Prognostic value of mismatch repair deficiency in patients with advanced gastric cancer, treated by surgery and adjuvant 5-fluorouracil and leucovorin chemoradiotherapy

被引：14
作者：
Kim, Su Mi [1 ,4 ]
An, Ji Yeong [1 ]
Byeon, Sun-Ju [3 ]
Lee, Jeeyun [2 ]
Kim, Kyoung-Mee [3 ]
Choi, Min-Gew [1 ]
Lee, Jun Ho [1 ]
Sohn, Tae Sung [1 ]
Moon, Jae [1 ]
Kim, Sung [1 ]
机构：
[1] Sungkyunkwan Univ, Samsung Med Ctr, Dept Surg, Sch Med, Seoul, South Korea
[2] Sungkyunkwan Univ, Samsung Med Ctr, Sch Med, Dept Med,Div Hematol Oncol, Seoul, South Korea
[3] Sungkyunkwan Univ, Samsung Med Ctr, Sch Med, Dept Pathol & Translat Genom, Seoul, South Korea
[4] CHA Univ, Sch Med, Dept Surg, CHA Bundang Hosp, Seongnam, South Korea
来源：
EJSO | 2020年 / 46卷 / 01期
关键词：
Gastric cancer; Mismatch repair protein; Adjuvant chemoradiotherapy; Prognosis; MICROSATELLITE-INSTABILITY; CLINICOPATHOLOGICAL CHARACTERISTICS; STAGE-II; CHEMOTHERAPY; SURVIVAL; IMMUNOHISTOCHEMISTRY; MUTATIONS; CARCINOMA; BENEFIT; MARKER;
D O I：
10.1016/j.ejso.2019.08.025
中图分类号：
R73 [肿瘤学];
学科分类号：
100214 ;
摘要：
Objective: The predictive value of mismatch repair protein deficiency (MMRD) for chemoradiotherapeutic outcome has rarely been reported in gastric cancer. This study investigated the clinical significance of MMRD as a prognostic factor for tumor recurrence, and as a predictor of response to adjuvant chemoradiotherapy in advanced gastric cancer patients. Methods: Between 1995 and 2008, tissue specimens of 881 patients who underwent radical gastrectomy for stage II and 111 gastric cancer were analyzed. MMRD was assessed using immunohistochemical stains for MLHI, PMS2, MSH2, and MSH6. Patients were divided into two groups according to adjuvant treatment: a 5-fiuorouracil/leucovorin (FL) adjuvant chemoradiotherapy group and a surgery alone group. Disease-free survival (DFS) was compared between the two groups correlated to MMRD. Risk factors for tumor recurrence were analyzed using multivariate analysis. Results: Of the 881 gastric cancer patients, 88(10.0%) exhibited MMRD and 398(45.2%) patients received adjuvant FL chemoradiotherapy. The multivariate analysis revealed that MMRD was a good independent prognostic factor (hazard ratio, 0.572; 95% confidence interval, 0.370-0.883; P = 0.012). For stage Ill gastric cancer displaying mismatch repair protein proficiency (MMRP), adjuvant FL chemoradiotherapy after surgery resulted in better DFS than surgery alone (P = 0.001). Among the stage II gastric cancer patients, adjuvant FL chemoradiotherapy did not show survival benefit, regardless of MMRD. Conclusion: MMRD is a good independent prognostic factor in advanced gastric cancer. Adjuvant FL chemoradiotherapy was beneficial in patients with stage Ill gastric cancer with MMRP but not in those with MMRD. (C) 2019 Elsevier Ltd, BASO - The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
引用
收藏
页码：189 / 194
页数：6
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