8.15, p = 0.750).

Conclusions

MSI status is not a prognostic indicator in the general CRC population but appears to be an adverse prognostic indicator for RFS in stage III CRC patients who received adjuvant chemotherapy.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Singapore General Hospital, 20 College Road, Academia, Singapore, 169856, Singapore

    Winson Jianhong Tan, Julie Liana Hamzah, Fung Joon Foo, Choong Leong Tang & Min Hoe Chew

  2. Centre for Qualitative Medicine, DUKE NUS Graduate Medical School, Singapore, Singapore

    Sanchalika Acharyya

  3. Department of Pathology, Singapore General Hospital, Singapore, Singapore

    Kiat Hon Lim

  4. Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore

    Iain Bee Huat Tan

Authors
  1. Winson Jianhong Tan
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  2. Julie Liana Hamzah
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  3. Sanchalika Acharyya
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  4. Fung Joon Foo
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  5. Kiat Hon Lim
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  6. Iain Bee Huat Tan
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  7. Choong Leong Tang
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  8. Min Hoe Chew
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Correspondence to Winson Jianhong Tan.

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The authors declare that they have no conflicts of interest.

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Tan, W.J., Hamzah, J.L., Acharyya, S. et al. Evaluation of Long-Term Outcomes of Microsatellite Instability Status in an Asian Cohort of Sporadic Colorectal Cancers. J Gastrointest Canc 49, 311–318 (2018). https://doi.org/10.1007/s12029-017-9953-6

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  • DOI: https://doi.org/10.1007/s12029-017-9953-6

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