2021 年第 5 期 第 16 卷

错配修复蛋白表达状态与Ⅱ期结直肠癌患者临床病理特征的相关性及对预后的影响

Relevance between mismatch repair protein expression status and clinicopathological features of patients with stage Ⅱ colorectal cancer and its impact on prognosis

作者：胡雪晴1赵赟博1杜俊2王晖1张子瑾1黄莹莹1

英文作者：Hu Xueqing1 Zhao Yunbo1 Du Jun2 Wang Hui1 Zhang Zijin1Huang Yingying1

单位：1北京医院肿瘤内科国家老年医学中心中国医学科学院老年医学研究所100730；2北京医院病理科国家老年医学中心中国医学科学院老年医学研究所100730

英文单位：1Department of Oncology Beijing Hospital National Center of Gerontology Institute of Geriatric Medicine Chinese Academy of Medical Sciences Beijing 100730 China; 2Department of Pathology Beijing Hospital， National Center of Gerontology Institute of Geriatric Medicine Chinese Academy of Medical Sciences Beijing 100730 China

关键词：结直肠癌；错配修复蛋白；预后

英文关键词：Colorectalcancer;Mismatchrepairprotein;Prognosis

• 摘要：

• 目的 探讨错配修复蛋白表达状态与Ⅱ期结直肠癌患者临床病理特征的相关性及对预后的影响。方法 纳入北京医院2012年1月至2016年2月收治的267例接受根治性手术治疗的Ⅱ期结直肠癌患者行回顾性研究，分析患者病理特征、临床预后与错配修复蛋白表达状态的相关性。结果 267例患者平均年龄(67±13)岁，错配修复蛋白表达缺失45例（16.9%）。患者肿瘤原发部位为右半结肠的错配修复蛋白表达缺失比例高于左半结肠和直肠者，组织学分级高级别者表达缺失比例高于低级别者，BRAF V600E基因突变型者表达缺失比例高于野生型者，差异均有统计学意义（均P<0.01）。错配修复蛋白表达缺失组5年无疾病生存（DFS）率为82.2%（37/45），表达完整组5年DFS率为64.0%（142/222），生存曲线显示表达缺失组DFS情况优于表达完整组（Log-rank P=0.039）。102例高危Ⅱ期结直肠癌患者中接受辅助化疗（无论单药或双药）者DFS情况优于无辅助化疗者（Log-rank P=0.018）。多因素Cox回归分析结果 显示美国东部肿瘤协作组评分（风险比=0.366，95%置信区间：0.123～0.983，P=0.031）、T分期（风险比=2.313，95%置信区间：1.332～4.653，P=0.014）是影响高危Ⅱ期结直肠癌患者DFS的危险因素。结论 错配修复蛋白表达缺失是Ⅱ期结直肠癌患者良好预后因素之一，高危Ⅱ期结直肠癌患者无论错配修复蛋白状态如何接受辅助化疗均可使DFS获益。

• Objective To explore the relevance between mismatch repair(MMR) protein expression status and clinicopathological features of patients with stage Ⅱ colorectal cancer(CRC) and its impact on prognosis. Methods From January 2012 to February 2016, 267 patients with stage Ⅱ CRC who underwent radical surgery in Beijing Hospital were enrolled in this retrospective study. The correlation between pathological characteristics, clinical prognosis and MMR protein expression status was analyzed. Results The age of 267 patients was (67±13)years. There were 45 cases(16.9%) with defective MMR(dMMR). The proportion of dMMR in the primary right colon was higher than that in the left colon and rectum, the proportion of dMMR in the high-grade histologic patients was higher than that in the low-grade histologic patients, and the proportion of dMMR in the BRAF V600E mutant patients was higher than that in the wild-type patients(all P<0.01). The 5-year disease-free survival(DFS) rate was 82.2%(37/45) in the dMMR group and 64.0%(142/222) in the proficient MMR(pMMR) group. The survival curve showed that the DFS rate in the dMMR group was better than that in the pMMR group(Log-rank P=0.039). The DFS of 102 patients with high risk stage Ⅱ CRC who received adjuvant chemotherapy (single or double drug) was better than that without adjuvant chemotherapy(Log-rank P=0.018). Multivariate Cox regression analysis showed that Eastern Cooperative Oncology Group score（hazard ratio= 0.366， 95% confidence interval: 0.123-0.983， P=0.031） and T stage（hazard ratio=2.313， 95% confidence interval: 1.332-4.653， P=0.014） were risk factors for DFS in high-risk patients with stage Ⅱ CRC. Conclusions dMMR is one of the good prognostic factors for patients with stage Ⅱ CRC. High risk stage Ⅱ CRC patients may benefit from adjuvant chemotherapy regardless of MMR status.