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首页> 外文期刊>Annals of Surgery >Microsatellite Instability (MSI) as an Independent Predictor of Pathologic Complete Response (PCR) in Locally Advanced Rectal Cancer A National Cancer Database (NCDB) Analysis
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Microsatellite Instability (MSI) as an Independent Predictor of Pathologic Complete Response (PCR) in Locally Advanced Rectal Cancer A National Cancer Database (NCDB) Analysis

机译：微卫星不稳定性（MSI）作为局部晚期直肠癌病理完全反应（PCR）的独立预测因子国家癌症数据库（NCDB）分析

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Objective: The relationship between microsatellite instability (MSI) and response to neoadjuvant chemoradiation in rectal cancer is not well understood. Background: We utilized the National Cancer Database (NCDB) to investigate the association between MSI and pathologic complete response (pCR) in this patient population. Methods: We analyzed 5086 patients between 2010 and 2015 with locally advanced rectal cancer who were tested for MSI and treated definitively with chemoradiation followed by surgery. Primary comparison groups were between 4450 MSI-negative(-) and 636 MSI-positive(+) patients. Multivariable regression analysis was conducted to identify demographic, therapeutic, and clinical characteristics predictive of pCR. Cox proportional-hazard ratios were used for survival. Results: All patients were treated with definitive chemoradiation (median dose 50.4 Gy) followed by resection within 4 months. MSI(+) patients were associated with earlier year of diagnosis and higher-grade tumors (P< 0.05). The overall pCR rate was 8.6%, including 8.9% for MSI(-) and 5.9% for MSI(+) tumors (P= 0.01). Along with lower T stage, MSI(+) cases were significantly associated with a reduced pCR rate (odds ratio 0.65, 95% confidence interval 0.43-0.96) with multivariable analysis. The 5-year survival for patients with pCR was 93% compared with 73% without it (<0.001). Conclusion: Microsatellite instability was independently associated with a reduction in pCR for locally advanced rectal cancer after neoadjuvant chemoradiation in this NCDB-based analysis.
机译：目的：微卫星不稳定性（MSI）与直肠癌中新辅助化学地区的关系尚不清楚。背景：我们利用国家癌症数据库（NCDB）来研究该患者人口中MSI和病理完全反应（PCR）之间的关联。方法：在2010年至2015年间分析了5086例患者，患有局部晚期直肠癌，患者进行MSI，并明确地治疗较疗化，随后进行手术。主要比较组在4450 mSi阴性（ - ）和636个MSI阳性（+）患者之间。进行多变量回归分析以鉴定PCR预测性的人口统计学，治疗和临床特征。 Cox比例危险比率用于存活。结果：所有患者均采用明确的校长（中位数剂量50.4 GY）处理，然后在4个月内切除。 MSI（+）患者与早期的诊断和较高级肿瘤有关（P <0.05）。整体PCR速率为8.6％，其中MSI（ - ）的8.9％和MSI（+）肿瘤的5.9％（P = 0.01）。随着较低的T阶段，MSI（+）病例与多变量分析具有降低的PCR速率（差异为0.65,95％置信区间0.43-0.96）。患有PCR患者的5年生存率为93％，而没有其73％（<0.001）。结论：在基于NCDB的分析中NEO​​CAUVANT校长后，微卫星不稳定性与局部晚期直肠癌的PCR减少相关。

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