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Multicenter Study
. 2023 Jul 17;38(1):197.
doi: 10.1007/s00384-023-04480-z.

The prognostic significance of microsatellite instability in colorectal cancer: a Swedish multi-center study

Petri Rantanen  1 , Anne Keränen  2 , Shabane Barot  3 , Sam Ghazi  2 , Annelie Liljegren  4 , Caroline Nordenvall  5 , Annika Lindblom  5   6 , Ulrik Lindforss  5
Affiliations
Multicenter Study

The prognostic significance of microsatellite instability in colorectal cancer: a Swedish multi-center study

Petri Rantanen et al. Int J Colorectal Dis. .

Abstract

Purpose: About 10 to 15% of patients with sporadic colorectal cancer display mutations in DNA mismatch repair (MMR) genes shown as microsatellite instability (MSI). Previous reports of colorectal cancer (CRC) indicate a better prognosis for patients with MSI tumors compared to patients with microsatellite stable (MSS) tumors. In this study, our aim was to investigate whether MSI is an independent prognostic factor in CRC.

Patients and methods: Patients with stage I-III colorectal cancer and subject to curative surgery during 2002-2006 in the Swedish low-risk colorectal cancer study group cohort were eligible for inclusion. Deficient MMR (dMMR) status was analyzed by immunohistochemistry (IHC) and/or by MSI testing with polymerase chain reaction (PCR). Prognostic follow-up and treatment data were retrieved from patient records. Statistical analyses to assess MSI-status and prognosis were done using logistic regression and survival analyses using the Kaplan-Meier method and Cox regression hazards models adjusted for age, sex, stage, comorbidity, and tumor location.

Results: In total, 463 patients were included, MSI high tumors were present in 66 patients (14%), and the remaining 397 were MSS/MSI low. Within 6 years, distant recurrences were present in 9.1% and 20.2% (P = 0.049), and death occurred in 25.8% and 31.5% in MSI and MSS patients, respectively. There was no statistically significant difference in overall mortality (HR 0.80, 95% CI 0.46-1.38), relapse-free survival (HR 0.82, 95% CI 0.50-1.36), or cancer-specific mortality (HR 1.60, 95% CI 0.73-3.51).

Conclusion: Despite distant metastases being less common in patients with MSI, there was no association between MSI and overall, relapse-free, or cancer-specific survival.

Keywords: Colorectal cancer; Microsatellite instability; Mismatch repair; Prognosis.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart
Fig. 2
Fig. 2
Kaplan-Meier curve illustrating the overall survival stratified by MSI status (MSI = dashed line; MSS = solid line)
Fig. 3
Fig. 3
Kaplan-Meier curve illustrating the relapse-free survival stratified by MSI-status (MSI = dashed line; MSS = solid line)
Fig. 4
Fig. 4
Kaplan-Meier curve illustrating the cancer-specific survival stratified by MSI status (MSI = dashed line; MSS = solid line)
See this image and copyright information in PMC

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