Low level of microsatellite instability correlates with short disease-free survival of gastric cancer patients undergoing neoadjuvant chemotherapy

Limited studies have been reported about the function of low level of microsatellite instability (MSI-L) in cancer. The aim of our study is to unveil the prognostic role of MSI-L in gastric cancer (GC). One hundred nine patients with locally advanced GC (T3-4a, N+, M0) who underwent neoadjuvant chemotherapy plus gastrectomy with extended (D2) lymph node dissection were collected. Clinicopathological characteristics, tumour regression score, disease-free survival (DFS), and overall survival (OS) were analysed and correlated with the MSI status. The MSI status of 96 patients was identified (7 (7.3%) with MSI-H, 12 (12.5%) with MSI-L, and 77 (80.2%) with MSS). MSI-L was significantly correlated with perineural invasion ( P = 0.009) and decreased MUC5AC expression ( P = 0.042). Poor response to neoadjuvant chemotherapy in MSI-L patients (83.3% assessed as poor response) was observed ( P = 0.501). Compared with patients with MSS tumours, patients with MSI-L tumours showed poor DFS ( P = 0.018) with a hazard ratio (HR) of 2.839 (95% CI 1.131–7.124, P = 0.026) from multivariable cox regression analysis. However, this was not associated with OS ( P = 0.063). MSI-L is an independent poor prognostic biomarker for the locally advanced gastric cancer treated with neoadjuvant chemotherapy. Further studies with larger sample sizes are needed for validation.