MMR与结直肠癌患者化疗敏感性的关系  

Relationship between mismatch repair gene MMR and chemotherapy sensitivity in advanced colorectal cancer patients with prognosis

作　　者：谢雅 孙培春 张建成 闫文锋 夏晓博 XIE Ya;SUN Pei-chun;ZHANG Jian-cheng;YAN Wen-feng;XIA Xiao-bo(Department of Gastrointestinal Surgery,Hennan Provincial People’s Hospital,People’s Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]河南省人民医院胃肠外科,郑州大学人民医院,郑州450000

出　　处：《医药论坛杂志》2024年第5期477-481,共5页Journal of Medical Forum

摘　　要：目的探究错配修复基因MMR与晚期结直肠癌患者化疗敏感性及预后的关系。方法回顾性收集分析2010年1月—2015年1月河南省人民医院胃肠外科接受过标准化疗且有完整资料的100例晚期结直肠癌患者临床病理资料及预后信息。免疫组织化学检测结直肠癌组织MLH1、PSM2、MSH2、MSH6蛋白表达情况,并分为pMMR及dMMR组,比较两组化疗敏感性和预后。结果免疫组化结果显示,MMR蛋白阳性染色表达定位于细胞核,部分可伴有胞质微弱着色;其中14例(14.0%)患者判读为MMR蛋白表达缺失即dMMR;其余86例(86%)患者为pMMR。MMR蛋白表达与结直肠癌的淋巴转移、肿瘤远期转移位置有关,且差异有统计学意义(均P<0.05),而与年龄、性别、肿瘤大小及位置、分化程度、浸润深度及血清CEA等无关(均P>0.05)。根据随访及治疗效果评价,dMMR组治疗敏感率为57.14%,pMMR组治疗敏感率为27.91%,差异有统计学意义(P<0.05)。同时,dMMR组患者生存期明显长于pMMR组,且差异有统计学意义(OR:0.446595%CI 0.2443~0.8158 P<0.05)。Cox回归模型单因素及多因素显示,浸润程度、淋巴结转移、远处转移位置及MMR蛋白表达是晚期结直肠癌患者总生存期的独立因素(均P<0.05)。而年龄、性别、肿瘤大小、位置、分化程度及血清CEA与生存期无密切关系(P>0.05)。结论肿瘤标记物MMR对晚期结直肠癌患者的后续免疫治疗尤为重要,微卫星状态的不同使其具有个体化的临床病理特征,微卫星状态检测和免疫组织化学指标对晚期结直肠癌患者的治疗和预后均存在重要的指导作用。Objective To investigate the Relationship between mismatch repair gene MMR and chemotherapy sensitivity in advanced colorectal cancer patients with prognosis.Methods The clinicopathological data and prognosis of 100 advanced colorectal cancer patients who received standard chemotherapy in Gastrointestinal Surgery Department of Hennan Provincial People’s Hospital from January 2010 to January 2015 were retrospectively analyzed.Immunohistochemistry was used to de⁃tect the protein expression of MLH1,PSM2,MSH2,and MSH6 in colorectal cancer tissues,and they were divided into pM⁃MR and dMMR groups to compare the chemotherapy sensitivity and prognosis of the two groups.Results Immunohistochemical staining showed that the positive expression of MMR protein was localized in the nucleus,and some of them were accompanied by weak staining of cytoplasm.Among them,14 patients(14.0%)were interpreted as missing MMR protein expression,namely dMMR.The other 86 patients(86%)were pMMR.MMR protein expression was associated with lymph node metastasis and metastasis of colorectal cancer,with statistically significant differences(all P<0.05),but not with age,gender,tumor size and location,degree of differentiation,infiltration depth,serum CEA,etc.(all P>0.05).According to the follow-up and evaluation of treatment effect,the treatment sensitivity rate of the dMMR group was 57.14%,and the treatment sensitivity rate of the pMMR group was 27.91%,which was statistically different(P<0.05).Meanwhile,the survival prognosis of patients in the dMMR group was significantly longer than that in the pM⁃MR group,which had a statistically difference(OR:0.446595%CI 0.2443-0.8158 P<0.05).Univariate and multivariate Cox regression model showed that infiltration,lymph node metastasis,distant metastasis,and MMR protein expression were independent factors for the overall survival of patients with advanced colorectal cancer(all P<0.05).However,age,gender,tumor size,location,differentiation degree and serum CEA were not closely related to survival(P>0.0

关 键 词：错配修复基因 晚期结直肠癌 化疗敏感性 预后 

分 类 号：R735.3[医药卫生—肿瘤]