Kim Dong Gyu, An Ji Yeong, Kim Hyunki, Shin Su-Jin, Choi Seohee, Seo Won Jun, Roh Chul Kyu, Cho Minah, Son Taeil, Kim Hyoung-Il, Cheong Jae-Ho, Hyung Woo Jin, Noh Sung Hoon, Choi Yoon Young
Department of Surgery, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Korea.
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Gastric Cancer. 2019 Dec;19(4):427-437. doi: 10.5230/jgc.2019.19.e38. Epub 2019 Nov 8.
We aimed to evaluate the clinical characteristics of microsatellite instability in early gastric cancer.
The microsatellite instability status of resected early gastric tumors was evaluated using two mononucleotide repeat markers (BAT25 and BAT26) and three dinucleotide repeat markers (D5S346, D2S123, and D17S250). Tumors with instability in two or more markers were defined as microsatellite instability-high (MSI-H) and others were classified as microsatellite stable (MSS).
Overall, 1,156 tumors were included in the analysis, with 85 (7.4%) classified as MSI-H compared with MSS tumors. For MSI-H tumors, there was a significant correlation with the female sex, older age, tumor location in the lower gastric body, intestinal histology, lymphovascular invasion (LVI), and submucosal invasion (P<0.05). There was also a trend toward an association with lymph node (LN) metastasis (P=0.056). In mucosal gastric cancer, there was no significant difference in MSI status in tumors with LN metastasis or tumors with LVI. In submucosal gastric cancer, LVI was more frequently observed in MSI-H than in MSS tumors (38.9% vs. 25.0%, P=0.027), but there was no difference in the presence of LN metastases. The prognosis of MSI-H tumors was similar to that of MSS tumors (log-rank test, P=0.797, the hazard ratio for MSI-H was adjusted by age, sex, pT stage, and the number of metastatic LNs, 0.932; 95% confidence interval, 0.423-2.054; P=0.861).
MSI status was not useful in predicting prognosis in early gastric cancer. However, the frequent presence of LVI in early MSI-H gastric cancer may help guide the appropriate treatment for patients, such as endoscopic treatment or limited LN surgical dissection.
我们旨在评估早期胃癌中微卫星不稳定性的临床特征。
使用两个单核苷酸重复标记（BAT25和BAT26）和三个二核苷酸重复标记（D5S346、D2S123和D17S250）评估切除的早期胃肿瘤的微卫星不稳定性状态。在两个或更多标记中存在不稳定性的肿瘤被定义为微卫星高度不稳定（MSI-H），其他肿瘤则分类为微卫星稳定（MSS）。
总体而言，1156例肿瘤纳入分析，与MSS肿瘤相比，85例（7.4%）被分类为MSI-H。对于MSI-H肿瘤，其与女性、年龄较大、胃体下部肿瘤位置、肠型组织学、淋巴管浸润（LVI）和黏膜下浸润显著相关（P<0.05）。与淋巴结（LN）转移也存在关联趋势（P=0.056）。在黏膜型胃癌中，有LN转移的肿瘤或有LVI的肿瘤在MSI状态上无显著差异。在黏膜下型胃癌中，MSI-H肿瘤比MSS肿瘤更常观察到LVI（38.9%对25.0%，P=0.027），但在LN转移的存在方面无差异。MSI-H肿瘤的预后与MSS肿瘤相似（对数秩检验，P=0.797，MSI-H的风险比经年龄、性别、pT分期和转移LN数量调整后为0.932；95%置信区间，0.423 - 2.054；P=0.861）。
MSI状态对预测早期胃癌的预后无用。然而，早期MSI-H胃癌中LVI的频繁存在可能有助于指导患者的适当治疗，如内镜治疗或有限的LN手术清扫。
