TY - JOUR
T1 - Survival of Locally Advanced MSI-high Gastric Cancer Patients Treated With Perioperative Chemotherapy
T2 - A Retrospective Cohort Study
AU - Vos, Elvira L.
AU - Maron, Steven B.
AU - Krell, Robert W.
AU - Nakauchi, Masaya
AU - Fiasconaro, Megan
AU - Capanu, Marinela
AU - Walch, Henry S.
AU - Chatila, Walid K.
AU - Schultz, Nikolaus
AU - Ilson, David H.
AU - Janjigian, Yelena Y.
AU - Ku, Geoffrey Y.
AU - Yoon, Sam S.
AU - Coit, Daniel G.
AU - Vanderbilt, Chad M.
AU - Tang, Laura H.
AU - Strong, Vivian E.
N1 - Publisher Copyright:
© 2022 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2023/5/1
Y1 - 2023/5/1
N2 - 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 ∼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 ∼9% worse compared with surgery alone, but chemotherapy was not significantly associated with survival.
AB - 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 ∼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 ∼9% worse compared with surgery alone, but chemotherapy was not significantly associated with survival.
UR - http://www.scopus.com/inward/record.url?scp=85150258328&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85150258328&partnerID=8YFLogxK
U2 - 10.1097/SLA.0000000000005501
DO - 10.1097/SLA.0000000000005501
M3 - Article
C2 - 35766391
AN - SCOPUS:85150258328
SN - 0003-4932
VL - 277
SP - 798
EP - 805
JO - Annals of Surgery
JF - Annals of Surgery
IS - 5
ER -
