K-ras基因突变与不同部位结肠癌临床病理特征及预后的关系  

Relationship between K-ras mutation and the clinicopathological features and prognosis of different colon cancer location

作　　者：袁辰桐 杨方正 王胜男 宫之奇 李宇[1] Yuan Chentong;Yang Fangzheng;Wang Shengnan;Gong Zhiqi;Li Yu(Department of Gastrointestinal Surgery,the Affiliated Hospital of Qingdao University,Qingdao 266003,China;Department of General Surgery,Qilu Hospital(Qing dao),Cheeloo College of Medicine Shandong University,Qingdao 266035,China;Department of Thoracic Surgery^Affiliated Hospital of Qingdao University,Qingdao 266003,China)

机构地区：[1]青岛大学附属医院胃肠外科,山东省266003 [2]山东大学齐鲁医院(青岛)普外科,青岛266035 [3]青岛大学附属医院胸外科,山东省266003

出　　处：《中华普通外科杂志》2020年第12期918-923,共6页Chinese Journal of General Surgery

摘　　要：目的探讨不同部位结肠癌肿瘤原发灶中K-ras基因的突变情况与患者临床病理特征及预后的关系。方法回顾性分析2015年8月至2018年7月在青岛大学附属医院行手术治疗的221例结肠癌患者的临床资料,分析K-ras基因突变情况与不同部位结肠癌患者的临床病理特征及预后的关系。结果左、右半结肠癌患者K-ras基因的突变率羞异有统计学意义(26.4%比47.8%,P=0.001)。肿瘤部位与患者的K-ras基因型、病理类型、分化程度﹑肿瘤大小,T分期及清扫淋巴结数量均有关(均P<0.05)。与左半结肠癌患者相比,右半结肠癌患者的K-ras基因阳性突变率更高。多因素回归分析结果显示,性别(HR=0.499,95%C1:0.266~0.934,P=0.030)、,肿瘤位置(HR=2.695,95%CI:1.350~5.380,P=0.005),肝转移(HR=5.600,95%CI:1.683~18.635,P=0.005)及组织学类型(HR=0.461,95%C1,0.225~0.941,P=0.034)均是影响K-ras基因突变的独立危险因素。COX回归分析结果显示,肿瘤位置(RR=2.245,95%CI:1.269~3.971,P=0.005),K-ras基因突变(RR=1.847,95%CI:1.078~3.165,P=0.026)及肝转移(RR=2.903,95%C1:1.368~6.161,P=0.006)均为影响患者预后的独立因素。结论K-ras基因突变与结肠癌肿瘤原发灶部位密切相关,可以为患者靶向药物治疗的选择及判断预后提供依据。Objective To investigate the relationship between K-ras gene mutation in primary tumor and the clinicopathological features and prognosis of colon cancer in different location.Methods 22l colon cancer patients who underwent surgical treatment in the Affiliated Hospital of Qingdao University from Aug 2015 to July 2018 were collected to analyze the relationship between K-ras mutation and clinicopathological features and prognosis.ResultsThe mutation rates of K-ras in the left and right-sided colon cancer patients were significantly different(26.4%rs.47.8%,P=0.001),x^2 tests showed that the tumor locations were closely correlated with the K-ras mutation,histological type,classifications of differentiation,tumor siaes,T stage,and numbers of harvested lymph node(P<0.05)of the patients.Right-sided colon cancer had higher positive mutation rate of K-ras gene.Multi-factor logistic regression analysis showed that gender(HR=0.499,95%CI 0.266-0.934,P=0.030),tumor location(HR=2.695,95%CI 1.350-5.380,P=0.005),liver metastasis(HR=5.600,95%C11.683-18.635,P=0.005),and histological types(HR=0.461,95%C10.225-0.941,P=0.034)were independent risk factors for K-ras mutation.Meanwhile,Cox regression analysis showed that tumor location(RR=2.245,95%C11.269-3.971,P=0.005),K-ras mutation(RR=1.847,95%CI 1.078-3.165,P=0.026)and liver metastasis(RR=2.903,95%Cl 1.368-6.161,P=0.006)were independent factors affecting the prognosis of patients.ConclusionThe mutation of K-ras gene is closely related to the location of colon cancer.It will provide a basis for selection of target therapy and prediction of the prognosis of these patients.

关 键 词：结肠肿瘤 突变 病理学 临床 预后 

分 类 号：R735.35[医药卫生—肿瘤]