Microsatellite instability is highly prevalent in older patients with colorectal cancer
BackgroundClinical guidelines suggest screening of colorectal cancer (CRC) for microsatellite instability (MSI). However, microsatellite instability—high (MSI-H) CRC is not rare in older patients. This study aimed to investigate the prevalence of MSI-H CRC in an unselected population in an age-based...
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| Format: | Article |
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Frontiers Media S.A.
2024-03-01
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| Series: | Frontiers in Surgery |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fsurg.2024.1288061/full |
| _version_ | 1827307924179910656 |
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| author | Daniel Jakob Valerie Orth Daniel Gödde Hubert Zirngibl Peter C. Ambe Peter C. Ambe |
| author_facet | Daniel Jakob Valerie Orth Daniel Gödde Hubert Zirngibl Peter C. Ambe Peter C. Ambe |
| author_sort | Daniel Jakob |
| collection | DOAJ |
| description | BackgroundClinical guidelines suggest screening of colorectal cancer (CRC) for microsatellite instability (MSI). However, microsatellite instability—high (MSI-H) CRC is not rare in older patients. This study aimed to investigate the prevalence of MSI-H CRC in an unselected population in an age-based manner.Material and methodsA retrospective analysis of data from patients undergoing radical surgery for CRC was performed. Only cases with results from MSI testing using immunochemistry (IHC) were analyzed. Age-based analyses were performed using two cut-off ages: 50 years. as stated in Amsterdam II guidelines, and 60 years. as outlined in the revised Bethesda criteria.ResultsThe study population included 343 (146 female and 197 male) patients with a median age of 70 years (range 21–90 years). The prevalence of MSI-H tumors in the entire cohort was 18.7%. The prevalence of MSI-H CRC was 22.5% in the group ≤50 years vs. 18.2% in the group >50 years using the age limit in the Amsterdam II guidelines. MSI-H CRC was present in 12.6% of the group aged ≤60 years compared to 20.6% in the control group >60 years.ConclusionMSI screening of CRC based on age alone is associated with negative selection of a relevant number of cases. MSI-H CRC is also common in elderly patients, who may be negatively selected secondary to an age-based screening algorithm. Following the results of this study, screening based on clinical criteria should be omitted in favor of systematic screening as is already internationally practiced. |
| first_indexed | 2024-04-24T18:48:35Z |
| format | Article |
| id | doaj.art-7a549dbbb9d649f89d8e5295af41da81 |
| institution | Directory Open Access Journal |
| issn | 2296-875X |
| language | English |
| last_indexed | 2024-04-24T18:48:35Z |
| publishDate | 2024-03-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Surgery |
| spelling | doaj.art-7a549dbbb9d649f89d8e5295af41da812024-03-27T04:38:01ZengFrontiers Media S.A.Frontiers in Surgery2296-875X2024-03-011110.3389/fsurg.2024.12880611288061Microsatellite instability is highly prevalent in older patients with colorectal cancerDaniel Jakob0Valerie Orth1Daniel Gödde2Hubert Zirngibl3Peter C. Ambe4Peter C. Ambe5Faculty of Medicine, Witten/Herdecke University, Witten, GermanyChair of Surgery II, Witten/Herdecke University, Witten, GermanyDepartment of Pathology and Molecular Pathology, Witten/Herdecke University, Witten, GermanyChair of Surgery II, Witten/Herdecke University, Witten, GermanyChair of Surgery II, Witten/Herdecke University, Witten, GermanyDepartment of General Surgery, Visceral surgery and Coloproctology, GFO Kliniken Rhein Berg, Vinzenz-Pallotti-Hospital Bensberg, Bergisch Gladbach, GermanyBackgroundClinical guidelines suggest screening of colorectal cancer (CRC) for microsatellite instability (MSI). However, microsatellite instability—high (MSI-H) CRC is not rare in older patients. This study aimed to investigate the prevalence of MSI-H CRC in an unselected population in an age-based manner.Material and methodsA retrospective analysis of data from patients undergoing radical surgery for CRC was performed. Only cases with results from MSI testing using immunochemistry (IHC) were analyzed. Age-based analyses were performed using two cut-off ages: 50 years. as stated in Amsterdam II guidelines, and 60 years. as outlined in the revised Bethesda criteria.ResultsThe study population included 343 (146 female and 197 male) patients with a median age of 70 years (range 21–90 years). The prevalence of MSI-H tumors in the entire cohort was 18.7%. The prevalence of MSI-H CRC was 22.5% in the group ≤50 years vs. 18.2% in the group >50 years using the age limit in the Amsterdam II guidelines. MSI-H CRC was present in 12.6% of the group aged ≤60 years compared to 20.6% in the control group >60 years.ConclusionMSI screening of CRC based on age alone is associated with negative selection of a relevant number of cases. MSI-H CRC is also common in elderly patients, who may be negatively selected secondary to an age-based screening algorithm. Following the results of this study, screening based on clinical criteria should be omitted in favor of systematic screening as is already internationally practiced.https://www.frontiersin.org/articles/10.3389/fsurg.2024.1288061/fullearly onset colorectal cancercolorectal cancermicrosatellite instability (MSI)mismatch repairimmunohistochemistry |
| spellingShingle | Daniel Jakob Valerie Orth Daniel Gödde Hubert Zirngibl Peter C. Ambe Peter C. Ambe Microsatellite instability is highly prevalent in older patients with colorectal cancer Frontiers in Surgery early onset colorectal cancer colorectal cancer microsatellite instability (MSI) mismatch repair immunohistochemistry |
| title | Microsatellite instability is highly prevalent in older patients with colorectal cancer |
| title_full | Microsatellite instability is highly prevalent in older patients with colorectal cancer |
| title_fullStr | Microsatellite instability is highly prevalent in older patients with colorectal cancer |
| title_full_unstemmed | Microsatellite instability is highly prevalent in older patients with colorectal cancer |
| title_short | Microsatellite instability is highly prevalent in older patients with colorectal cancer |
| title_sort | microsatellite instability is highly prevalent in older patients with colorectal cancer |
| topic | early onset colorectal cancer colorectal cancer microsatellite instability (MSI) mismatch repair immunohistochemistry |
| url | https://www.frontiersin.org/articles/10.3389/fsurg.2024.1288061/full |
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