pMMR和MSS表型的Ⅱ期普危结肠癌、高位直肠癌单药辅助化疗的探讨  

Discussion of pMMR and MSS phenotype stage Ⅱ colon cancer,upper rectal cancer patients with general risk by adjuvant chemotherapy

作　　者：宫爱民[1] 任明智[2] 孙静阳[3] 刘斌[1] 赵长林[2] 张晓飞 王俊松[2] Gong Aimin;Ren Mingzhi;Sun Jingyang;Liu Bin;Zhao Changlin;Zhang Xiaofei;Wang Junsong(Department of the Second Colorectal Cancer Surgery, Dalian University Affiliated Xinhua Hospital, Dalian 116021, China;Department of Gastrointestinal Oncology / Dalian Colorectal Cancer Diagnosis and Treatment Base, Dalian University Affiliated Xinhua Hospital, Dalian 116021, China;Department of Pathology, Dalian University Affiliated Xinhua Hospital, Dalian 116021, China)

机构地区：[1]大连大学附属新华医院肛肠二科,116021 [2]大连大学附属新华医院胃肠肿瘤科/大连结肠与直肠癌诊疗基地,116021 [3]大连大学附属新华医院病理科,116021

出　　处：《中华结直肠疾病电子杂志》2018年第3期246-251,共6页Chinese Journal of Colorectal Diseases(Electronic Edition)

摘　　要：目的探讨Ⅱ期普危结肠癌、高位直肠癌患者在单药辅助化疗中是否获益。方法 40例患者癌组织常规进行IHC检测MLH1、MSH2、MSH6、PMS2蛋白确定为p MMR表型后,分为辅助化疗组20例,再经PCR-MSI检测确定为MSS表型,给予雷替曲塞,剂量为3 mg/m2,21天重复的方案用4周期。采用按随访结果确定生存时间评价客观有效率。依据NCI-CTC3.0版毒性分级标准评价不良反应。非辅助化疗组20例作为对照。结果辅助化疗组客观有效率为95.0%(19/20),复发率为5.0%(1/20),非辅化组复发率15.0%(3/20),辅助化疗组复发率明显低于非辅助化疗组(χ~2=5.556,P=0.0184)。辅助化疗组不良反应均为Ⅰ度和Ⅱ度,未发生心脏毒性;对血糖无影响。结论 p MMR和MSS表型的Ⅱ期普危结肠癌、高位直肠癌患者采用雷替曲塞辅助化疗安全有效。Objective Explore stage II colon cancer, upper rectal cancer patients with general risk beneift from single agent adjuvant chemotherapy or not.MethodsForty cases of tumor tissues detected MLH1, MSH2, MSH6, PMS2 proteins by IHC test and conifrmed as pMMR status.Twenty cases as adjuvant chemotherapy group conifrmed as MSS phenotype by PCR who treated Raltitrexed which dose was 3 mg/m2, d1, ivgtt in 15 min, Q21d for 4 cycles. The survival time was determined according to the follow-up results, and the objective efficiency was evaluated. Adverse events were evaluated according to the NCI-TC 3.0 version of toxicity classiifcation criteria. The non-adjuvant chemotherapy group 20 cases were control. ResultsAdjuvant chemotherapy group objective effective rate was 95.0% （19/20）, the recurrence rate was 5.0% （1/20）, the control group recurrence rate 15.0% （3/20）, adjuvant chemotherapy group recurrence rate was lower than control group （χ2=5.556,P=5.556）. Adjuvant chemotherapy group only occurred I or II degree adverse events,no cardiac toxicity,no influence on blood sugar.ConclusionspMMR and MSS phenotype stage II colon cancer, upper rectal cancer patients with general risk using Raltitrexed single-agent adjuvant chemotherapy were safe and effective.

关 键 词：结直肠肿瘤 病理分期 错配修复基因 微卫星不稳定 化疗 

分 类 号：R735.3[医药卫生—肿瘤]