The Effect of Microsatellite Instability on Clinicopathological Data and Survival in Colorectal Cancer

Abstract

Objectives: Colorectal cancer is known as the third most common type of cancer worldwide. The microsatellite instability (MSI) pathway is effective in the development of 15-20% of colorectal cancers. MSI is mainly caused by mutational inactivation of one of the four main MMR genes (MSH2, MLH1, MSH6 or PMS2). This study was planned to investigate clinicopathological features of MSI in colorectal cancer and its effect on prognosis. For this purpose, demographic and clinicopathological data of patient groups with MSI and microsatellite stability (MSS) were compared. Materials and Methods: In this study, the pathology reports of 109 patients who were diagnosed with colorectal cancer and were operated on between 01.01.2015 and 01.01.2019 in the Surgery Oncology Clinic of Cumhuriyet University Medical Faculty Hospital were analyzed retrospectively. MLH-1, MSH-2, MSH-6, and PMS-2 antibodies were evaluated together with demographic and histopathological features and survival time of the patients. Results: The histological grade distribution difference between the MSS and MSI groups was not statistically significant (p=0.838). Mostly observed T-stage was T3 in both groups, and the differences between the groups were not statistically significant (p=0.405). Regarding the N stage, N0 was more common in MSS and N2 in MSI; however, no significant difference was observed between the two groups (p=0.844). Lymphovascular invasion (LVI) was not observed in most cases in both groups, and the differences between the groups were not statistically significant (p=0.493). Perineural invasion (PNI) was present in most cases in both groups, and the differences between the groups were not statistically significant (p=0.987). Survival rates according to the groups were evaluated using the Kaplan Meier test, and no statistically significant difference was found in the 2-year survival rates (p>0.05). Conclusion: In this study, the relationship of MLH1, MSH2, MSH6, and PMS2’s immunohistochemical expression with clinicopathological parameters and survival in patients with colorectal cancer was investigated. According to study results, the losses of expression in the cases were 13.7% for MLH1, 9.1% for MSH2, 12.8% for MSH6, and 14.6% for PMS2. Although it was not statistically significant in the study, we think that the survival rate is higher in cases with MSI. However, the

Keywords

• Colorectal Cancer
• Microsatellite Instability
• Microsatellite Stability

Kolorektal Kanserde Mikrosatellit İnstabilitesinin Klinikopatolojik Veriler ve Sağkalım Üzerine Etkisi

Abstract

Amaç: Kolorektal kanserler tüm dünyada en yaygın görülen üçüncü kanser türü olarak bilinmektedir. Mikrosatellit instabilite (MSİ) yolağı kolorektal kanserlerin %15-20’sinin gelişiminde etkilidir. MSİ, esas olarak dört ana MMR genlerinden birinin (MSH2, MLH1, MSH6 veya PMS2) mutasyonla inaktivasyonundan kaynaklanır. Bu çalışma kolorektal kanserde MSİ’nin klinikopatolojik özellikler ve prognoz üzerine etkisini araştırmak için planlandı. Bu amaçla; MSİ ve mikrosatellit stabilite (MSS) hasta gruplarına ait demografik ve klinikopatolojik veriler karşılaştırıldı. Gereç ve Yöntem: Bu çalışmada, çalışma grubu olarak Cumhuriyet Üniversitesi Tıp Fakültesi Hastanesi Cerrahi Onkoloji Kliniği’nde 01.01.2015- 01.01.2019 tarihleri arasında kolorektal kanser tanısı almış ve opere edilmiş 109 hastaya ait patoloji raporları retrospektif olarak incelendi. MLH-1, MSH-2, MSH-6, PMS-2 antikorları, hastaların demografik ve histopatolojik özellikleriyle ve sağkalım süreleriyle birlikte değerlendirildi. Bulgular: MSS ve MSI grupları arasındaki histolojik derece dağılım farkı istatistiksel olarak anlamsızdı (p=0,838). Her iki grupta da T-evresi çoğunlukla T3 olup, gruplar arasındaki farklılıklar istatistiksel olarak anlamlı değildi (p=0,405). N evresi de MSS’de N0, MSİ’de ise N2 çoğunluktaydı ve her iki grup arasında anlamlı bir fark görülmedi (p=0,844). Lenfovasküler invazyon (LVI) her iki grupta da olguların çoğunluğunda olmayıp, gruplar arasındaki farklılıklar da istatistiksel olarak anlamlı değildi (p=0,493). Perinöral invazyon (PNI) her iki grupta da olguların çoğunluğunda var iken, gruplar arasındaki farklılıklar istatistiksel olarak anlamlı değildi (p=0,987). Gruplara göre sağkalım oranları Kaplan-Meier testi ile değerlendirildiğinde 2 yıllık sağkalım oranları arasında istatistiksel olarak anlamlı farklılık saptanmamıştır (p>0,05). Sonuç: Olgularımız arasında ekspresyon kaybı MLH1 için %13,7, MSH2 için %9,1, MSH6 için %12,8 ve PMS2 için %14,6 olarak bulunmuştur. Çalışmamızda MSİ gösteren olgularda, istatistiksel olarak anlamlı olmamakla birlikte sağ kalım oranının yüksek olduğunu düşünüyoruz. Ancak MSI için cinsiyet, yaş, grade, lokalizasyon, LVI, PNI açısından istatistiksel olarak anlamlı bir farklılık yoktu. MSI tespit etmek için daha çok parametrenin çalışılması gerektiği kanaatindeyiz

Keywords

• Kolorektal Kanser
• Mikrosatellit İnstabilitesi
• Mikrosatellit Stabilitesi

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