title: Use of 5-fluorouracil and survival in patients with microsatellite-unstable colorectal cancer.
abstract: OBJECTIVE
  5-Fluorouracil improves mortality in stage III colorectal cancer patients. In vitro studies suggest that microsatellite instability influences cell survival after 5-fluorouracil treatment. We investigated the survival influence of 5-fluorouracil in patients with microsatellite instability-high tumors.
  
  
  METHODS
  We collected data and tumors on 204 consecutive stage II and III colorectal cancer patients from registries at the University of California and Veterans Administration hospitals in San Diego, California, from 1982 to 1999. Archival DNA was extracted, and microsatellite instability was assessed by National Cancer Institute-recommended markers. Cox proportional hazard modeling was used to determine survival associations for microsatellite instability and 5-fluorouracil treatment status.
  
  
  RESULTS
  We identified 36 microsatellite instability-high (17.6%) and 168 non-microsatellite instability-high tumors (82.4%). Microsatellite instability-high tumors were significantly associated with proximal colon location, presence of mucin, and surrounding lymphoid reaction. Univariate and multivariate analyses showed no survival difference between microsatellite instability-high and non-microsatellite instability-high groups (hazard ratio, 1.04; P = 0.88). Dichotomized by use of 5-fluorouracil, there was increased risk of death in patients who received no adjuvant chemotherapy (hazard ratio, 2.02; P = 0.02). However, the benefit of 5-fluorouracil was different between microsatellite instability-high and non-microsatellite instability-high groups. Patients with non-microsatellite instability-high tumors who received 5-fluorouracil had better survival compared with patients who were not treated (P < 0.05). Conversely, patients with microsatellite instability-high tumors who were treated with 5-fluorouracil had no survival difference compared with patients without treatment (P = 0.52).
  
  
  CONCLUSIONS
  There is improved survival in patients with non-microsatellite instability-high tumors after 5-fluorouracil-based chemotherapy that does not extend to patients with microsatellite instability-high tumors. The microsatellite instability status of a patient's colorectal cancer may indicate differences in 5-fluorouracil-based chemosensitivity; this is consistent with in vitro studies.
authors.affiliation: Department of Gastroenterology and Cancer Center, University of California, and Veterans Administration Research Service, San Diego, 92161, USA. jcarethers@ucsd.edu
authors.forename: John M
authors.initials: JM
authors.lastname: Carethers
authors.forename: E Julieta
authors.initials: EJ
authors.lastname: Smith
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Behling
authors.forename: Lanchinh
authors.initials: L
authors.lastname: Nguyen
authors.forename: Akihiro
authors.initials: A
authors.lastname: Tajima
authors.forename: Ryan T
authors.initials: RT
authors.lastname: Doctolero
authors.forename: Betty L
authors.initials: BL
authors.lastname: Cabrera
authors.forename: Ajay
authors.initials: A
authors.lastname: Goel
authors.forename: Christian A
authors.initials: CA
authors.lastname: Arnold
authors.forename: Katsumi
authors.initials: K
authors.lastname: Miyai
authors.forename: C Richard
authors.initials: CR
authors.lastname: Boland
mesh_terms: D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000235:genetics* / Q000473:pathology; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use*; D005819:Genetic Markers; D006801:Humans; D008297:Male; D018895:Microsatellite Repeats / Q000235:genetics*; D008875:Middle Aged; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012042:Registries; D016019:Survival Analysis
chemical_list: D000964:Antimetabolites, Antineoplastic; D005819:Genetic Markers; D005472:Fluorouracil