Turner Kevin M, Delman Aaron M, Wima Koffi, Quillin R Cutler, Shah Shimul A, Ahmad Syed A, Patel Sameer H, Wilson Gregory C
Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Department of Surgery, Division of Transplantation, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Am J Surg. 2023 Feb;225(2):322-327. doi: 10.1016/j.amjsurg.2022.08.007. Epub 2022 Aug 18.
Microsatellite instability (MSI) has been associated with improved overall survival (OS) in locoregional colorectal cancer; however, the effects on colorectal liver metastases (CRLM) have not been studied.
The National Cancer Database (NCDB) was queried for patients with CRLM that underwent metastasectomy. Patients with microsatellite stable tumors (MSS) (n = 2,316, 84.4%) were compared those with MSI (n = 427, 15.6%).
Baseline characteristics, including sex, race, and underlying comorbidities, were similar between groups. MSS patients had lower rates of high-risk pathologic features and higher rates of receiving multi-agent chemotherapy. On Kaplan-Meier analysis, median OS in the MSS group was improved compared with the MSI group (41.1 mo vs. 33.2 mo, p < 0.01). On multivariate analysis MSI status remained associated with worse OS (HR: 1.21 95% CI: 1.01-1.46, p = 0.04).
This national analysis of CRLM validates MSI status as a biomarker to guide clinical decision-making due to the associated poor prognosis.
微卫星不稳定性（MSI）与局部区域结直肠癌患者总生存期（OS）的改善相关；然而，其对结直肠癌肝转移（CRLM）的影响尚未得到研究。
查询国家癌症数据库（NCDB）中接受转移灶切除术的CRLM患者。将微卫星稳定肿瘤（MSS）患者（n = 2316，84.4%）与MSI患者（n = 427，15.6%）进行比较。
两组间的基线特征，包括性别、种族和基础合并症，相似。MSS患者具有高危病理特征的比例较低，接受多药化疗的比例较高。根据Kaplan-Meier分析，MSS组的中位OS较MSI组有所改善（41.1个月对33.2个月，p < 0.01）。多因素分析显示，MSI状态仍与较差的OS相关（HR：1.21，95%CI：1.01 - 1.46，p = 0.04）。
这项对CRLM的全国性分析证实，由于MSI状态与预后不良相关，其可作为指导临床决策的生物标志物。
