可切除胃癌患者中微卫星不稳定性的预后意义。

Prognostic significance of microsatellite instability in patients with resectable gastric cancer.

机构信息

Department of Gastroenterology, Faculdade de Medicina, Instituto do Cancer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Universidade de Sao Paulo, Sao Paulo, Brazil.

出版信息

J Gastrointest Surg. 2024 Oct;28(10):1687-1695. doi: 10.1016/j.gassur.2024.07.019. Epub 2024 Aug 14.

DOI:10.1016/j.gassur.2024.07.019

PMID:39147611

Abstract

BACKGROUND

Microsatellite instability (MSI) gastric cancer (GC) generally has a better prognosis than microsatellite-stable (MSS) GC and has been associated with nonsurvival benefit with the addition of chemotherapy (CMT) compared with surgery alone. However, patients with MSI have distinct clinicopathological characteristics. This study aimed to compare the survival outcomes between patients with MSI GC and those with MSS GC. In addition, this study analyzed the survival outcomes of patients with MSI GC who received CMT.

METHODS

This study reviewed all patients with GC who underwent curative gastrectomy. Patients were divided into MSI group and the MSS group. Propensity score matching (PSM) was used to match clinicopathological factors.

RESULTS

Among the 378 patients enrolled, 78 (20.6%) had MSI. Older age (P < .001), subtotal gastrectomy (P = .008), pN0 (P = .020), and earlier pTNM stage (P = .012) were associated with MSI GC. Survival analysis showed better disease-free survival (DFS) and overall survival (OS) of patients in the MSI group (P = .012 and P = .019, respectively). After PSM, 78 patients were matched to each group. All variables assigned to the scores were well matched, and both groups became equivalent. After the matching, the differences in DFS and OS according to MSI/MSS status were estimated to be larger than before (DFS: 63.3% vs 41.4%; P = .002; OS: 65.8% vs 42.5%; P = .002). Regarding patients referred for CMT, there was no difference in DFS and OS between patients with MSI GC who underwent CMT and those who underwent surgery alone (P = .255 and P = .178, respectively).

CONCLUSION

Even after controlling for clinicopathological characteristics, MSI was identified as a prognostic factor for patient survival. MSI GC showed no significant survival benefit with the addition of CMT.

摘要

背景

微卫星不稳定（MSI）胃癌（GC）的预后通常优于微卫星稳定（MSS）GC，并且与单独手术相比，添加化疗（CMT）与非生存获益相关。然而，MSI 患者具有明显的临床病理特征。本研究旨在比较 MSI GC 患者与 MSS GC 患者的生存结果。此外，本研究分析了接受 CMT 的 MSI GC 患者的生存结果。

方法

本研究回顾性分析了所有接受根治性胃切除术的 GC 患者。患者分为 MSI 组和 MSS 组。采用倾向评分匹配（PSM）匹配临床病理因素。

结果

在纳入的 378 例患者中，78 例（20.6%）为 MSI。年龄较大（P<0.001）、行胃次全切除术（P=0.008）、pN0（P=0.020）和较早的 pTNM 分期（P=0.012）与 MSI GC 相关。生存分析显示 MSI 组患者的无病生存率（DFS）和总生存率（OS）更好（P=0.012 和 P=0.019）。PSM 后，每组匹配 78 例患者。所有分配给评分的变量均得到很好的匹配，两组变得等效。匹配后，根据 MSI/MSS 状态估计 DFS 和 OS 的差异大于之前（DFS：63.3% vs 41.4%；P=0.002；OS：65.8% vs 42.5%；P=0.002）。对于接受 CMT 治疗的患者，接受 CMT 治疗的 MSI GC 患者与单独接受手术的患者在 DFS 和 OS 方面没有差异（DFS：P=0.255；OS：P=0.178）。