Ⅱ期结直肠癌中微卫星状态与差分化细胞群的关系及其对预后的影响  

Correlation between microsatellite status and poorly differentiated clusters and their prognostic value in stageⅡcolorectal cancer

作　　者：陈振伟[1] 邱敏[1] 姚秀娟[2] 胡毕文[1] 曹晨曦[1] 于亚威[2] Chen Zhenwei;Qiu Min;Yao Xiujuan;Hu Biwen;Cao Chenxi;Yu Yawei(Department of Anorectal Surgery,the Second Affiliated Hospital of Jiaxing College,Jiaxing 314000,China;Department of Pathology,the Second Affiliated Hospital of Jiaxing College,Jiaxing 314000,China)

机构地区：[1]嘉兴学院附属第二医院肛肠外科,314000 [2]嘉兴学院附属第二医院病理科,314000

出　　处：《中华普通外科学文献（电子版）》2021年第3期185-192,共8页Chinese Archives of General Surgery(Electronic Edition)

基　　金：浙江省医药卫生计划项目(2021KY354);嘉兴市科技局项目(2019AD32254,2018AY32002)。

摘　　要：目的探讨Ⅱ期结直肠癌中微卫星状态(MS)与差分化细胞群(PDC)之间的相关性及其对患者预后的影响,为术后辅助治疗提供参考。方法回顾性收集2014年12月至2017年12月在嘉兴学院附属第二医院行根治性手术的311例Ⅱ期结直肠癌患者的临床病理资料和随访结果,分析MS、PDC之间的相关性以及两者与其他临床病理特征之间的关系。采用Kaplan-Meier法绘制生存曲线,比较不同的MS和PDC状态对患者无病生存期(DFS)的影响。多因素Cox回归分析预后的影响因素。结果311例中微卫星稳定(MSS)252例,微卫星不稳定(MSI)59例;按PDC二分类法,PDC阳性(PDC+)171例,PDC阴性(PDC-)140例;按PDC三分级法,G1210例,G257例,G344例。MS与PDC无明确相关性。MSS和MSI患者的中位DFS,总体比较和PDC-亚组中比较差异无统计学意义(P=0.232、0.589),但在PDC+亚组中差异有统计学意义(P=0.027);PDC+和PDC-患者的中位DFS,总体比较和MSS亚组中比较差异有统计学意义(P=0.001、<0.001),而在MSI亚组中差异无统计学意义(P=0.935);G1、G2和G3患者的中位DFS,无论是总体比较还是MSS亚组、MSI亚组中比较,差异均无统计学意义(P=0.246、0.371、0.498)。基于PDC和MS的联合分组中PDC+MSI组、PDC-MSI组、PDC+MSS组和PDC-MSS组的中位DFS差异有统计学意义(P=0.001),其中PDC+MSS组的DFS明显小于其他三组。多因素分析显示,PDC+MSS是影响DFS的独立预后因素(HR=2.670,95%CI:1.537~4.637,P<0.001)。结论Ⅱ期CRC中MS与PDC无明确相关性,但二者共同影响患者的预后。MSS和MSI患者的生存差异主要见于PDC+的患者,而在PDC-的患者中无明显差异;PDC+和PDC-患者的生存差异主要见于MSS的患者,而在MSI的患者中无明显差异。对于MSS且PDC+的患者,应予以积极的辅助治疗。对于Ⅱ期CRC来说,PDC的二分类法比三分级法更有临床价值,建议将PDC+纳入复发危险因素。Objective To investigate the correlation between microsatellite status (MS) and poorly differentiated clusters (PDC) in stage Ⅱ colorectal cancer and their influences on prognosis,and to provide reference for postoperative adjuvant therapy.Methods The clinical,pathological and survival data of 311 patients with stage Ⅱ colorectal cancer who underwent radical surgery in the Second Affiliated Hospital of Jiaxing College from December 2014 to December 2017 were collected retrospectively.The correlation among MS,PDC and other clinicopathologic parameters was analyzed.After follow-up,the survival curves were plotted with Kaplan-Meier method to compare disease free survival (DFS) between different MS and PDC status.The prognostic factors were analyzed by multivariate Cox regression.Results Among the 311 patients,there were 252 microsatellite stability (MSS) and 59 microsatellite instability (MSI) cases.According to two classification method,the number of PDC positive (PDC+) and PDC negative (PDC-)were 171 and 140 cases,respectively.According to three grade method,the number of PDC G1,G2 and G3 were 210,57 and 44 cases,respectively.There was no clear correlation between MS and PDC.There was no significant difference in median DFS between MSS and MSI patients in overall comparison or PDC-subgroup (P=0.232,0.589),but with a statistically significant difference in PDC+ subgroup (P=0.027).There were significant differences in median DFS between PDC+ and PDC-patients in overall comparison and MSS subgroup (P<0.01),but without significant difference in MSI subgroup (P=0.935).There was no significant difference in the median DFS of G1,G2 and G3 patients,either in overall comparison or in MSS subgroup and MSI subgroup (P=0.246,0.371,0.498).Joint grouping based on PDC and MS,there was significant difference in median DFS of PDC+MSI,PDC-MSI,PDC+MSS and PDC-MSS groups (P=0.001),and PDC+MSS group had a worse survival than the other groups.Multivariate Cox regression analysis showed that PDC+MSS was an independent prognostic fac

关 键 词：微卫星状态 差分化细胞群 结直肠肿瘤 无病生存期 

分 类 号：R735.34[医药卫生—肿瘤]