# Comprehensive characterisation of pancreatic ductal adenocarcinoma with microsatellite instability: histology, molecular pathology and clinical implications

Source: https://onco.cc/key-papers/paper-luchini-msi-dmmr-pancreatic-systematic-review-gut-2021/  
OnCo record `paper-luchini-msi-dmmr-pancreatic-systematic-review-gut-2021` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Pooling 34 studies and 8,323 patients, this review put mismatch repair deficient pancreatic cancer at about 1 to 2%, typically with medullary or colloid appearance and without the usual KRAS and TP53 mutations, and recommended testing those histologies.

## Summary

PubMed, SCOPUS and Embase were searched to November 2019 for MSI or mismatch repair deficiency in pancreatic ductal adenocarcinoma; 34 studies with 8,323 patients were included and compared with SEER and TCGA references. MSI/dMMR had a very low prevalence, around 1 to 2%, and was strongly associated with medullary and mucinous/colloid histology and with a KRAS/TP53 wild-type background with commoner JAK gene mutations; survival data were unclear. The authors recommend routine testing of medullary or colloid tumours by immunohistochemistry followed by MSI PCR where doubtful, and next-generation sequencing where tissue is limited or profiling is being done anyway.

## Fields

- Kind: Key paper
- Last checked: 2026-09-24
- Journal: Gut
- Year: 2021
- DOI: 10.1136/gutjnl-2020-320726
- Authors: Luchini C, Brosens LAA, Wood LD, et al.
- Findings: MSI/dMMR prevalence about 1 to 2%.; Associated with medullary and colloid histology and KRAS/TP53 wild-type tumours.; Test by immunohistochemistry, then PCR where doubtful, or on a sequencing panel.
- What it means: It tells the pathologist which pancreatic cancers to test for the one immunotherapy-responsive subgroup and how.
- Caveats: Heterogeneous assays across 34 studies.; Survival of MSI pancreatic cancer remains unclear.

## Sources

- Luchini et al., Gut 2021: systematic review of mismatch repair deficient pancreatic cancer (34 studies, 8,323 patients): https://doi.org/10.1136/gutjnl-2020-320726
- PubMed: https://pubmed.ncbi.nlm.nih.gov/32350089/

## Connected records

- biomarkers: [dMMR (mismatch repair deficiency by IHC)](https://onco.cc/biomarkers/dmmr-ihc/), [MSI-high (microsatellite instability by PCR or sequencing)](https://onco.cc/biomarkers/msi-high/)
- cancers: [Mismatch repair deficient (MSI-high) pancreatic ductal adenocarcinoma](https://onco.cc/cancers/msi-high-pdac/), [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/)
- technologies: [MSI and mismatch-repair testing](https://onco.cc/technologies/msi-mmr-testing/)
- targets: [Mismatch repair proteins (MLH1, MSH2, MSH6, PMS2)](https://onco.cc/targets/mmr/), [TP53](https://onco.cc/targets/tp53/)
- pathways: [Mismatch repair & microsatellite instability](https://onco.cc/pathways/mismatch-repair-msi/)
- terms: [Microsatellite instability (MSI-H) / mismatch repair deficiency (dMMR)](https://onco.cc/terms/msi/)
- journals: [Gut](https://onco.cc/journals/gut/)
- trials: [KEYNOTE-158](https://onco.cc/trials/keynote-158/)
- drugs: [VENTANA MMR RxDx Panel](https://onco.cc/drugs/ventana-mmr-rxdx/)

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