Comparison of Clinical and Histopathological Parameters amongst Microsatellite Unstable and Microsatellite Stable Cases of Colorectal Carcinomas in an Indian Setting
Published: September 1, 2021 | DOI: https://doi.org/10.7860/JCDR/2021/49545.15378
Divya Shelly, KV Vinu Balraam, Reena Bharadwaj, C Bharani
1. Associate Professor, Department of Pathology, INHS Asvini, Colaba, Mumbai, Maharashtra, India.
2. Graded Specialist, Department of Pathology, Military Hospital, Roorkee, Uttarakhand, India.
3. Consultant, Department of Pathology, Apollo Hospitals, New Delhi, India.
4. Senior Resident, Department of Pathology, Seth GS Medical College, Mumbai, Maharashtra, India
Correspondence
Dr. KV Vinu Balraam,
Graded Specialist, Department of Pathology, Military Hospital Roorkee, Roorkee
Cantonment, Haridwar District-247667, Uttarakhand, India.
E-mail: vbalraam@gmail.com
Introduction: In this era of prognosis based medicine, it is important to identify microsatellite unstable Colorectal Cancers (CRCs) as they offer good prospects to the patient and they respond poorly to 5-fluorouracil and platinum based chemotherapeutic regime.
Aim: To find out the prevalence of Microsatellite Instability-High (MSI-H) in CRC, to identify clinicopathological features associated with Microsatellite Instability (MSI) and assess the value of surgical pathology in predicting MSI-H.
Materials and Methods: The present study was a case-control study conducted in a tertiary care centre of Pune in Western India from January 2013 to December 2020. Thirty-five CRCs deficient in Mismatch Repair (MMR) proteins contrasted with 206 Microsatellite Stable (MSS) CRCs were studied and analysed for a given set of clinical and histopathological parameters to find out any correlation between the occurrence of microsatellite unstable tumours and these variables were presented as percentages.
Results: In the present study, the prevalence rate of MSI-H was found to be 14.5% and the statistical analysis was carried out using the software Statistical Package for the Social Sciences (SPSS) version 27.0. Univariate analysis revealed that right-sided/proximal location of tumours, age at diagnosis less than 50 years, no lymph node deposits (N0 disease), presence of Tumour Infiltrating Lymphocytes (TILs), peri-tumoural reaction, mucinous component, increased stromal plasma cells, histological heterogeneity, signet ring/medullary component and Crohn-like reaction were all statistically significant predictors of microsatellite instability (p-value <0.05). Multivariate analysis of these significant parameters revealed right-sided location of tumours, age at diagnosis less than 50 years, N0 disease, and presence of TILs, increased stromal plasma cells, histological heterogeneity and Crohn-like reaction to be independent predictors.
Conclusion: Clinical parameters and histological evaluation is handy in screening for the MSI-H colorectal carcinomas. This would go a long way in selecting the patients who will require confirmatory molecular testing and thus precluding the need of Immunohistochemistry (IHC), which will be helpful in day-to-day practice as it is uncomplicated, cost-effective and easy to replicate.
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