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Microsatellite instability as a prognostic factor in stage II colon cancer patients: a meta-analysis of published literature
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Department of Surgery, Sunderby hospital Luleå, Luleå, Sweden. (Clister)
Department of Surgery, Sunderby hospital Luleå, Luleå, Sweden..
Faculty Hospital Pilsen, Charles University, Prague, Czech Republic.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. (Clister)
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2017 (English)In: Anticancer Research, ISSN 0250-7005, E-ISSN 1791-7530, Vol. 37, no 12, p. 6563-6574Article, review/survey (Refereed) Published
Abstract [en]

BACKGROUND/AIM: The prognostic role of microsatellite instability (MSI) in stage II colon cancer patients remains controversial despite the fact that it has been investigated in a number of studies. Hazard ratios differ considerably among these studies. We performed a meta-analysis to define the significance of MSI in this group of patients.

MATERIALS AND METHODS: Studies indexed in PubMed presenting separate data on MSI status and survival outcomes for stage II colon cancer patients have been analyzed using fixed-effect meta-analysis of hazard ratio (HR) according to the method of Peto.

RESULTS: Analysis was performed on 19 studies including 5,998 patients. A 47.3% of patients received postoperative chemotherapy and included 52.8% males and 47.2% females. Eight studies included some rectal cancer patients although this cohort was not clearly defined in 3 of these. MSI observed in 20.8% (mean) of patients (median 19.9%). HR for overall survival (OS) of MSI vs. microsatellite stable (MSS) tumors for the entire population: 0.73 (95% confidence interval (CI)=0.33-1.65); HR for disease-free survival (DFS):0.60 (95%CI=0.27-1.32). No statistical significant difference was found when studies analyzing MSI with genotyping (MG) and immunohistochemistry (IHC) were compared separately (MG vs. IHC: HR OS 0.45, 95%CI=0.10-2.05 vs. 0.95, 95%CI=0.57-1.58; HR DFS 0.51, 95%CI=0.14-1.85 vs. 0.67, 95%CI=0.26-1.70). However, numerically MSI determination with genotyping shows significantly lower hazard ratios for both DFS and OS. Separate analysis of studies describing colon cancer patients only showed HR OS 0.72 (95%CI=0.31-1.71); HR DFS 0.60 (95%CI=0.27-1.31).

CONCLUSION: No significant relation was found between MSI status and OS or DFS. Routine determination of MSI status to guide postoperative management of stage II colon cancer patients cannot be recommended. New large scale high quality studies are needed to answer this question definitively, since currently analyzed studies vary considerably.

Place, publisher, year, edition, pages
2017. Vol. 37, no 12, p. 6563-6574
Keywords [en]
Colon cancer, meta-analysis, microsatellite instability, predictive factor, prognostic factor, systematic review
National Category
Cancer and Oncology
Identifiers
URN: urn:nbn:se:umu:diva-142558DOI: 10.21873/anticanres.12113ISI: 000417022100008PubMedID: 29187431OAI: oai:DiVA.org:umu-142558DiVA, id: diva2:1162665
Available from: 2017-12-05 Created: 2017-12-05 Last updated: 2018-06-09Bibliographically approved

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Gkekas, IoannisNovotny, JanStrigård, KarinPalmqvist, RichardGunnarsson, Ulf

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