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. 2015 May;3(3):699-705.
doi: 10.3892/mco.2015.506. Epub 2015 Feb 6.

Microsatellite instability and survival in gastric cancer: A systematic review and meta-analysis

Lin Zhu  1 , Zhi Li  1 , Yan Wang  1 , Chenlu Zhang  1 , Yunpeng Liu  1 , Xiujuan Qu  1
Affiliations

Microsatellite instability and survival in gastric cancer: A systematic review and meta-analysis

Lin Zhu et al. Mol Clin Oncol. 2015 May.

Abstract

Microsatellite instability (MSI) is associated with the prognosis in several cancers and is used for determination of the chemotherapy regimen in stage II colon cancer in the National Comprehensive Cancer Network guideline. However, the association between MSI and the prognosis of gastric cancer remains unclear. PubMed database was searched until January 2014 using MeSH terms and key words to identify the studies evaluating MSI and prognosis of gastric cancer and the references were manually searched. The main outcome was the overall survival rate and the subordinate outcome was the association between high-frequency MSI (MSI-H) and clinicopathological characteristics. Eight studies met the inclusion criteria and the majority of data were collected retrospectively. There were 1,976 patients, 431 of which were MSI-H patients, with a range of 11.68-33.82%. Four studies used the National Cancer Institute panel to define MSI-H, the other four had microsatellite markers ranging 2-11. Significant associations were found in three studies and the overall summary estimate was hazard ratio, 0.63 (95% confidence interval, 0.52-0.77), with no evidence of inter-study heterogeneity (I2=0.0%). MSI-H patients were identified to have a tendency to have less lymph node (LN) metastasis, superficial tumor invasion and to be intestinal type. In conclusion, MSI-H gastric cancers have an improved prognosis, accompanied with reduced risk of LN metastasis, tumor invasion and mortality.

Keywords: gastric neoplasms; microsatellite instability; overall survival; prognosis.

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Figures

Figure 1.
Figure 1.
Search strategy process. HNPCC, hereditary nonpolyposis colorectal cancer; OS, overall survival.
Figure 2.
Figure 2.
Forest plots evaluating hazard ratio (HR) of the high-frequency microsatellite instability (MSI-H) compared to microsatellite stable (MSS), based on overall survival (OS). CI, confidence interval; MSI-L, low-frequency microsatellite instability.
Figure 3.
Figure 3.
Funnel plot of eight studies. s.e., standard error; HR, hazard ratio.
Figure 4.
Figure 4.
Forest plots evaluating odds ratio (OR) of the high-frequency microsatellite instability (MSI-H) compared to microsatellite stable (MSS), based on lymph node metastasis. CI, confidence interval; MSI-L, low-frequency microsatellite instability.
Figure 5.
Figure 5.
Forest plots evaluating odds ratio (OR) of the high-frequency microsatellite instability (MSI-H) compared to microsatellite stable (MSS), based on T invasion. CI, confidence interval; MSI-L, low-frequency microsatellite instability.
Figure 6.
Figure 6.
Forest plots evaluating odds ratio (OR) of the high-frequency microsatellite instability (MSI-H) compared to microsatellite stable (MSS), based on TNM. CI, confidence interval; MSI-L, low-frequency microsatellite instability; TNM, tumor-node-metastasis.
Figure 7.
Figure 7.
Forest plots evaluating odds ratio (OR) of the high-frequency microsatellite instability (MSI-H) compared to microsatellite stable (MSS), based on the Lauren classification. CI, confidence interval; MSI-L, low-frequency microsatellite instability.
See this image and copyright information in PMC

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