Related Experiment Video
Updated: Jan 5, 2026
Competing-Risk Nomogram for Predicting Cancer-Specific Survival in Multiple Primary Colorectal Cancer Patients after Surgery
Published on: September 27, 2024
Is microsatellite instability-high really a favorable prognostic factor for advanced colorectal cancer? A
Bingyan Wang1, Fei Li1, Xin Zhou1
1Department of General Surgery, Peking University Third Hospital, Beijing, China.
Background:
Stage II colorectal cancer with microsatellite instability-high (MSI-H) has been proven to have a better prognosis. However, in advanced stage, this trend remains controversial. This study aimed to explore the prognostic role of MSI-H in stage III and IV colorectal cancer (CRC) through meta-analysis.
Methods:
A comprehensive search was performed in PubMed, Cochrane Central Library, and Embase databases. All randomized clinical trials and non-randomized studies were included based on inclusion and exclusion criteria and on survival after a radical operation with or without chemotherapy. The adjusted log hazard ratios (HRs) were used to estimate the prognostic value between MSI-H and microsatellite-stable CRCs. The random-effects model was used to estimate the pooled effect size.
Results:
Thirty-six studies were included. Randomized controlled trials (RCT) and non-RCT were analyzed separately. For stage III CRCs, pooled HR for overall survival (OS) was 0.96 (95% confidence interval [CI] 0.75-.123) in the RCT subgroup and 0.89 (95% CI 0.62-1.28) in the non-RCT subgroup. For disease-free survival (DFS), the HR for the RCT group was 0.83 (95% CI 0.65-1.07), similar to the non-RCT subgroup (0.83, 95% CI 0.65-1.07). Disease-specific survival (DSS) was also calculated, which had an HR of 1.07 (95% CI 0.68-1.69) in the non-RCT subgroup. All these results showed that MSI-H has no beneficial effects in stage III CRC. For stage IV CRC, the HR for OS in the RCT subgroup was 1.23 (95% CI 0.92-1.64) but only two RCTs were included. For non-RCT study, the combined HR for OS and DFS was 1.10 (95% CI 0.77-1.51) and 0.72 (95% CI 0.53-0.98), respectively, suggesting the beneficial effect for DFS and non-beneficial effect for OS.
Conclusion:
For stage III CRC, MSI-H had no prognostic effect for OS, DFS, and DSS. For stage IV CRC, DFS showed a beneficial result, whereas OS did not; however, the included studies were limited and needed further exploration.
