散发性同时性多原发结直肠癌临床病理特征及预后分析  

Analysis of clinicopathological features and prognosis of sporadic synchronous multiple primary colorectal cancers

作　　者：秦兆甫 徐国徽 周诗琪 郑棚文 朱玉萍[1] 鞠海星[1] 李德川[1] 马德宁 Qin Zhaofu;Xu Guohui;Zhou Shiqi;Zheng Pengwen;Zhu Yuping;Ju Haixing;Li Dechuan;Ma Dening(Zhejiang Cancer Hospital,Department of Colorectal Surgery,Hangzhou Institute of Medicine(HIM),Chinese Academy of Sciences,Hangzhou 310022,China)

机构地区：[1]浙江省肿瘤医院结直肠外科、中国科学院杭州医学研究所,杭州310022

出　　处：《中华胃肠外科杂志》2023年第12期1171-1178,共8页Chinese Journal of Gastrointestinal Surgery

基　　金：浙江省卫生厅健康面上项目(2021KY104)。

摘　　要：目的探讨散发性同时性多原发结直肠癌(SSCRC)多个癌灶相对位置及微卫星状态对于临床病理特征及预后的影响。方法回顾性收集自2008年1月至2022年7月期间,于浙江省肿瘤医院结直肠外科收治的278例SSCRC患者的临床病理及随访资料。按照多个癌灶的相对位置,将患者分为3组,分别是:(1)右半组(多个癌灶均分布于盲肠、升结肠、结肠肝曲、横结肠);(2)左半组(多个癌灶均分布于结肠脾曲,降结肠,乙状结肠、直肠);(3)左半+右半组(多个癌灶在右半结肠和左半结肠/直肠均有分布)。按照微卫星状态(MSI),将患者分为两组,分别是:MSI-H组(错配修复缺陷)和MSI-L+MSS组(错配修复完整)。比较组间的临床特征和预后差异。不同临床特征的比较采用χ^(2)检验,预后比较采用Kaplan-Meier生存分析和Log-rank检验。结果278例SSCRC患者中,有256例(92.1%)癌灶数量为2个,22例(7.9%)>2个;255例(91.7%)病灶病理表现为腺癌,23例(8.3%)病灶包含或表现为黏液腺癌;136例(48.9%)发生淋巴结转移;癌灶浸润深度超过肌层的患者238例(85.6%);TNM分期为Ⅲ或Ⅳ期者147例(52.9%);左半组、右半组以及左半+右半组分别有155例(55.8%)、55例(19.8%)和68例(24.5%)。全组有199例行完整4项错配修复蛋白的免疫组化检查,其中有166例微卫星状态为MSI-L+MSS;33例微卫星状态为MSI-H。左半组、左半+右半组以及右半组比较,女性比例分别占16.8%(26/155)、26.5%(18/68)和49.1%(27/55),差异有统计学意义(χ^(2)=22.335,P<0.001);癌灶数量≥3个的比例分别占5.2%(8/155)、16.2%(11/68)和5.5%(3/55),差异有统计学意义(χ^(2)=8.438,P=0.015);黏液腺癌的比例分别占4.5%(7/155)、8.8%(6/68)和18.2%(10/55),差异有统计学意义(χ^(2)=10.026,P=0.007);淋巴结转移比例分别占55.5%(86/155)、48.5%(33/68)和30.9%(17/55),差异有统计学意义(χ^(2)=9.817,P=0.007);浸润T3~4分期比例分别占81.3%(126/155)、88.2%(60/68)、94.5%(52/55),差异有统计Objective To investigate the impact of relative locations of multiple foci and microsatellite status of sporadic,synchronous,multiple,primary,colorectal carcinomas on clinicopathological features and prognosis.Methods The clinicopathologic and prognostic data of 278 patients with sporadic,synchronous,multiple,primary,colorectal carcinomas who had been admitted to the Department of Colorectal Surgery at Zhejiang Cancer Hospital from January 2008 to July 2022 were retrospectively collected.The patients were categorized into three groups based on the relative locations of their multiple cancer foci:(1)a right-sided group that comprised patients with multiple cancer foci in the cecum,ascending colon,hepatic flexure of the colon,and transverse colon;(2)a left-sided group that comprised patients with multiple cancer foci in the splenic flexure of the colon,descending colon,sigmoid colon,and rectum;and(3)a left-and right-sided group that comprised patients with multiple cancer foci in the right half of the colon and left half of the colon/rectum.Additionally,the patients were further divided into two groups based on microsatellite status:a high microsatellite instability(MSI-H)and a low MSI/stable MSI(MSI/L&MSS)group.We compared differences in clinical characteristics and prognostic indicators between these groups.Theχ^(2) test was utilized to compare selected clinical characteristics,whereas Kaplan-Meier survival analyses and log-rank tests were performed to compare their effects on prognosis.Result Among 278 patients with SSCRC,256(92.1%)presented with two cancer foci and 22(7.9%)with more than two foci.Additionally,255 patients(91.7%)had adenocarcinomas,whereas the remaining 23(8.3%)had mucinous adenocarcinomas.Lymph node metastases were identified in 136 patients(48.9%);the cancer foci had infiltrated beyond the muscular layer in 238(85.6%);and 147 patients(52.9%)were diagnosed with TNM Stage III–IV disease.There were 155 patients(55.8%)in the left-sided group,55(19.8%)in the right-sided group,and 68(24.5%)in the

关 键 词：结直肠癌 散发性同时性多原发 临床病理特征 预后 微卫星状态 

分 类 号：R735.34[医药卫生—肿瘤]