MLH1 AND MSH2 PROTEIN EXPRESSION LOSS AND MICROSATELLITE INSTABILITY IN COLORECTAL ADENOMAS OF PATIENTS WITH LYNCH SYNDROME: A SYSTEMATIC REVIEW AND META-ANALYSIS.
Gustavo Carreira Xavier, Lucas Araújo Vaz, Marina Cota Caldeira et al.
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In 30 seconds
This systematic review and meta-analysis assessed the relationship between microsatellite instability (MSI) and loss of MLH1 or MSH2 expression in colorectal adenomas from people with Lynch syndrome. Five studies contributed 145 adenomas. MSI was significantly associated with MSH2 expression loss (OR=13,91 [3,97-48,72]; P=0,000038; I²=0%), whereas the association with MLH1 loss was not statistically significant (OR=2,19 [0,93-5,16]; P=0,073; I²=0%). The authors note that the evidence base is limited and further, larger studies are needed.
Key findings
- MSI was associated with MSH2 expression loss in adenomas (OR=13,91 [3,97-48,72]; P=0,000038; I²=0%).
- The association between MSI and MLH1 expression loss was not statistically significant (OR=2,19 [0,93-5,16]; P=0,073; I²=0%).
- The meta-analysis included 5 studies and 145 adenomas from individuals with Lynch syndrome.
Why it matters
The findings suggest that MSH2 loss may be more closely associated with MSI in Lynch syndrome-associated adenomas than MLH1 loss. This distinction may inform interpretation of molecular findings in precursor lesions, while the small evidence base means the results should be viewed as preliminary rather than definitive.
What to keep in mind
Only 5 studies and 145 adenomas were included; the authors call for larger-scale research and caution that publication-bias tests are difficult to interpret with so few studies.