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Articles by E. Y Chang
Total Records ( 2 ) for E. Y Chang
  E. Y Chang , P. B Dorsey , J Frankhouse , R. G Lee , D Walts , W Johnson , G Anadiotis and N. Johnson
 

Background  Microsatellite instability (MSI) is a genetic aberration associated with less aggressive tumor biology. Some tumors with MSI also have lymphocytic infiltrate (LI), which suggests a heightened immune response against the tumor.

Objective  To evaluate the combined prognostic significance of MSI and LI in a colon cancer population.

Design  Colon cancers were prospectively evaluated for MSI by assessing 11 satellite markers and were classified as MSI+ if 2 or more satellite markers displayed instability. Tumors were classified as LI+ if at least 5 lymphocytes were observed per 10 high-power fields.

Setting  Community hospital system.

Patients  Individuals undergoing definitive surgery for colon cancer.

Main Outcome Measures  Overall and disease-free survival were compared according to combined MSI and LI status.

Results  In 150 patients, tumors were classified as follows: 95 were MSI–/LI–, 9 were MSI–/LI+, 30 were MSI+/LI–, and 16 were MSI+/LI+. Median follow-up was 40.6 months. Five-year disease-free survival was 56.7% for patients with MSI–/LI– tumors and 88.9% for those with MSI+/LI+ tumors (P = .01). Patients with MSI+/LI– and MSI–/LI+ tumors had 5-year survival of 75.4% and 75.0%, respectively.

Conclusions  Patients with colon cancer and MSI–/LI– tumors have worse disease-free survival rate regardless of stage at diagnosis. Patients exhibiting both MSI+ and LI+ tumors have more favorable disease-free survival rates. Both MSI and LI show promise as a combined prognostic marker and with further study may prove to be particularly useful in selecting patients with stage II disease for adjunctive therapy.

  S Kumar , E. Y Chang , J Frankhouse , P. B Dorsey , R. G Lee and N. Johnson
 

Background  Microsatellite instability (MSI) and lymphocytic infiltrate (LI) in colon cancer are associated with less aggressive biological characteristics. Patients with stage II disease who are negative for MSI and LI have been found to have a less favorable prognosis. These patients may be candidates for more aggressive adjuvant therapy.

Objective  To evaluate the outcomes of patients with colon cancer treated with and without adjuvant chemotherapy on the basis of stage, MSI, and LI.

Design  Prospective evaluation of MSI and LI status with retrospective analysis of chemotherapy regimen.

Setting  Community hospital system.

Patients  A total of 167 patients with colon cancer.

Intervention  Definitive resection of colorectal cancer with or without chemotherapy.

Main Outcome Measure  Disease-free survival (DFS) with and without chemotherapy according to combined MSI and LI status.

Results  Data on MSI and LI status and chemotherapeutic regimens were available for 140 patients. The 5-year DFS was 50% for patients with stage II disease who underwent chemotherapy vs 76% for those who did not (P = .02). In the group negative for MSI and LI, 5-year DFS was 29% for those undergoing chemotherapy and 91% for those who did not (P = .001).

Conclusions  Forgoing adjuvant chemotherapy should be considered in patients with stage II colon cancer who are negative for MSI and LI. The MSI and LI status shows promise as a combined prognostic marker and may prove particularly useful in selecting patients with stage II disease for adjunctive therapy.

 
 
 
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