title: Predictors of disease-free survival in colorectal cancer with microsatellite instability: An AGEO multicentre study.
abstract: BACKGROUND
  A microsatellite instability (MSI) phenotype is found in about 12% of colorectal cancers (CRCs) and is associated with a low recurrence rate after curative surgery. Several studies have identified clinical and pathological factors predictive of recurrence in resected CRC, but not in the MSI subgroup.
  
  
  METHODS
  This multicentre retrospective study included patients with stage I, II or III MSI CRCs. Disease-free survival (DFS) was calculated with the Kaplan-Meier method. Factors associated with DFS were identified in univariate and multivariate Cox analyses.
  
  
  RESULTS
  We studied 521 patients with MSI CRC. Respectively 11%, 51% and 38% of patients were at stage I, II and III. Mean age was 68.7years and 36% of the patients received adjuvant chemotherapy. Median follow-up was 32.8months. The disease recurrence rates were 6% and 21% in stage II and III patients, respectively. The 3-year DFS rate was 77%. In univariate analysis, age, bowel obstruction, lymph node invasion, stage T4, vascular emboli, lymphatic invasion and perinervous invasion were associated with poorer DFS (P<0.05). Three relevant independent predictors of poor DFS were identified in multivariate analysis, namely bowel obstruction (HR=2.46; 95%CI 1.31-4.62, P=0.005), vascular emboli (HR=2.79; 95%CI 1.74-4.47, P<0.001) and stage T4 (HR=2.16; 95%CI 1.31-3.56, P=0.002).
  
  
  CONCLUSIONS
  Bowel obstruction, vascular emboli and stage T4 are independently associated with MSI CRC recurrence, suggesting that screening for vascular emboli in routine clinical practice may assist with adjuvant chemotherapy decision-making.
authors: Department of Gastroenterology, Poitiers University Hospital, Poitiers, France. Electronic address: davidtougeron@hotmail.fr.
authors: D
authors: D
authors: Tougeron
authors: Department of Gastroenterology, Poitiers University Hospital, Poitiers, France.
authors: G
authors: G
authors: Sickersen
authors: Methodology and Quality of Life in Oncology Unit, Besançon University Hospital, Besançon, France.
authors: G
authors: G
authors: Mouillet
authors: Department of Gastroenterology, Georges Pompidou European Hospital, Paris, France.
authors: A
authors: A
authors: Zaanan
authors: Department of Gastroenterology, Ambroise Paré Hospital, Boulogne-Billancourt, France.
authors: I
authors: I
authors: Trouilloud
authors: Paris Descartes University, Cochin Hospital, Paris, France.
authors: R
authors: R
authors: Coriat
authors: Department of Gastroenterology, Avicenne Hospital, Bobigny, France.
authors: T
authors: T
authors: Aparicio
authors: Department of Medical Oncology, Avicenne Hospital, Bobigny, France.
authors: G
authors: G
authors: Des Guetz
authors: Department of Gastroenterology, Bordeaux Nord Clinic, Bordeaux, France.
authors: C
authors: C
authors: Lecaille
authors: Department of Gastroenterology, Jean Mermoz Lyon Hospital, Lyon, France.
authors: P
authors: P
authors: Artru
authors: Department of Gastroenterology, Nantes University Hospital, Nantes, France.
authors: E
authors: E
authors: Cauchin
authors: Department of Gastroenterology, Rouen University Hospital, Rouen, France.
authors: D
authors: D
authors: Sefrioui
authors: Department of Medical Oncology, Saint-Antoine Hospital, Paris, France.
authors: T
authors: T
authors: Boussaha
authors: Department of Medical Oncology, Poitiers University Hospital, Poitiers, France.
authors: A
authors: A
authors: Ferru
authors: Department of Gastroenterology, Nantes University Hospital, Nantes, France.
authors: T
authors: T
authors: Matysiak-Budnik
authors: Department of Gastroenterology, Poitiers University Hospital, Poitiers, France.
authors: C
authors: C
authors: Silvain
authors: Department of Molecular Oncology, Poitiers University Hospital, Poitiers, France.
authors: L
authors: L
authors: Karayan-Tapon
authors: Department of Biochemistry, Tours University Hospital, Tours, France.
authors: J C
authors: JC
authors: Pagès
authors: Methodology and Quality of Life in Oncology Unit, Besançon University Hospital, Besançon, France.
authors: D
authors: D
authors: Vernerey
authors: Methodology and Quality of Life in Oncology Unit, Besançon University Hospital, Besançon, France.
authors: F
authors: F
authors: Bonnetain
authors: Department of Gastroenterology, Rouen University Hospital, Rouen, France.
authors: P
authors: P
authors: Michel
authors: Department of Gastroenterology, Georges Pompidou European Hospital, Paris, France.
authors: J
authors: J
authors: Taïeb
authors: Department of Gastroenterology, Tours University Hospital, Tours, France.
authors: T
authors: T
authors: Lecomte
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000235:genetics; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000235:genetics* / Q000628:therapy; D003123:Colorectal Neoplasms, Hereditary Nonpolyposis / Q000175:diagnosis / Q000235:genetics / Q000628:therapy; D013505:Digestive System Surgical Procedures; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D053842:Microsatellite Instability; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D014408:Biomarkers, Tumor
keywords: Colorectal cancer; Microsatellite instability; Prognosis; Surgery; Vascular emboli