Mismatch Repair Status Correlates With Survival in Young Adults With Metastatic Colorectal Cancer

Dana M van der Heide; Kiran K Turaga; Carlos H F Chan; Scott K Sherman

doi:10.1016/j.jss.2021.03.040

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Mismatch Repair Status Correlates With Survival in Young Adults With Metastatic Colorectal Cancer

Journal article

Open access

Peer reviewed

Mismatch Repair Status Correlates With Survival in Young Adults With Metastatic Colorectal Cancer

Dana M van der Heide, Kiran K Turaga, Carlos H F Chan and Scott K Sherman

The Journal of surgical research, Vol.266, pp.104-112

05/11/2021

DOI: 10.1016/j.jss.2021.03.040

PMCID: PMC8338754

PMID: 33989889

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https://www.ncbi.nlm.nih.gov/pmc/articles/8338754View

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Abstract

Young adults with metastatic colorectal cancer (mCRC) may have higher rates of deficient mismatch repair (dMMR) than older patients. This study sought to assess patterns of MMR-testing and survival among young adult mCRC patients in the National Cancer Database (NCDB), hypothesizing that dMMR correlates with worse survival than in MMR-proficient (pMMR) patients. Stage-IV colorectal cancers were identified in NCDB (2010-2016). Demographic and clinical features were compared between younger (age ≤ 30) and older mCRC patients and tested for association with overall survival. Stage-IV disease without other recorded metastatic sites defined peritoneal metastasis (PM). Fisher-exact tests compared proportions and Cox models tested association with overall survival. Of 124,587 stage-IV colorectal cancers, 1,123 (0.9%) were in young patients. Young patients were more likely to have mucinous histology, high-grade, rectal primaries, and isolated peritoneal metastases (P < 0.001). Younger patients more often had MMR-testing (29.1 versus 16.6%), with dMMR found at similar rates in young and older patients (21.7 versus 17.1% of those tested, P= 0.4). Despite higher rates of adverse prognostic features, younger patients had better survival (median 20.7 versus 14.8 months, P < 0.001). In MMR-tested patients, dMMR correlated with higher mortality risk compared to pMMR (median 16.6 months versus 25.5 months, P = 0.01). On multivariable analysis, grade and MMR-status remained independently associated with survival. Median survival was worse with dMMR by 8.9 months compared to pMMR in young adults with mCRC. Despite higher rates of familial syndromes in young patients and recommendations for universal MMR-testing, over 70% of young mCRC patients had no MMR-status recorded.

Mismatch Repair

Genetic Testing

Colon Cancer

Survival

Outcomes

Peritoneal Metastases

Tumors

Details

Title: Subtitle: Mismatch Repair Status Correlates With Survival in Young Adults With Metastatic Colorectal Cancer
Creators: Dana M van der Heide - University of Iowa
Kiran K Turaga - University of Chicago
Carlos H F Chan - University of Iowa
Scott K Sherman - Roy J. and Lucille A. Carver College of Medicine
Resource Type: Journal article
Publication Details: The Journal of surgical research, Vol.266, pp.104-112
DOI: 10.1016/j.jss.2021.03.040
PMID: 33989889
PMCID: PMC8338754
NLM abbreviation: J Surg Res
ISSN: 0022-4804
eISSN: 1095-8673
Grant note: DOI: 10.13039/100000002, name: National Institutes of Health, award: T32#CA078586, T32#CA148062
Language: English
Date published: 05/11/2021
Academic Unit: Surgery; Radiation Oncology
Record Identifier: 9984312985002771

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