Microsatellite Instability Status in Gastric Cancer: A Reappraisal of Its Clinical Significance and Relationship with Mucin Phenotypes
Kim Joo-Yeun, 신나리, 김아롱, 이현정, 박원영, 김지연, 이창훈, 허기영, 박도윤,
소속 상세정보
( Kim Joo-Yeun )
Pusan National University Hospital Department of Pathology
신나리 ( Shin Na-Ri )
Pusan National University Hospital Department of Pathology
김아롱 ( Kim Ah-Rong )
Pusan National University Hospital Department of Pathology
이현정 ( Lee Hyun-Jeong )
Pusan National University Hospital Department of Pathology
박원영 ( Park Won-Young )
Pusan National University Hospital Department of Pathology
김지연 ( Kim Jee-Yeon )
Pusan National University Hospital Department of Pathology
이창훈 ( Lee Chang-Hun )
Pusan National University Hospital Department of Pathology
허기영 ( Huh Gi-Yeong )
Pusan National University Hospital Department of Forensic Medicine
박도윤 ( Park Do-Youn )
Pusan National University Hospital Department of Pathology
KMID : 0357920130470010028
Abstract
Background: Gastric cancers with microsatellite instabilities (MSI) have been reported to be associated with favorable prognosis. However, the significance of the effect of MSI on the clinicopathological features, as well as its association with mucin phenotype, remains unclear. Methods: MSI status was assessed in 414 cases of gastric cancer using polymerase chain reaction analysis of five microsatellite loci, as recommended by National Cancer Institution criteria. The expression of mucins (MUC5AC, MUC6, MUC2, and CD10) was assessed. Results: Out of 414 total cases of gastric cancer, 380 (91.7%), 11 (2.7%), and 23 (5.6%) were microsatellite stable (MSS), low-level MSI (MSI-L), and high-level MSI (MSI-H), respectively. Compared to MSS/MSI-L, MSI-H gastric cancers were associated with older age (p=0.010), tumor size (p=0.014), excavated gross (p=0.042), intestinal type (p=0.028), aggressive behaviors (increase of T stage [p=0.009]), perineural invasion [p=0.022], and lymphovascular emboli [p=0.027]). MSI-H gastric cancers were associated with tumor necrosis (p=0.041), tumor-infiltrating lymphocytes (≥2/high power field, p<0.001), expanding growth patterns (p=0.038), gastric predominant mucin phenotypes (p=0.028), and MUC6 expression (p=0.016). Tumor necrosis (≥10% of mass, p=0.031), tumorinfiltrating lymphocytes (p<0.001), intestinal type (p=0.014), and gastric mucin phenotypes (p= 0.020) could represent independent features associated with MSI-H gastric cancers. MSI-H intestinal type gastric cancers had a tendency for poor prognosis in univariate analysis (p=0.054) but no association in Cox multivariate analysis (p=0.197). Conclusions: Our data suggest that MSI-H gastric cancers exhibit distinct aggressive biologic behaviors and a gastric mucin phenotype. This contradicts previous reports that describe MSI-H gastric cancer as being associated with favorable prognosis.
키워드
Stomach; Adenocarcinoma; Microsatellite instability; Mucin; Survival
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