Single patient classifier assay, microsatellite instability, and epstein-barr virus status predict clinical outcomes in stage II/III gastric cancer: Results from CLASSIC trial

Chul Kyu Roh, Yoon Young Choi, Seohee Choi, Won Jun Seo, Minah Cho, Eunji Jang, Taeil Son, Hyoung Il Kim, Hyeseon Kim, Woo Jin Hyung, Yong Min Huh, Sung Hoon Noh, Jae Ho Cheong

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8 Citations (Scopus)


Purpose: Clinical implications of single patient classifier (SPC) and microsatellite instability (MSI) in stage II/III gastric cancer have been reported. We investigated SPC and the status of MSI and Epstein-Barr virus (EBV) as combinatory biomarkers to predict the prognosis and responsiveness of adjuvant chemotherapy for stage II/III gastric cancer. Materials and Methods: Tumor specimens and clinical information were collected from patients enrolled in CLASSIC trial, a randomized controlled study of capecitabine plus oxaliplatin-based adjuvant chemotherapy. The results of nine-gene based SPC assay were classified as prognostication (SPC-prognosis) and prediction of chemotherapy benefit (SPC-prediction). Five quasi-monomorphic mononucleotide markers were used to assess tumor MSI status. EBV-encoded small RNA in situ hybridization was performed to define EBV status. Results: There were positive associations among SPC, MSI, and EBV statuses among 586 patients. In multivariate analysis of disease-free survival, SPC-prognosis [hazard ratio (HR): 1.879 (1.101–3.205), 2.399 (1.415–4.067), p=0.003] and MSI status (HR: 0.363, 95% confidence interval: 0.161–0.820, p=0.015) were independent prognostic factors along with age, Lauren classification, TNM stage, and chemotherapy. Patient survival of SPC-prognosis was well stratified regardless of EBV status and in microsatellite stable (MSS) group, but not in MSI-high group. Significant survival benefit from adjuvant chemotherapy was observed by SPC-Prediction in MSS and EBV-negative gastric cancer. Conclusion: SPC, MSI, and EBV statuses could be used in combination to predict the prognosis and responsiveness of adjuvant chemotherapy for stage II/III gastric cancer.

Original languageEnglish
Pages (from-to)132-139
Number of pages8
JournalYonsei medical journal
Issue number2
Publication statusPublished - 2019 Feb


All Science Journal Classification (ASJC) codes

  • Medicine(all)

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