title: Microsatellite and chromosomal stable colorectal cancers demonstrate poor immunogenicity and early disease recurrence.
abstract: OBJECTIVE
  Colorectal cancers may demonstrate chromosomal instability (CSI) or microsatellite instability (MSI-H). A third group of microsatellite and chromosome stable (MACS) colorectal cancer has been described more recently. Patients with MSI-H colorectal cancers demonstrate improved outcome and a pronounced inflammatory infiltrate. Enhanced host immune response and increased immunogenicity might explain these observations. This study aims to further characterize colorectal cancer immunogenicity.
  
  
  METHODS
  Microsatellite stability status was determined in resected tumour samples. Microsatellite stable (MSS) tumour samples were stratified by DNA ploidy status, as determined by flow cytometry into aneuploid MSS (CSI) and diploid MSS (MACS) cancers. Lymphocyte proliferation, quantified by bromodeoxyuridine incorporation assays assessed tumour protein immunogenicity and ELISA assays quantified inflammatory cytokine release. Kaplan-Meier survival curves and multivariate analyses were used to determine prognostic value.
  
  
  RESULTS
  Patients with MSI-H colorectal cancer had improved outcome but those with MACS cancers undergoing curative surgery had significantly poorer disease-free survival (P = 0.002). The MACS phenotype was an independent predictor of poor outcome (HR = 2.44, 1.33-4.47, P = 0.004). Lymphocyte proliferation assays confirmed enhanced immunogenicity of MSI-H proteins and reduced immunogenicity of MACS proteins (P < 0.0001). In vitro levels of IFN-gamma (P = 0.004) and IL-18 (P < 0.0001) mirrored these differences in lymphocyte activity.
  
  
  CONCLUSIONS
  Stratification of colorectal cancer by MSI and ploidy status may have prognostic value in patients undergoing curative surgery. MSI-H cancers display enhanced immunogenic properties but the immune response to MACS cancers appears to be absent and this may contribute to their poor prognosis.
authors.affiliation: SpR General Surgery, North East Thames Region, UK. ayanbanerjea@hotmail.com
authors.forename: A
authors.initials: A
authors.lastname: Banerjea
authors.forename: R E
authors.initials: RE
authors.lastname: Hands
authors.forename: M P
authors.initials: MP
authors.lastname: Powar
authors.forename: S A
authors.initials: SA
authors.lastname: Bustin
authors.forename: S
authors.initials: S
authors.lastname: Dorudi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000782:Aneuploidy; D049109:Cell Proliferation; D043171:Chromosomal Instability / Q000235:genetics / Q000276:immunology*; D015179:Colorectal Neoplasms / Q000235:genetics* / Q000276:immunology*; D004171:Diploidy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D055261:Immunogenetic Phenomena; D053208:Kaplan-Meier Estimate; D008214:Lymphocytes / Q000276:immunology; D008297:Male; D053842:Microsatellite Instability; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000235:genetics* / Q000276:immunology*; D010641:Phenotype