Incidence and Outcomes of Patients With Mismatch Repair Deficient Rectal Cancer Operated in 2016: A Nationwide Cohort From The Netherlands

IF 3.3 3区医学 Q2 ONCOLOGY

Clinical colorectal cancer Pub Date : 2024-12-10 DOI:10.1016/j.clcc.2024.12.003

Eline G.M. van Geffen , Cornelis R.C. Hogewoning , Sanne-Marije J.A. Hazen , Tania C. Sluckin , Marilyne M. Lange , Petur Snaebjornsson , Regina G.H. Beets-Tan , Corrie A.M. Marijnen , Cornelis Verhoef , Myriam Chalabi , Pieter J. Tanis , Miranda Kusters , Tjeerd S. Aukema , behalf of the Dutch Snapshot Research Group

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引用次数: 0

Abstract

Introduction

Data regarding the incidence and outcomes of mismatch repair deficient (dMMR) rectal cancer is limited. This study characterizes dMMR rectal cancer patients, comparing response after neoadjuvant radiotherapy and oncological outcomes to mismatch repair proficient (pMMR) rectal cancer patients.

Method

A retrospective cross-sectional cohort study was conducted in 67 Dutch centers. Data including patient and tumor characteristics, radiological and pathological reports and oncological follow-up outcomes were gathered from documentation in electronic patient files for patients who underwent a curative resection for primary rectal cancer in 2016. MMR-status was verified in pathology reports from immunohistochemistry or PCR microsatellite instability testing.

Results

MMR-status was determined in 1645 (54.9%) of 3001 stage I-IV rectal cancer patients, of which 46 (2.8%) were dMMR. Median follow up was 50 months (IQR 38-55). MMR-status was determined more often in younger patients. DMMR tumors were more locally advanced (cT4 23.9% vs. 8.8%, P = .010), and more distally located (mean distance to anorectal junction 3.6 cm vs. 5.3 cm, P = .004) than pMMR tumors. While radiological response after neoadjuvant (chemo)radiotherapy was similar, pathological complete response was significantly higher in dMMR compared to pMMR tumors (24.0% vs. 10.0%, P = .039). Four-year local recurrence, distant metastases, cancer-specific or overall survival rate between patients with dMMR or pMMR tumors were similar.

Conclusion

In this population-based cohort, 2.8% of rectal cancers in which MMR-status was determined were subtyped as dMMR. Surprisingly, dMMR was associated with higher pathological complete response rate to neoadjuvant (chemo) radiotherapy than pMMR. MMR-status did not impact oncological outcomes.

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2016年手术的错配修复缺陷直肠癌患者的发病率和结局：来自荷兰的全国队列

关于错配修复缺陷（dMMR）直肠癌的发病率和预后的数据有限。本研究描述了dMMR直肠癌患者的特征，比较了错配修复熟练（pMMR）直肠癌患者在新辅助放疗后的反应和肿瘤预后。方法：在荷兰67个中心进行回顾性横断面队列研究。数据包括患者和肿瘤特征、放射学和病理学报告以及肿瘤随访结果，收集自2016年接受根治性直肠癌切除术患者的电子患者档案文件。免疫组织化学或PCR微卫星不稳定性检测的病理报告证实了核磁共振状态。结果：3001例I-IV期直肠癌患者中有1645例（54.9%）检测到mmr状态，其中46例（2.8%）为dMMR。中位随访50个月（IQR 38-55）。mmr状态在年轻患者中更为常见。DMMR肿瘤比pMMR肿瘤更局部进展（cT4 23.9%比8.8%,P = 0.010），更远端定位（平均距离肛门直肠结3.6 cm比5.3 cm, P = 0.004）。虽然新辅助（化疗）放疗后的放射学反应相似，但dMMR肿瘤的病理完全缓解率明显高于pMMR肿瘤（24.0%比10.0%,P = 0.039）。dMMR或pMMR肿瘤患者的四年局部复发率、远处转移率、癌症特异性生存率或总生存率相似。结论：在这个以人群为基础的队列中，确定mmr状态的2.8%的直肠癌亚型为dMMR。令人惊讶的是，与pMMR相比，dMMR对新辅助（化疗）放疗的病理完全缓解率更高。mmr状态不影响肿瘤预后。

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来源期刊

Clinical colorectal cancer 医学-肿瘤学

CiteScore

5.50

自引率

2.90%

发文量

审稿时长

27 days

期刊介绍： Clinical Colorectal Cancer is a peer-reviewed, quarterly journal that publishes original articles describing various aspects of clinical and translational research of gastrointestinal cancers. Clinical Colorectal Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of colorectal, pancreatic, liver, and other gastrointestinal cancers. The main emphasis is on recent scientific developments in all areas related to gastrointestinal cancers. Specific areas of interest include clinical research and mechanistic approaches; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; and integration of various approaches.