The Heterogeneity Between Lynch-Associated and Sporadic MMR Deficiency in Colorectal Cancers

J Natl Cancer Inst. 2018 Sep 1;110(9):975-984. doi: 10.1093/jnci/djy004.


Background: Previous studies demonstrated that prognosis of germline deficiency in mismatch repair protein (dMMR) was different from that of sporadic dMMR. The underlying mechanism has not been studied.

Methods: From a prospectively maintained database, we collected dMMR colorectal cancer (CRC) patients identified by postoperative immunohistochemistry screening. According to genetic test, patients were grouped as Lynch-associated or sporadic dMMR. We compared the clinical-pathological features, prognosis, and immunoreactive differences between the two groups. By whole-exome sequencing and neoantigen detection pipeline, mutational frequencies and neoantigen burdens were also compared. All statistical tests were two-sided.

Results: Sixty-seven sporadic dMMR and 85 Lynch-associated CRC patients were included in the study. Sporadic dMMR patients were older (P < .001) and their tumors were poorly differentiated (P = .03). The survival was better in the Lynch-associated group (P = .001). After adjustment, the difference still remained statistically significant (hazard ratio = 0.29, 95% confidence interval = 0.09 to 0.95, P = .04). The scores of Crohn's-like reaction (CRO; P < .001), immunoreactions in the invasive margin (IM; P = .01), tumor stroma (TS; P = .009), and cancer nest (CN; P = .02) of the Lynch-associated group were statistically significantly higher. The numbers of CD3+, CD8+, Foxp3+ tumor-infiltrating lymphocytes (TILs) in IM; CD3+, CD4+ TILs in TS; and CD3+, CD4+, CD8+ TILs in CN were statistically significantly higher in Lynch-associated dMMR patients. Based on the 16 patients who under went whole-exome sequencing, there were also more somatic mutations and neoantigen burdens in the Lynch-associated group compared with the sporadic dMMR group (439/pt vs 68/pt, P = .006; 628/pt vs 97/pt, P = .009).

Conclusions: There are heterogeneities in dMMR CRCs. Lynch-associated dMMR patients present with more somatic mutations and neoantigens compared with sporadic dMMR, which probably results in stronger immunoreactions and survival improvement.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Biomarkers, Tumor
  • Brain Neoplasms / complications*
  • Colorectal Neoplasms / complications
  • Colorectal Neoplasms / diagnosis
  • Colorectal Neoplasms / etiology*
  • Colorectal Neoplasms / mortality
  • Colorectal Neoplasms, Hereditary Nonpolyposis / complications*
  • Exome Sequencing
  • Female
  • Genetic Heterogeneity
  • Humans
  • Immunohistochemistry
  • Kaplan-Meier Estimate
  • Lymphocyte Count
  • Male
  • Microsatellite Instability
  • Middle Aged
  • Mutation
  • Neoplasm Staging
  • Neoplastic Syndromes, Hereditary / complications*
  • Proportional Hazards Models
  • Prospective Studies
  • Young Adult


  • Biomarkers, Tumor

Supplementary concepts

  • Turcot syndrome