{"entity":{"id":"paper-pietrantonio-msi-gastric-meta-analysis-jco-2019","kind":"paper","name":"Individual patient data meta-analysis of microsatellite instability as a biomarker in gastric cancer (MAGIC, CLASSIC, ARTIST, ITACA-S)","aka":[],"tldr":"Pooling four trials showed that microsatellite-unstable gastric cancers have a much better prognosis after surgery and gain nothing from perioperative or adjuvant chemotherapy, which may even harm them.","summary":"Individual patient data meta-analysis of 1,556 patients from four randomised trials of resectable gastric cancer (MAGIC, CLASSIC, ARTIST, ITACA-S), of whom 7.8 percent had microsatellite instability-high tumours.\n\nFive-year disease-free survival was 71.8 versus 52.3 percent and overall survival 77.5 versus 59.3 percent for microsatellite-unstable versus stable tumours; chemotherapy improved survival in stable tumours (hazard ratio 0.65) but not in unstable ones (hazard ratio 1.03), with a suggestion of harm.","asOf":"2026-09-17","links":[{"label":"J Clin Oncol 2019","url":"https://doi.org/10.1200/JCO.19.01124"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/31513484/"}],"tags":[],"related":[],"cancers":["gastric-msi-high"],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":["jco"],"dependsOn":[],"notes":[],"journal":"Journal of Clinical Oncology","year":2019,"doi":"10.1200/JCO.19.01124","pmid":"31513484","authors":"Pietrantonio F, Miceli R, Raimondi A, et al.","paperType":"meta-analysis","findings":["Five-year overall survival 77.5 percent (unstable) vs 59.3 percent (stable) with surgery alone.","Chemotherapy hazard ratio 1.03 in microsatellite-unstable tumours vs 0.65 in stable."],"whatItMeans":"Microsatellite instability testing is recommended before perioperative chemotherapy for gastric cancer, and immunotherapy-based trials are the preferred approach for unstable tumours.","caveats":["Small number of microsatellite-unstable patients (121); confidence intervals were wide."],"changedPractice":true,"participants":1556},"route":"/key-papers/paper-pietrantonio-msi-gastric-meta-analysis-jco-2019/","neighbours":{"cancer":[{"id":"gastric-msi-high","kind":"cancer","name":"Microsatellite-unstable (MSI-high) gastric cancer","route":"/cancers/gastric-msi-high/"}],"journal":[{"id":"jco","kind":"journal","name":"Journal of Clinical Oncology","route":"/journals/jco/"}]}}