Clinicopathologic Factors Associated with Mismatch Repair Status Among Filipino Patients with Young-Onset Colorectal Cancer

Dennis Lee Sacdalan; Reynaldo L Garcia; Michele H Diwa; Danielle Benedict Sacdalan

doi:10.2147/CMAR.S286618

Clinicopathologic Factors Associated with Mismatch Repair Status Among Filipino Patients with Young-Onset Colorectal Cancer

Cancer Manag Res. 2021 Mar 1:13:2105-2115. doi: 10.2147/CMAR.S286618. eCollection 2021.

Authors

Dennis Lee Sacdalan^{1

2

3}, Reynaldo L Garcia², Michele H Diwa⁴, Danielle Benedict Sacdalan^{1

5}

Affiliations

¹ Division of Medical Oncology, Department of Medicine, University of the Philippines, Manila, Philippines.
² National Institute of Molecular Biology and Biotechnology, University of the Philippines, Diliman, Quezon City, Philippines.
³ Augusto P. Sarmiento Cancer Institute, The Medical City, Pasig City, Philippines.
⁴ Department of Pathology, University of the Philippines, Manila, Philippines.
⁵ Department of Pharmacology and Toxicology, University of the Philippines, Manila, Philippines.

Abstract

Introduction: Young-onset colorectal cancer is recognized as a distinct disease that may be sporadic or hereditary in nature. Microsatellite instability testing is recommended as a routine procedure in evaluating colorectal cancer specimens, especially in young-onset disease, because of implications in management. Immunohistochemistry of mismatch repair proteins serves as an inexpensive alternative to microsatellite instability testing with the added advantage of monitoring protein expression levels that may suggest underlying genetic or epigenetic alterations. This descriptive study aimed to determine the frequencies of proficient and deficient mismatch repair status among Filipino young-onset colorectal cancer patients, and to investigate their clinicopathologic profile.

Methods: Tumor tissues were prospectively collected from patients from two tertiary hospitals in the Philippines. Patients of age ≤45 years with resected adenocarcinoma of the colon or rectum were recruited.

Results: Seventy-seven out of 124 patients had tumor samples sent for immunohistochemistry. Of these, 61 samples (79%) were found to have proficient status while 16 samples (21%) had deficient status. Mismatch repair protein deficiencies, when present, more commonly involved MSH2 and MSH6 (9%) rather than MLH1 and PMS2 (5%). The deficient group had a mean age of 37.1 years and a female preponderance (56.25%), presenting as locally advanced ascending or descending colon tumors with mucinous histology in half of the population. The mismatch repair proficient group presented as locally advanced rectal and sigmoid tumors but with fewer mucinous adenocarcinomas (26.2%) compared to the deficient group. In both the mismatch repair proficient and deficient patients with family history reports, most did not have any known relative with cancer (75.4% and 68.75%, respectively).

Conclusion: This is the first attempt to perform mismatch repair testing among young-onset colorectal cancer patients in the Philippines and to gather data on their clinicopathologic characteristics. However, the limited sample size precludes conclusive results for the associations of mismatch repair with clinicopathologic features.

Keywords: biomarkers; early-onset colorectal cancer; immunohistochemistry; microsatellite instability.