Immunohistochemistry testing for mismatch repair deficiency in Stage 2 colon cancer

A cohort study of two cancer centres

Matthew Grant, Andrew Haydon, Lewis Au, Simon Wilkins, Karen Oliva, Eva Segelov, Yoland Antill, Peter Carne, Pravin Ranchod, Adrian Polglase, Chip Farmer, Martin Chin, Roger Wale, Paul Simpson, Stephen Bell, Stewart Skinner, Paul McMurrick, Jeremy Shapiro

Research output: Contribution to journalArticleResearchpeer-review

2 Citations (Scopus)

Abstract

Background/Objectives: Adjuvant chemotherapy for Stage II colon cancer offers a small (2-3%) overall survival benefit and is not universally recommended. Mismatch repair deficiency (dMMR) confers an improved prognosis identifying patients unlikely to benefit from adjuvant chemotherapy. The aim of this study was to investigate the use of dMMR immunohistochemistry in two major cancer treatment centres. Methods: Prospective data were collected on all patients with resected Stage II colon cancer between 2010 and 2015 across two large Australian hospitals. Data collected included patient demographics, tumour histology, dMMR immunohistochemistry, chemotherapy use, and outcomes. Results: All 355 patients (56.1% female, median age 81) with resected Stage 2 Colon cancer entered on to the surgical database were included in this analysis. MMR testing was performed on 167 patient samples (47%), most occurred post-2013 (73.1% vs. 26.9% patients). dMMR rates were 34.1%. 25 (7.3%) received adjuvant chemotherapy, with no patient >80 years receiving treatment. Presence of ≥2 high-risk feature increased the likelihood of adjuvant chemotherapy. Only 3.6% dMMR patients received chemotherapy; both were young with high-risk features. 27/288 (7.6%) patients (with follow up) relapsed, with 7 disease-free post-resection of metastatic disease, 9 are alive with metastatic disease, and 11 deceased. Conclusions: Unlike clinical trial populations, Stage 2 colon cancer patients are often elderly, have high rates of dMMR tumours, are rarely offered chemotherapy, yet still have excellent outcomes. dMMR immunohistochemistry is being increasingly used to identify Stage 2 patients who do not require chemotherapy.

Original languageEnglish
Pages (from-to)71-75
Number of pages5
JournalInternational Journal of Surgery
Volume51
DOIs
Publication statusPublished - 1 Mar 2018

Keywords

  • Chemotherapy
  • Colorectal cancer
  • Immunohistochemistry
  • Mismatch repair deficiency

Cite this

@article{78268c94ef884357a7932cedef645285,
title = "Immunohistochemistry testing for mismatch repair deficiency in Stage 2 colon cancer: A cohort study of two cancer centres",
abstract = "Background/Objectives: Adjuvant chemotherapy for Stage II colon cancer offers a small (2-3{\%}) overall survival benefit and is not universally recommended. Mismatch repair deficiency (dMMR) confers an improved prognosis identifying patients unlikely to benefit from adjuvant chemotherapy. The aim of this study was to investigate the use of dMMR immunohistochemistry in two major cancer treatment centres. Methods: Prospective data were collected on all patients with resected Stage II colon cancer between 2010 and 2015 across two large Australian hospitals. Data collected included patient demographics, tumour histology, dMMR immunohistochemistry, chemotherapy use, and outcomes. Results: All 355 patients (56.1{\%} female, median age 81) with resected Stage 2 Colon cancer entered on to the surgical database were included in this analysis. MMR testing was performed on 167 patient samples (47{\%}), most occurred post-2013 (73.1{\%} vs. 26.9{\%} patients). dMMR rates were 34.1{\%}. 25 (7.3{\%}) received adjuvant chemotherapy, with no patient >80 years receiving treatment. Presence of ≥2 high-risk feature increased the likelihood of adjuvant chemotherapy. Only 3.6{\%} dMMR patients received chemotherapy; both were young with high-risk features. 27/288 (7.6{\%}) patients (with follow up) relapsed, with 7 disease-free post-resection of metastatic disease, 9 are alive with metastatic disease, and 11 deceased. Conclusions: Unlike clinical trial populations, Stage 2 colon cancer patients are often elderly, have high rates of dMMR tumours, are rarely offered chemotherapy, yet still have excellent outcomes. dMMR immunohistochemistry is being increasingly used to identify Stage 2 patients who do not require chemotherapy.",
keywords = "Chemotherapy, Colorectal cancer, Immunohistochemistry, Mismatch repair deficiency",
author = "Matthew Grant and Andrew Haydon and Lewis Au and Simon Wilkins and Karen Oliva and Eva Segelov and Yoland Antill and Peter Carne and Pravin Ranchod and Adrian Polglase and Chip Farmer and Martin Chin and Roger Wale and Paul Simpson and Stephen Bell and Stewart Skinner and Paul McMurrick and Jeremy Shapiro",
year = "2018",
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language = "English",
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pages = "71--75",
journal = "International Journal of Surgery",
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Immunohistochemistry testing for mismatch repair deficiency in Stage 2 colon cancer : A cohort study of two cancer centres. / Grant, Matthew; Haydon, Andrew; Au, Lewis; Wilkins, Simon; Oliva, Karen; Segelov, Eva; Antill, Yoland; Carne, Peter; Ranchod, Pravin; Polglase, Adrian; Farmer, Chip; Chin, Martin; Wale, Roger; Simpson, Paul; Bell, Stephen; Skinner, Stewart; McMurrick, Paul; Shapiro, Jeremy.

In: International Journal of Surgery, Vol. 51, 01.03.2018, p. 71-75.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Immunohistochemistry testing for mismatch repair deficiency in Stage 2 colon cancer

T2 - A cohort study of two cancer centres

AU - Grant, Matthew

AU - Haydon, Andrew

AU - Au, Lewis

AU - Wilkins, Simon

AU - Oliva, Karen

AU - Segelov, Eva

AU - Antill, Yoland

AU - Carne, Peter

AU - Ranchod, Pravin

AU - Polglase, Adrian

AU - Farmer, Chip

AU - Chin, Martin

AU - Wale, Roger

AU - Simpson, Paul

AU - Bell, Stephen

AU - Skinner, Stewart

AU - McMurrick, Paul

AU - Shapiro, Jeremy

PY - 2018/3/1

Y1 - 2018/3/1

N2 - Background/Objectives: Adjuvant chemotherapy for Stage II colon cancer offers a small (2-3%) overall survival benefit and is not universally recommended. Mismatch repair deficiency (dMMR) confers an improved prognosis identifying patients unlikely to benefit from adjuvant chemotherapy. The aim of this study was to investigate the use of dMMR immunohistochemistry in two major cancer treatment centres. Methods: Prospective data were collected on all patients with resected Stage II colon cancer between 2010 and 2015 across two large Australian hospitals. Data collected included patient demographics, tumour histology, dMMR immunohistochemistry, chemotherapy use, and outcomes. Results: All 355 patients (56.1% female, median age 81) with resected Stage 2 Colon cancer entered on to the surgical database were included in this analysis. MMR testing was performed on 167 patient samples (47%), most occurred post-2013 (73.1% vs. 26.9% patients). dMMR rates were 34.1%. 25 (7.3%) received adjuvant chemotherapy, with no patient >80 years receiving treatment. Presence of ≥2 high-risk feature increased the likelihood of adjuvant chemotherapy. Only 3.6% dMMR patients received chemotherapy; both were young with high-risk features. 27/288 (7.6%) patients (with follow up) relapsed, with 7 disease-free post-resection of metastatic disease, 9 are alive with metastatic disease, and 11 deceased. Conclusions: Unlike clinical trial populations, Stage 2 colon cancer patients are often elderly, have high rates of dMMR tumours, are rarely offered chemotherapy, yet still have excellent outcomes. dMMR immunohistochemistry is being increasingly used to identify Stage 2 patients who do not require chemotherapy.

AB - Background/Objectives: Adjuvant chemotherapy for Stage II colon cancer offers a small (2-3%) overall survival benefit and is not universally recommended. Mismatch repair deficiency (dMMR) confers an improved prognosis identifying patients unlikely to benefit from adjuvant chemotherapy. The aim of this study was to investigate the use of dMMR immunohistochemistry in two major cancer treatment centres. Methods: Prospective data were collected on all patients with resected Stage II colon cancer between 2010 and 2015 across two large Australian hospitals. Data collected included patient demographics, tumour histology, dMMR immunohistochemistry, chemotherapy use, and outcomes. Results: All 355 patients (56.1% female, median age 81) with resected Stage 2 Colon cancer entered on to the surgical database were included in this analysis. MMR testing was performed on 167 patient samples (47%), most occurred post-2013 (73.1% vs. 26.9% patients). dMMR rates were 34.1%. 25 (7.3%) received adjuvant chemotherapy, with no patient >80 years receiving treatment. Presence of ≥2 high-risk feature increased the likelihood of adjuvant chemotherapy. Only 3.6% dMMR patients received chemotherapy; both were young with high-risk features. 27/288 (7.6%) patients (with follow up) relapsed, with 7 disease-free post-resection of metastatic disease, 9 are alive with metastatic disease, and 11 deceased. Conclusions: Unlike clinical trial populations, Stage 2 colon cancer patients are often elderly, have high rates of dMMR tumours, are rarely offered chemotherapy, yet still have excellent outcomes. dMMR immunohistochemistry is being increasingly used to identify Stage 2 patients who do not require chemotherapy.

KW - Chemotherapy

KW - Colorectal cancer

KW - Immunohistochemistry

KW - Mismatch repair deficiency

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JF - International Journal of Surgery

SN - 1743-9191

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