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Journal of Environmental Pathology, Toxicology and Oncology
IF: 1.241 5-Year IF: 1.349 SJR: 0.356 SNIP: 0.613 CiteScore™: 1.61

ISSN Print: 0731-8898
ISSN Online: 2162-6537

Journal of Environmental Pathology, Toxicology and Oncology

DOI: 10.1615/JEnvironPatholToxicolOncol.2018026876
pages 21-28

Predicting the Efficacy of 5-Fluorouracil–Based Adjuvant Chemotherapy in Gastric Cancer by Microsatellite Instability: A Meta-Analysis

Fuxing Zhao
Department of Affiliated Hospital of Qinghai University, Affiliated Cancer Hospital of Qinghai University, Xining, China
Xinyue Yuan
Department of Affiliated Hospital of Qinghai University, Affiliated Cancer Hospital of Qinghai University, Xining, China
Dengfeng Ren
Department of Affiliated Hospital of Qinghai University, Affiliated Cancer Hospital of Qinghai University, Xining, China
Guoshuang Shen
Department of Affiliated Hospital of Qinghai University, Affiliated Cancer Hospital of Qinghai University, Xining, China
Ziyi Wang
Department of Affiliated Hospital of Qinghai University, Affiliated Cancer Hospital of Qinghai University, Xining, China
Fangchao Zheng
Department of Medical Oncology, Affiliated Hospital of Qinghai University, Affiliated Cancer Hospital of Qinghai University, Xining, 810000, China; Department of Medical Oncology, Shouguang Hospital of Traditional Chinese Medicine, Weifang, 261000, China
Raees Ahmad
Department of Affiliated Hospital of Qinghai University, Affiliated Cancer Hospital of Qinghai University, Xining, China
Zhijun Ma
Department of Affiliated Hospital of Qinghai University, Affiliated Cancer Hospital of Qinghai University, Xining, China
Jiuda Zhao
Department of Affiliated Hospital of Qinghai University, Affiliated Cancer Hospital of Qinghai University, Xining, China

ABSTRACT

Microsatellite instability (MSI) implies the deletion of mismatch repair genes caused by DNA methylation or gene mutation. MSI is a good predictor for efficacy of 5-fluorouracil (FU)–based chemotherapy in the treatment of colorectal cancer. Some gastric cancer studies have reported that MSI has no apparent impact on prognosis after patients receive 5-FU–based adjuvant chemotherapy. However, other studies suggest that high-frequency MSI (MSI-H) status reduced survival in patients receiving 5-FU–based adjuvant chemotherapy. Thus, the correlation between MSI status and efficacy of 5-FU–based adjuvant chemotherapy for gastric cancer remains controversial. We performed a PubMed, Embase, and Cochrane search to retrieve studies that explore the correlation between MSI status and 5-FU–based adjuvant chemotherapy efficacy in gastric cancer. After extracting 65 potentially eligible studies, four were ultimately included in this meta-analysis using Stata software (ver. 12.0). For each study, we estimated the hazard ratio (HR) value for overall survival (OS), and HR was extracted per the survival curve in the studies. Heterogeneity was estimated using the random-effects model. Overall, 1174 patients after operation were included: 84 patients were classed as MSI-H and 1090 as microsatellite stable (MSS)/low-frequency MSI (MSI-L). For the four studies, the overall estimate of HR for OS between MSI-H and MSS/MSI-L groups was 1.90 (95% confidence interval: 0.91–3.93; p = 0.08). We found no correlation to exist between MSI status and efficacy of 5-FU–based adjuvant chemotherapy for gastric cancer. Although MSI can effectively predict efficacy of 5-FU–based chemotherapy in patients with colorectal cancer, the correlation between MSI status and efficacy of 5-FU–based adjuvant chemotherapy for gastric cancer remains controversial. This meta-analysis suggests that MSI status is unrelated to efficacy of 5-FU–based adjuvant chemotherapy in gastric cancer, and more prospective clinical studies are needed to further investigate predictive value of MSI status in patients with gastric cancer who, after operation, receive 5-FU–based adjuvant chemotherapy.


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