Methylation and microsatellite status and recurrence following adjuvant FOLFOX in colorectal cancer

The prognostic impact of CpG island methylator phenotype (CIMP) and microsatellite instability (MSI) on the treatment outcome of colon cancer patients receiving adjuvant 5‐fluorouracil/leucovorin/oxaliplatin (FOLFOX) is unclear. We investigated CIMP and MSI status in colorectal cancer patients treated with adjuvant FOLFOX. Stages II and III sporadic colorectal cancer patients who underwent curative resection followed by adjuvant FOLFOX were included. Eight CpG island loci (CACNA1G, CRABP1, IGF2, MLH1, NEUROG1, CDKN2A (p16), RUNX3 and SOCS1) and five microsatellite markers were examined. Disease‐free survival (DFS) was analyzed according to CIMP and MSI status. A total of 322 patients were included: male/female 192/130, median age 61 years (range 30–78), proximal/distal location 118/204 and Stages II/III 43/279. CIMP status was high in 25 patients (7.8%) and 21 patients (6.5%) had MSI‐high tumor. CIMP/MSI status was not significantly associated with DFS: 3‐year DFS 100% in CIMP(−)/MSI(+), 84% in CIMP(−)/MSI(−), 82% in CIMP(+)/MSI(−) and 75% in CIMP(+)/MSI(+) (p = 0.33). Results of exploratory analysis showed that concurrent methylation at NEUROG1 and CDKN2A (p16) was associated with shorter DFS: 3‐year DFS 69% in NEUROG1(+)/CDKN2A (p16)(+) versus 87% in NEUROG1(−)/CDKN2A (p16)(−) (p = 0.006). In conclusion, concurrent methylation of NEUROG1 and CDKN2A (p16) is associated with recurrence following adjuvant FOLFOX in Stages II/III colorectal cancer. What's new? Colorectal cancer is characterized by a number of molecular subtypes, the impact of which on the outcome of leucovorin, 5‐fluorouracil, and oxaliplatin (FOLFOX) therapy is not fully understood. In this report, the colorectal cancer CpG island methylator phenotype (CIMP), which is associated with microsatellite instability, was not linked to disease‐free survival. High disease recurrence, however, was associated with methylation of the CpG loci NEUROG1 and CDKN2A (p16), suggesting that these loci may be valuable prognostic markers.