A cross-sectional analysis from a real-world cohort of patients with microsatellite instability colorectal cancer (MSI-CRC) with localized disease from the Spanish RETUD registry.
Authors: Fernandez Montes Ana Fernandez , Lopez Carolina Muriel , López Sandra , Ferriol Martinez Candela , Paez David , de Frutos González Belén , Gomez Espana Maria Auxiliadora , García-Benito Carmé , Vidal-Tocino Rosario , Melian Sosa Marcos , Sastre Valera Javier , Garcia-Alfonso Pilar , Ghanem Ismael , La Casta Adelaida , Gallego Javier , Martínez de Castro Eva , Verdaguer Helena , Santos Cristina , Jimenez Encarnacion , Gravalos Cristina 
Published: January 2025

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Background:
Microsatellite instability (MSI) localized colorectal cancer (CRC) constitutes a subgroup of patients (pts) with different clinical and molecular characteristics and prognosis compared to microsatellite stable (MSS) disease. Here, we present our real world data regarding the management and clinical outcomes of a cohort of MSI-h localized CRC patients included in the Spanish Group of Treatment of Digestive Tumors (TTD) Registry (RETUD).
Methods:
RETUD is a national, multicenter registry for gastrointestinal tumors from the Spanish TTD Group. In this cross-sectional analysis we evaluated a real-world cohort of MSI-h localized CRC pts diagnosed from 1
st
January 2017 to 29
th
April 2024. Baseline characteristics and neo/adjuvant treatments are descriptively presented. Disease-free survival (DFS) and overall survival (OS) analyzed by Kaplan-Meier method are presented along with 95% confidence intervals (CI).
Results:
Five hundred and sixty-one (561) evaluable pts out of 679 MSI-CRC included in RETUD had a localized disease as initial diagnosis. Pts had a median age of 73.1 years and were predominantly Caucasian (97.7%) and female (52.6%). Fifty (12.4%) pts had Lynch Syndrome. Main tumor baseline characteristics are described (Table). Local-locoregional therapeutic procedures were: primary tumor resection in 531 (99.1%) pts and radiotherapy in 18 (3.2%) pts. A total of 198 (35.3%) pts received systemic therapy, mostly chemotherapy (n=165 83.3%) but 18 (9.1%) were treated with pembrolizumab due to unresectable disease. At database cut-off, 123 (21.9%) patients died, mostly due to not related intercurrent illness, and 96 (17.1%) pts developed metastasis. After a median follow up period of 28.5 months, the median (95% CI) OS was not reached and DFS was 78.2 (55.4-NA) months. The impact of adjuvant systemic therapy (chemotherapy vs. non-chemotherapy) for both stage II and stage III pts is under evaluation.
Conclusions:
Our work provides valuable real-world data from a cohort of MSI-h localized CRC pts treated under clinical practice conditions in Spain, reiterating the good disease prognosis exhibited by this subset of pts in contrast to MSS pts.

Main tumor characteristics.

Stage at initial diagnosis, n (%)

I/II n (%)
55 (9.8) / 258 (46.0)

III, n (%)
248 (44.2)

Location of primary tumor
a
, n (%)

right colon /left colon /rectum
447 (78.4) / 82 (14.4) / 41 (7.2)

Type histological
b
, n (%)

Intestinal
271 (48.9)

Mucinous (colloid) adenocarcinoma (>50% mucinous)
115 (20.8)

Signet ring cell carcinoma (>50% signet ring)
14 (2.5)

Medullary carcinoma
18 (3.2)

a
Pts with more than 1 primary tumor; the percentage may be over 100%.
b
Unknown histology in 132 (23.8%) pts and missing data in 7 pts.