{"entity":{"id":"paper-luchini-msi-dmmr-pancreatic-systematic-review-gut-2021","kind":"paper","name":"Comprehensive characterisation of pancreatic ductal adenocarcinoma with microsatellite instability: histology, molecular pathology and clinical implications","aka":[],"tldr":"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.","asOf":"2026-09-24","links":[{"label":"Luchini et al., Gut 2021: systematic review of mismatch repair deficient pancreatic cancer (34 studies, 8,323 patients)","url":"https://doi.org/10.1136/gutjnl-2020-320726"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/32350089/"}],"tags":[],"related":["msi-high","dmmr-ihc"],"cancers":["pancreatic","msi-high-pdac"],"sections":[],"technologies":["msi-mmr-testing"],"targets":["mmr"],"drugs":[],"companies":[],"institutions":[],"pathways":["mismatch-repair-msi"],"terms":["msi"],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":["gut"],"dependsOn":[],"notes":[],"journal":"Gut","year":2021,"doi":"10.1136/gutjnl-2020-320726","pmid":"32350089","authors":"Luchini C, Brosens LAA, Wood LD, et al.","paperType":"meta-analysis","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."],"whatItMeans":"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."],"changedPractice":false,"participants":8323},"route":"/key-papers/paper-luchini-msi-dmmr-pancreatic-systematic-review-gut-2021/","neighbours":{"biomarker":[{"id":"dmmr-ihc","kind":"biomarker","name":"dMMR (mismatch repair deficiency by IHC)","route":"/biomarkers/dmmr-ihc/"},{"id":"msi-high","kind":"biomarker","name":"MSI-high (microsatellite instability by PCR or sequencing)","route":"/biomarkers/msi-high/"}],"cancer":[{"id":"msi-high-pdac","kind":"cancer","name":"Mismatch repair deficient (MSI-high) pancreatic ductal adenocarcinoma","route":"/cancers/msi-high-pdac/"},{"id":"pancreatic","kind":"cancer","name":"Pancreatic ductal adenocarcinoma","route":"/cancers/pancreatic/"}],"technology":[{"id":"msi-mmr-testing","kind":"technology","name":"MSI and mismatch-repair testing","route":"/technologies/msi-mmr-testing/"}],"target":[{"id":"mmr","kind":"target","name":"Mismatch repair proteins (MLH1, MSH2, MSH6, PMS2)","route":"/targets/mmr/"},{"id":"tp53","kind":"target","name":"TP53","route":"/targets/tp53/"}],"pathway":[{"id":"mismatch-repair-msi","kind":"pathway","name":"Mismatch repair & microsatellite instability","route":"/pathways/mismatch-repair-msi/"}],"term":[{"id":"msi","kind":"term","name":"Microsatellite instability (MSI-H) / mismatch repair deficiency (dMMR)","route":"/terms/msi/"}],"journal":[{"id":"gut","kind":"journal","name":"Gut","route":"/journals/gut/"}],"trial":[{"id":"keynote-158","kind":"trial","name":"KEYNOTE-158","route":"/trials/keynote-158/"}],"drug":[{"id":"ventana-mmr-rxdx","kind":"drug","name":"VENTANA MMR RxDx Panel","route":"/drugs/ventana-mmr-rxdx/"}]}}