Survival of locally advanced MSI-high gastric cancer patients treated with perioperative chemotherapy: A retrospective cohort study Journal Article
| Authors: | Vos, E. L.; Maron, S. B.; Krell, R. W.; Nakauchi, M.; Fiasconaro, M.; Capanu, M.; Walch, H. S.; Chatila, W. K.; Schultz, N.; Ilson, D. H.; Janjigian, Y. Y.; Ku, G. Y.; Yoon, S. S.; Coit, D. G.; Vanderbilt, C. M.; Tang, L. H.; Strong, V. E. |
| Article Title: | Survival of locally advanced MSI-high gastric cancer patients treated with perioperative chemotherapy: A retrospective cohort study |
| Abstract: | Objective: To evaluate the efficacy of chemotherapy in patients with microsatellite instability (MSI)-high gastric cancer. Background: Although MSI-high gastric cancer is associated with a superior prognosis, recent studies question the benefit of perioperative chemotherapy in this population. Methods: Locally advanced gastric adenocarcinoma patients who either underwent surgery alone or also received neoadjuvant, perioperative, or adjuvant chemotherapy between 2000 and 2018 were eligible. MSI status, determined by next-generation sequencing or mismatch repair protein immunohistochemistry, was determined in 535 patients. Associations among MSI status, chemotherapy administration, overall survival (OS), disease-specific survival, and disease-free survival were assessed. Results: In 535 patients, 82 (15.3%) had an MSI-high tumor and similar to 20% better OS, disease-specific survival, and disease-free survival. Grade 1 (90%-100%) pathological response to neoadjuvant chemotherapy was found in 0 of 40 (0%) MSI-high tumors versus 43 of 274 (16%) MSS. In the MSI-high group, the 3-year OS rate was 79% with chemotherapy versus 88% with surgery alone (P = 0.48). In the MSS group, this was 61% versus 59%, respectively (P = 0.96). After multivariable interaction analyses, patients with MSI-high tumors had superior survival compared with patients with MSS tumors whether given chemotherapy (hazard ratio= 0.53, 95% confidence interval: 0.28-0.99) or treated with surgery alone (hazard ratio = 0.15, 95% confidence interval: 0.02-1.17). Conclusions: MSI-high locally advanced gastric cancer was associated with superior survival compared with MSS overall, despite worse pathological chemotherapy response. In patients with MSI-high gastric cancer who received chemotherapy, the survival rate was similar to 9% worse compared with surgery alone, but chemotherapy was not significantly associated with survival. |
| Keywords: | chemotherapy; immunotherapy; microsatellite instability; neoadjuvant; esophageal; gastric cancer; gastric adenocarcinoma; microsatellite; instability; epstein-barr-virus; mismatch repair deficiency; mismatch repair defect |
| Journal Title: | Annals of Surgery |
| Volume: | 277 |
| Issue: | 5 |
| ISSN: | 0003-4932 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2023-05-01 |
| Start Page: | 798 |
| End Page: | 805 |
| Language: | English |
| ACCESSION: | WOS:000989182800013 |
| DOI: | 10.1097/sla.0000000000005501 |
| PROVIDER: | wos |
| PMCID: | PMC9797619 |
| PUBMED: | 35766391 |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF -- Corresponding author is MSK author: Vivian E. Strong -- Source: Wos |
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