Department of Hematology/Oncology, Kyungpook National University Hospital, Kyungpook National University School of Medicine, 200 Dongduk-Ro, Daegu, Jung-Gu 700-712, South Korea.
Med Oncol. 2011 Dec;28 Suppl 1:S214-8. doi: 10.1007/s12032-010-9701-2. Epub 2010 Oct 16.
Microsatellite instability (MSI) is a molecular marker that can provide valuable prognostic information for colorectal cancer (CRC). However, the predictive role of the MSI status remains less clear than its role in prognostication due to mixed results from previous studies. Therefore, this study investigated the usefulness of the MSI status as a predictive factor for stage II or III CRC patients who received adjuvant doxifluridine therapy. Among 3030 patients with CRC who underwent surgical resection between 1997 and 2006, 564 patients were diagnosed with stage II or III, and adjuvant doxifluridine therapy was administered to 394 patients (70.0%). The MSI status was assessed using the markers BAT25 and BAT26, and samples with instability at both markers were scored as exhibiting high-frequency MSI (MSI-H). Among the 564 patients, 290 patients (51.4%) had stage II, and MSI-H was found in 41 patients (7.3%). With a median follow-up duration of 35.1 months (range, 0.5-135.2), the 5-year overall survival (OS) rate and relapse-free survival (RFS) rate were 87.5 and 76.2%, respectively. MSI-H showed a favorable survival trend for OS (P = 0.098) and significant survival benefit for RFS (P = 0.037) in all patients. In a univariate analysis, the doxifluridine-treated patients with MSI-H showed improved RFS compared to those with low or stable MSI (MSI-L/S) (P = 0.036), while the MSI status was not significantly associated with OS (P = 0.107). In a multivariate analysis, MSI-H was not significantly associated with RFS (Hazard ratio = 2.467, P = 0.125). In conclusion, this study confirmed the positive prognostic role of MSI-H. However, MSI-H patients with stage II or III CRC did not seem to benefit from doxifluridine adjuvant therapy.
微卫星不稳定性 (MSI) 是一种分子标志物，可为结直肠癌 (CRC) 提供有价值的预后信息。然而，由于之前的研究结果存在差异，MSI 状态的预测作用仍不如其预后作用明确。因此，本研究探讨了 MSI 状态作为接受辅助多柔比星氟尿嘧啶治疗的 II 期或 III 期 CRC 患者的预测因素的有用性。在 1997 年至 2006 年间接受手术切除的 3030 例 CRC 患者中，有 564 例患者被诊断为 II 期或 III 期，其中 394 例（70.0%）接受了辅助多柔比星氟尿嘧啶治疗。使用标记物 BAT25 和 BAT26 评估 MSI 状态，并且在两个标记物均不稳定的样本中评分显示高频 MSI (MSI-H)。在 564 例患者中，有 290 例（51.4%）为 II 期，41 例（7.3%）为 MSI-H。中位随访时间为 35.1 个月（范围，0.5-135.2），5 年总生存率（OS）和无复发生存率（RFS）分别为 87.5%和 76.2%。MSI-H 对 OS（P=0.098）和 RFS（P=0.037）均显示出有利的生存趋势。在单因素分析中，与低或稳定 MSI（MSI-L/S）相比，接受多柔比星氟尿嘧啶治疗的 MSI-H 患者的 RFS 得到改善（P=0.036），而 MSI 状态与 OS 无显著相关性（P=0.107）。在多因素分析中，MSI-H 与 RFS 无显著相关性（风险比=2.467，P=0.125）。总之，本研究证实了 MSI-H 的阳性预后作用。然而，II 期或 III 期 CRC 伴 MSI-H 的患者似乎并未从多柔比星氟尿嘧啶辅助治疗中获益。
