Correlation of microsatellite instability at multiple loci with long-term survival in advanced gastric carcinoma.
OBJECTIVE
Microsatellite instability (MSI) correlates with clinicopathologic characteristics and long-term prognosis in patients having gastric carcinoma.


METHODS
Analysis of prospectively collected data and biologic material.


METHODS
Tertiary University Hospital, Policlinico "Le Scotte," Siena, Italy.


METHODS
Two hundred fifty patients with gastric carcinoma.


METHODS
Five mononucleotide repeats (BAT-26, BAT-25, NR-24, NR-21, and NR-27) were analyzed in these patients.


RESULTS
An MSI phenotype was identified in 63 patients (25.2%) and correlated with specific clinicopathologic characteristics. Favorable prognosis was confirmed for patients with an MSI phenotype in univariate (P < .001) and multivariate (P = .05) analyses. Significant differences in clinicopathologic characteristics and long-term prognoses were observed among patients with microsatellite-stable tumors, tumors having instability at 2 to 4 markers, and tumors having instability at all 5 markers (MSI/5). The MSI/5 phenotype was associated with older age (P < .001), female sex (P = .001), antral tumor location (P = .04), intestinal histotype (P = .003), and less infiltration of the serosa (P = .006); lymph node involvement was rare (P < .001) and was limited to few (median, 3) metastatic lymph nodes (P = .001). Long-term survival of patients with the MSI/5 phenotype is favorable and was confirmed in multivariate analysis (relative risk vs patients with stable tumors, 0.32; 95% confidence interval, 0.16-0.63; P = .002).


CONCLUSIONS
Compared with stable tumors, MSI tumors have distinct clinicopathologic features and are associated with a better prognosis. Patients with the MSI/5 phenotype have a very good prognosis.
Corso
Giovanni
G
Sezione di Chirurgia Oncologica, Dipartimento di Patologia Umana e Oncologia, Policlinico Le Scotte, University of Siena, 53100 Siena, Italy.
Pedrazzani
Corrado
C
Marrelli
Daniele
D
Pascale
Valeria
V
Pinto
Enrico
E
Roviello
Franco
F
D014408:Biomarkers, Tumor / Q000235:genetics*; D016009:Chi-Square Distribution; D005260:Female; D005743:Gastrectomy; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008207:Lymphatic Metastasis; D008297:Male; D053842:Microsatellite Instability; D009367:Neoplasm Staging; D010641:Phenotype; D016133:Polymerase Chain Reaction; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000235:genetics* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D016019:Survival Analysis
D014408:Biomarkers, Tumor