Predictors of disease-free survival in colorectal cancer with microsatellite instability: An AGEO multicentre study
Mené sur 521 patients atteints d'un cancer colorectal de stade I à III avec instabilité microsatellitaire (âge moyen : 68,7 ans ; durée médiane de suivi : 32,8 mois), cet essai multicentrique identifie les facteurs prédictifs associés à la survie sans maladie
Background : A microsatellite instability (MSI) phenotype is found in about 12% of colorectal cancers (CRCs) and is associated with a low recurrence rate after curative surgery. Several studies have identified clinical and pathological factors predictive of recurrence in resected CRC, but not in the MSI subgroup.
Patients and methods : This multicentre retrospective study included patients with stage I, II or III MSI CRCs. Disease-free survival (DFS) was calculated with the Kaplan–Meier method. Factors associated with DFS were identified in univariate and multivariate Cox analyses.
Results : We studied 521 patients with MSI CRC. Respectively 11%, 51% and 38% of patients were at stage I, II and III. Mean age was 68.7 years and 36% of the patients received adjuvant chemotherapy. Median follow-up was 32.8 months. The disease recurrence rates were 6% and 21% in stage II and III patients, respectively. The 3-year DFS rate was 77%. In univariate analysis, age, bowel obstruction, lymph node invasion, stage T4, vascular emboli, lymphatic invasion and perinervous invasion were associated with poorer DFS (P < 0.05). Three relevant independent predictors of poor DFS were identified in multivariate analysis, namely bowel obstruction (HR = 2.46; 95%CI 1.31–4.62, P = 0.005), vascular emboli (HR = 2.79; 95%CI 1.74–4.47, P < 0.001) and stage T4 (HR = 2.16; 95%CI 1.31–3.56, P = 0.002).
Conclusions : Bowel obstruction, vascular emboli and stage T4 are independently associated with MSI CRC recurrence, suggesting that screening for vascular emboli in routine clinical practice may assist with adjuvant chemotherapy decision-making.
European Journal of Cancer , résumé, 2014