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Giovanni Corso, MD; Corrado Pedrazzani, MD; Daniele Marrelli, MD; Valeria Pascale; Enrico Pinto, MD; Franco Roviello, MD

Arch Surg. 2009;144(8):722-727.

Hypothesis  Microsatellite instability (MSI) correlates with clinicopathologic characteristics and long-term prognosis in patients having gastric carcinoma.

Design  Analysis of prospectively collected data and biologic material.

Setting  Tertiary University Hospital, Policlinico "Le Scotte," Siena, Italy.

Patients  Two hundred fifty patients with gastric carcinoma.

Main Outcome Measures  Five mononucleotide repeats (BAT-26, BAT-25, NR-24, NR-21, and NR-27) were analyzed in these patients.

Results  An MSI phenotype was identified in 63 patients (25.2%) and correlated with specific clinicopathologic characteristics. Favorable prognosis was confirmed for patients with an MSI phenotype in univariate (P < .001) and multivariate (P = .05) analyses. Significant differences in clinicopathologic characteristics and long-term prognoses were observed among patients with microsatellite-stable tumors, tumors having instability at 2 to 4 markers, and tumors having instability at all 5 markers (MSI/5). The MSI/5 phenotype was associated with older age (P < .001), female sex (P = .001), antral tumor location (P = .04), intestinal histotype (P = .003), and less infiltration of the serosa (P = .006); lymph node involvement was rare (P < .001) and was limited to few (median, 3) metastatic lymph nodes (P = .001). Long-term survival of patients with the MSI/5 phenotype is favorable and was confirmed in multivariate analysis (relative risk vs patients with stable tumors, 0.32; 95% confidence interval, 0.16-0.63; P = .002).

Conclusions  Compared with stable tumors, MSI tumors have distinct clinicopathologic features and are associated with a better prognosis. Patients with the MSI/5 phenotype have a very good prognosis.

Author Affiliations: Sezione di Chirurgia Oncologica, Dipartimento di Patologia Umana e Oncologia, Policlinico "Le Scotte," University of Siena, and Istituto Toscano Tumori, Siena, Italy.

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Arch Surg. 2009;144(8):727.
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