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. 2023 Jan 19:16:17562848221150306.
doi: 10.1177/17562848221150306. eCollection 2023.

Clinical significance of neoadjuvant chemotherapy for locally advanced colorectal cancer patients with deficient mismatch repair: possibly residual value in the era of immunotherapy

Mian Chen  1   2   3 , Junguo Chen  1   2   3 , Jun Huang  1   2   3 , Huashan Liu  1   2   3 , Wuteng Cao  4 , Shuangling Luo  1   2   3 , Zhanzhen Liu  1   2   3 , Huanxin Hu  1   2   3 , Sicong Lai  1   2   3 , Yujie Hou  1   2   3 , Liang Kang  5 , Liang Huang  5
Affiliations

Clinical significance of neoadjuvant chemotherapy for locally advanced colorectal cancer patients with deficient mismatch repair: possibly residual value in the era of immunotherapy

Mian Chen et al. Therap Adv Gastroenterol. .

Abstract

Background: Deficient mismatch repair (dMMR) or microsatellite instability is one of the well-established molecular biomarkers in colorectal cancer (CRC). The efficiency of neoadjuvant chemotherapy (NAC) in locally advanced colorectal cancer (LACC) patients with dMMR is unclear.

Objectives: We assessed the tumor response and clinical outcome in LACC patients with dMMR received NAC.

Design: Retrospective, single-center analysis.

Methods: From 2013 to 2018, a total of 577 LACC patients with dMMR who underwent radical surgery were identified. Among them, 109 patients who received adjuvant chemotherapy were further screened out for analysis. According to whether receiving NAC or not, 109 patients were divided into two groups with the purpose of retrospectively analyzing their characteristics, treatment, and survival results, especially the 5-year disease-free survival (DFS) and 5-year overall survival.

Results: Baseline characteristics were matched between the two groups. One of 40 patients in NAC group recurred, while 13 of 69 patients in non-NAC group recurred. Univariate and multivariate analyses showed that NAC (hazard ratio: 0.115; 95% confidence interval: 0.015-0.897; p = 0.039) was independent influence factor for DFS. In NAC group, there were 13/40 (32.5%) patients for tumor regression grade 1 and 27/40 (67.5%) patients converted clinical positive N-stage into negative N-stage.

Conclusion: In this study, NAC was associated with better tumor downstaging and longer 5-year DFS in LACC patients with dMMR. Consequently, NAC might be an additional treatment choice when it comes to such patients in the future.

Keywords: deficient mismatch repair; locally advanced colorectal cancer; neoadjuvant chemotherapy; prognosis.

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Conflict of interest statement

The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
Flowchart representing the selection of eligible patients for the present study. CRC, colorectal cancer; dMMR, deficient mismatch repair; NAC, neoadjuvant chemotherapy.
Figure 2.
Figure 2.
(a) The proportion of mismatch repair proteins deficient patients in CRC patients. (b) The mismatch repair proteins deficient of 109 LACC patients. CRC, colorectal cancer; LACC, locally advanced colorectal cancer.
Figure 3.
Figure 3.
Oncological outcomes LACC patients with dMMR. (a) Kaplan–Meier estimates for DFS. (b) Kaplan–Meier estimates for OS. DFS, disease-free survival; dMMR, deficient mismatch repair; LACC, locally advanced colorectal cancer; OS, overall survival.
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