Colorectal Cancer
Copyright ©The Author(s) 2005. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 14, 2005; 11(26): 3998-4002
Published online Jul 14, 2005. doi: 10.3748/wjg.v11.i26.3998
Microsatellite instable double primary cancers of the colorectum and stomach exhibit less favorable outcome
Young Ho Kim, Sang Yong Song, Young Dae Kwon, Dae Shick Kim, Ho Kyung Chun, Jong Chul Rhee
Young Ho Kim, Jong Chul Rhee, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Republic of Korea
Sang Yong Song, Dae Shick Kim, Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Republic of Korea
Young Dae Kwon, Department of Preventive Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Republic of Korea
Ho Kyung Chun, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Republic of Korea
Author contributions: All authors contributed equally to the work.
Correspondence to: Dr. Sang Yong Song, Department of Pathology, Samsung Medical Center, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Republic of Korea. yodasong@smc.samsung.co.kr
Telephone: +82-2-3410-2800 Fax: +82-2-3410-0025
Received: August 26, 2004
Revised: October 2, 2004
Accepted: October 7, 2004
Published online: July 14, 2005
Abstract

AIM: To ascertain the adequacy of the microsatellite instability (MSI) as a prognostic indicator by assessing MSI status of patients with double primary gastric and colorectal cancer (DPGCC).

METHODS: Sixteen patients were studied, all of whom exhibited sporadic DPGCC, and had no family history of hereditary non-polyposis colorectal cancer, according to the Amsterdam criteria. A total of 32 cancers from 16 DPGCC patients, and 216 single primary CRC, were assessed for MSI in 5 microsatellite loci, BAT25, BAT26, D2S123, D5S346, and D17S250.

RESULTS: MSI was observed in 6 (37.5%) of 16 GC and 4 (25.0%) of 16 CRC. Thirty tumors (13.9%) out of 216 single primary CRC and one tumor (16.7%) out of 6 double primary CRC were found to be microsatellite unstable. Of the 6 GC with MSI in DPGCC, 5 (31.3%) were MSI-high and one (6.3%) was MSI-low. In 5 of 16 DPGCC patients, the cancer recurred in or adjacent to the anastomosis or metastasized to the kidney or lung. The MSI-high DPGCC cases were associated with a younger age of onset (47.5 years vs 62.5 years), higher frequency of lymph node metastasis (100% vs 25%), and advanced Dukes stage (C, 100% vs 41.7%), as well as a higher frequency of recurrence or metastasis (100% vs 8.3%). Only recurrence or metastasis showed statistical significance by Fisher’s exact test.

CONCLUSION: Our data suggest that MSI may play an important role in the development of DPGCC, and that it may be used clinically as a molecular predictive marker for recurrence or late metastasis of DPGCC.

Keywords: Stomach neoplasms; Colorectal neoplasms; Microsatellite instability; Double primary