Microsatellite instability in colorectal cancer: frequency, clinical and morphological features, role in the choice of treatment
Keywords:colorectal cancer, microsatellite instability, immunotherapy
Background. The purpose was to evaluate the frequency, clinical and morphological features of microsatellite instability (MSI) in colorectal cancer (CRC) in the Ukrainian population. Materials and methods. The study included 351 patients with CRC. Two methods were used to diagnose MSI: 1) detection of the instability in the microsatellite loci using polymerase chain reaction; 2) immunohistochemically, by detecting the deficiency of the mismatch repair system proteins (MLH1, MSH2, MSH6, PMS2; Dako). In addition, some patients were tested for KRAS, NRAS and BRAF mutations by realtime polymerase chain reaction. Results. It was shown that the frequency of MSI among Ukrainian patients with CRC was 14.2 %. The frequency of MSIH status was significantly higher in men (25.35 %) than in women (10 %) (P = 0.04). The MSIH status was associated with younger age (P = 0.002) in men. In addition, MSIH CRC was more often associated with special histological types of CRC, inflammatory infiltration and higher rate of BRAF mutation (P = 0.03). Although almost half of the MSIH CRC showed high grade, distant metastases rate was significantly lower comparing with MSI (17.4 vs. 52.9 %, P = 0.001) regardless of gender. Conclusions. Screening of patients with CRC on MSI will allow the identification of additional candidates for immunotherapy in order to improve treatment efficacy and outcomes.
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