PMID- 38482236 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20240315 IS - 2078-6891 (Print) IS - 2219-679X (Electronic) IS - 2078-6891 (Linking) VI - 15 IP - 1 DP - 2024 Feb 29 TI - Clinicopathological features and prognoses in younger and older patients with mismatch repair defects colorectal cancer: a retrospective comparative cohort study. PG - 260-270 LID - 10.21037/jgo-24-4 [doi] AB - BACKGROUND: Microsatellite instability-high (MSI-H) is an important biomarker for predicting the effects of immune checkpoint inhibitors (ICIs) in colorectal cancer (CRC) patients. However, due to the low mutation rate of MSI-H/deficient mismatch repair (dMMR) in the overall population, some doctors are of the view that testing this indicator increases the burden on patients, and consequently some patients fail to receive the most beneficial treatment methods. In order to provide testing criteria for younger patients with a higher proportion of MSI-H, we designed this retrospective controlled study. METHODS: A retrospective analysis was conducted of 1,901 patients who were admitted to the Affiliated Cancer Hospital of Zhengzhou University from January 2017 to December 2019 and underwent CRC-related gene testing. For this analysis, 100 patients aged 40 or younger are defined as the young group, and 305 patients aged 71 and older but younger than 80 are defined as the elderly group. We included patients who met the following criteria: (I) underwent preoperative colonoscopy or gastroscopy and were diagnosed with CRC; (II) received perioperative adjuvant therapy; (III) underwent curative surgery for CRC. Each patient was followed up from the time of surgery until April 30, 2023, or death, with follow-up visits scheduled every 3 months for the first 2 years after surgery, and every 6 months thereafter. Clinical characteristics such as age, gender, body mass index (BMI), tumor depth (T), number of metastatic lymph nodes (N), distant metastasis (M), tumor, node, metastasis (TNM) stage, extent of surgical resection, tumor size, tumor location, differentiation grade, and carcinoembryonic antigen (CEA) levels were collected. The microsatellite instability (MSI) status was analyzed using fluorescence in situ hybridization (FISH). RESULTS: In young CRC patients, the proportion of MSI-H is higher than in elderly CRC patients (33% vs. 10.16%, P<0.001). The proportion of poorly differentiated tumors is also higher in young CRC patients compared to elderly CRC patients (53% vs. 31.15%, P<0.001). However, there were no significant differences in clinical characteristics between young and elderly CRC patients. In terms of prognosis, survival analysis of the young group showed that MSI status [hazard ratio (HR) =0.26, 95% confidence interval (CI): 0.08-0.88, P=0.03], TNM staging (HR =3.84, 95% CI: 1.38-10.71, P=0.010) were associated with the prognosis of CRC patients. CONCLUSIONS: The mutation rate of MSI-H is higher in young CRC patients compared to older. Our study further confirms that MSI-H can serve as a favorable prognostic marker for CRC patients. This finding may provide valuable guidance for clinicians in terms of prognosis assessment and treatment selection. If feasible, we hope that MSI testing can be performed for all CRC patients to enable targeted testing, with particular attention to monitoring the MSI status in young patients. This will aid clinicians in selecting appropriate treatment strategies for these patients. CI - 2024 Journal of Gastrointestinal Oncology. All rights reserved. FAU - Zhang, Jiachen AU - Zhang J AD - Department of General Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China. FAU - Li, Sen AU - Li S AD - Department of General Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China. FAU - Ma, Pengfei AU - Ma P AD - Department of General Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China. FAU - Zhang, Junli AU - Zhang J AD - Department of General Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China. FAU - Cao, Yanghui AU - Cao Y AD - Department of General Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China. FAU - Liu, Chenyu AU - Liu C AD - Department of General Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China. FAU - Zhang, Xijie AU - Zhang X AD - Department of General Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China. AD - The Second School of Clinical Medicine, Lanzhou University, Lanzhou, China. FAU - Li, Zhenyu AU - Li Z AD - Department of General Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China. FAU - Li, Changzheng AU - Li C AD - Department of General Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China. FAU - Zhao, Yuzhou AU - Zhao Y AD - Department of General Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China. LA - eng PT - Journal Article DEP - 20240228 PL - China TA - J Gastrointest Oncol JT - Journal of gastrointestinal oncology JID - 101557751 PMC - PMC10932669 OTO - NOTNLM OT - Colorectal cancer (CRC) OT - age OT - clinicopathological feature OT - microsatellite instability (MSI) OT - prognosis COIS- Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jgo.amegroups.com/article/view/10.21037/jgo-24-4/coif). The authors have no conflicts of interest to declare. EDAT- 2024/03/14 06:47 MHDA- 2024/03/14 06:48 PMCR- 2024/02/29 CRDT- 2024/03/14 04:21 PHST- 2024/01/03 00:00 [received] PHST- 2024/02/19 00:00 [accepted] PHST- 2024/03/14 06:48 [medline] PHST- 2024/03/14 06:47 [pubmed] PHST- 2024/03/14 04:21 [entrez] PHST- 2024/02/29 00:00 [pmc-release] AID - jgo-15-01-260 [pii] AID - 10.21037/jgo-24-4 [doi] PST - ppublish SO - J Gastrointest Oncol. 2024 Feb 29;15(1):260-270. doi: 10.21037/jgo-24-4. Epub 2024 Feb 28.