Reduced likelihood of metastases in patients with microsatellite-unstable colorectal cancer.
OBJECTIVE
The outcome of patients with colorectal cancer is more favorable when the tumor exhibits high-frequency microsatellite instability (MSI). Although associated with earlier-stage tumors, MSI has been proposed as an independent predictor of survival. We tested the prognostic value of MSI in a large series of patients diagnosed with colorectal cancer in the last decade.


METHODS
The survival of 893 consecutive patients with colorectal cancer characterized by microsatellite status was analyzed. The 89 (10%) patients with MSI cancer were classified according to tumor mismatch repair (MMR) defect, MMR germ-line mutation, hMLH1 and p16 promoter methylation, BRAF and K-ras mutations, and frameshifts of target genes.


RESULTS
The colorectal cancer-specific survival was significantly (P = 0.02) better in patients with MSI cancer than in those with stable tumor (MSS). MSI did not predict a significantly lower risk of cancer-related death if tumor stage was included in the multivariate analysis [hazard ratio, 0.72; 95% confidence interval (95% CI), 0.40-1.29; P = 0.27]. Instead, MSI was strongly associated with a decreased likelihood of lymph node (odds ratio, 0.31; 95% CI, 0.17-0.56; P < 0.001) and distant organ (odds ratio, 0.13; 95% CI, 0.05-0.33; P < 0.001) metastases at diagnosis, independently of tumor pathologic features. Molecular predictors of reduced metastatic risk, and then of more favorable prognosis, included TGFbetaRII mutation for all MSI tumors, hMSH2 deficiency for hereditary non-polyposis colorectal cancer, and absence of p16 methylation for sporadic hMLH1-deficient cancers.


CONCLUSIONS
Tumor MSI is a stage-dependent predictor of survival in patients with colorectal cancer. The decreased likelihood of metastases in patients with MSI cancer is associated with specific genetic and epigenetic changes of the primary tumor.
Malesci
Alberto
A
Department of Gastroenterology, IRCCS Istituto Clinico Humanitas, Rozzano, Milan, Italy. alberto.malesci@humanitas.it
Laghi
Luigi
L
Bianchi
Paolo
P
Delconte
Gabriele
G
Randolph
Ann
A
Torri
Valter
V
Carnaghi
Carlo
C
Doci
Roberto
R
Rosati
Riccardo
R
Montorsi
Marco
M
Roncalli
Massimo
M
Gennari
Leandro
L
Santoro
Armando
A
D000368:Aged; D020137:Base Pair Mismatch; D015179:Colorectal Neoplasms / Q000235:genetics* / Q000401:mortality / Q000473:pathology*; D019175:DNA Methylation; D004260:DNA Repair; D043243:DNA Sequence, Unstable; D044127:Epigenesis, Genetic; D005260:Female; D006801:Humans; D008297:Male; D018895:Microsatellite Repeats / Q000235:genetics*; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011379:Prognosis; D016896:Treatment Outcome