title: Reduced likelihood of metastases in patients with microsatellite-unstable colorectal cancer.
abstract: 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.
authors.affiliation: Department of Gastroenterology, IRCCS Istituto Clinico Humanitas, Rozzano, Milan, Italy. alberto.malesci@humanitas.it
authors.forename: Alberto
authors.initials: A
authors.lastname: Malesci
authors.forename: Luigi
authors.initials: L
authors.lastname: Laghi
authors.forename: Paolo
authors.initials: P
authors.lastname: Bianchi
authors.forename: Gabriele
authors.initials: G
authors.lastname: Delconte
authors.forename: Ann
authors.initials: A
authors.lastname: Randolph
authors.forename: Valter
authors.initials: V
authors.lastname: Torri
authors.forename: Carlo
authors.initials: C
authors.lastname: Carnaghi
authors.forename: Roberto
authors.initials: R
authors.lastname: Doci
authors.forename: Riccardo
authors.initials: R
authors.lastname: Rosati
authors.forename: Marco
authors.initials: M
authors.lastname: Montorsi
authors.forename: Massimo
authors.initials: M
authors.lastname: Roncalli
authors.forename: Leandro
authors.initials: L
authors.lastname: Gennari
authors.forename: Armando
authors.initials: A
authors.lastname: Santoro
mesh_terms: 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