Isolated tumor cell clusters (ITC) in lymph nodes and PD-L1 expression on tumor-associated immune cells are prognostic factors for microsatellite instable-high gastric cancers

IF 5 2区医学 Q2 Medicine

Translational Oncology Pub Date : 2025-07-01 DOI:10.1016/j.tranon.2025.102465

Menghan Cui , Yangli Zhou , Yin Han , Nannan Chen , Min Zhao , Yan Wang , Fengxia He

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引用次数: 0

Abstract

Background

Microsatellite instable-high (MSI-H) gastric cancer (GC) represents a distinct subgroup. However, controversy exists regarding the role of MSI in GCs, and the factors leading to internal prognostic differences among MSI-H GCs are rarely studied.

Methods

We identified 53 MSI-H cases from 941 consecutive GCs and conducted a detailed investigation of the clinical significance, clinicopathological correlations, and prognostic indicators of MSI-H GCs.

Results

Compared to MSI-low (MSI-L)/microsatellite stable (MSS) GCs, the MSI-H cohort was characterized by older age, female predominance, antral location, fewer lymph node (LN) metastases (H&E), and earlier tumor stage, but was also associated with larger tumor size, poor differentiation, and a high incidence of isolated tumor cell clusters (ITC) in negative LNs. ITC was then found to be correlated with tumor volume, Lauren subtype, pT stage, LN status (H&E), and lymphovascular invasion, with tumor size identified as an independent risk factor. Regarding prognosis, MSI-H GCs did not show longer survival time compared to MSI-L/MSS cases overall and in Stage Ⅲ-Ⅳ, but exhibited shorter survival time in Stage Ⅰ-Ⅱ. Moreover, in addition to age, pN stage, and distant metastasis, ITC and PD-L1 expression influenced survival in MSI-H GCs. ITC was confirmed as an independent unfavorable prognostic factor, while PD-L1 expression on interstitial immune cells independently predicted a favorable outcome.

Conclusions

Our results suggest that MSI-H GC represents a peculiar clinicopathological entity with frequent occurrence of ITC in negative LNs. ITC and PD-L1 are crucial prognostic indicators for MSI-H patients.

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淋巴结内分离的肿瘤细胞簇（ITC）和肿瘤相关免疫细胞上PD-L1的表达是微卫星不稳定高胃癌的预后因素

微卫星不稳定高（MSI-H）胃癌是一个独特的亚群。然而，关于MSI在GCs中的作用存在争议，导致MSI- h GCs内部预后差异的因素很少被研究。方法从941例连续GCs中筛选出53例MSI-H病例，对MSI-H GCs的临床意义、临床病理相关性及预后指标进行详细分析。结果与msi -低(MSI-L)/微卫星稳定（MSS） GCs相比，MSI-H队列具有年龄较大、女性居多、中心位置、淋巴结（LN）转移（H&；E）较少、肿瘤分期较早的特点，但也与阴性LNs中肿瘤大小较大、分化差、分离肿瘤细胞簇（ITC）发生率高相关。然后发现ITC与肿瘤体积、Lauren亚型、pT分期、LN状态（H&；E）和淋巴血管侵犯相关，肿瘤大小被确定为独立的危险因素。在预后方面，与MSI-L/MSS病例相比，MSI-H GCs在总体和Ⅲ-Ⅳ期的生存时间并不更长，但在Ⅰ-Ⅱ期的生存时间较短。此外，除了年龄、pN分期和远处转移外，ITC和PD-L1的表达也影响MSI-H GCs的生存。ITC被证实是一个独立的不利预后因素，而间质免疫细胞上PD-L1的表达独立地预测了有利的预后。结论MSI-H GC是一种特殊的临床病理实体，在阴性LNs中经常发生ITC。ITC和PD-L1是MSI-H患者的重要预后指标。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Translational Oncology ONCOLOGY-

CiteScore

8.40

自引率

2.00%

发文量

314

审稿时长

54 days

期刊介绍： Translational Oncology publishes the results of novel research investigations which bridge the laboratory and clinical settings including risk assessment, cellular and molecular characterization, prevention, detection, diagnosis and treatment of human cancers with the overall goal of improving the clinical care of oncology patients. Translational Oncology will publish laboratory studies of novel therapeutic interventions as well as clinical trials which evaluate new treatment paradigms for cancer. Peer reviewed manuscript types include Original Reports, Reviews and Editorials.