Mismatch repair status and clinical outcome in endometrial cancer: a systematic review and meta-analysis

Crit Rev Oncol Hematol. 2013 Oct;88(1):154-67. doi: 10.1016/j.critrevonc.2013.03.002. Epub 2013 Apr 4.


Background: The association between the deficiency in mismatch repair (MMR) genes and prognosis in women with endometrial cancer is unclear. Here we report a systematic review and meta-analysis exploring this association.

Methods: We searched literature databases (MEDLINE, EMBASE, and Cochrane) from 1980 until December 2011 to identify studies evaluating the association between MMR status and clinical outcome in endometrial cancer. The main outcome measures were overall survival (OS) and disease-free survival (DFS).

Results: Twenty-three studies met the inclusion criteria. The median sample size of studies was 112, 74% were retrospective case-series and 70% performed microsatellite instability (MSI) analysis to evaluate the status of MMR. Only 22% of studies used the panel of five microsatellite markers recommended by the National Cancer Institute. Seven studies used immunohistochemistry to define MMR deficiency, but only two of them determined the expression of all four MMR proteins. Overall, significant associations between MMR and outcome were observed in 32% of studies. There was marked inter-study heterogeneity for estimates of OS and DFS. Pooled analysis did not show any significant association between deficiency in MMR and worse OS (6 studies, hazard ratio [HR] 2.0, p=0.11) or DFS (4 studies, HR ratio 1.31, p=0.66).

Conclusion: There is no definitive evidence of a significant association between MMR status and detrimental survival in endometrial cancer.

Keywords: Endometrial cancer; Microsatellite instability; Mismatch repair; Prognosis.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • DNA Mismatch Repair*
  • DNA-Binding Proteins / metabolism
  • Endometrial Neoplasms / genetics*
  • Endometrial Neoplasms / metabolism
  • Endometrial Neoplasms / mortality*
  • Female
  • Humans
  • Microsatellite Instability
  • Patient Outcome Assessment
  • Prognosis
  • Proportional Hazards Models


  • DNA-Binding Proteins