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Received:April 29, 2022 Published Online:February 20, 2023
Received:April 29, 2022 Published Online:February 20, 2023
中文摘要: 目的 探讨结直肠癌肠系膜癌结节(TD)的临床病理意义及其与DNA错配修复(MMR)蛋白表达的关系。方法 回顾性分析2018年1月至2021年12月广西中医药大学第一附属医院术后经病理确诊并进行免疫组化检测MMR蛋白4项(MLH1、MSH2、MSH6、PMS2)的393例结直肠癌患者临床病理特征,将4项蛋白全部阳性归为错配修复完整(pMMR)组,其余为MMR缺陷(dMMR)组,根据肠系膜TD数目分为TD阴性组、TD阳性组(TD数目≥1),比较各组间差异。 结果 dMMR组40例(10.2%),pMMR组353例(89.8%);TD阴性组331例(84.2%),TD阳性组62例(15.8%);TD与肿瘤分级、T分期及淋巴结转移有关(P<0.05),与性别、年龄、部位等无关(P>0.05);MMR蛋白表达与年龄、肿瘤分级、是否黏液腺癌有关(P<0.05),与肿瘤T分期、淋巴结转移、远处转移和TD无关(P>0.05)。结论 结直肠癌肠系膜TD是结直肠癌预后不良的指标,或可等同于转移阳性淋巴结进行分期;MMR蛋白表达缺失是青年、低分化、黏液性结直肠癌重要发病原因。
Abstract:ObjectiveTo investigate the clinicopathological significance of colorectal cancer with mesenteric tumor deposit(TD) and the relationship with DNA mismatch repair(MMR) protein expression. MethodsThe clinicopathological characteristics of 393 patients with colorectal cancer in the First Affiliated Hospital of Guangxi University of Chinese Medicine from January 2018 to December 2021 were retrospectively analyzed, all patients were diagnosed with postoperative pathology and the MMR proteins (MLH1, MSH2, MSH6, PMS2) were detected by immunohistochemistry. The patients were divided into the deficient mismatch repair (dMMR) group and proficiency mismatch repair(pMMR)group. According to the number of mesenteric TD, all the patients were divided into TD-negative group, TD-positive group (≥1). The differences between the groups were compared. ResultsThere were 40 cases (10.2%) in dMMR group, 353 cases (89.8%) in pMMR group, 331 cases (84.2%) in the TD-negative group, 62 cases (15.8%) in the TD-positive group. TD is related to tumor grading, T stage and lymph node metastasis (P<0.05), and did not related to gender, age, location, etc(P>0.05). MMR protein expression was related to age, tumor grade, and whether mucinous adenocarcinoma (P<0.05), and did not related to tumor T stage, lymph node metastasis, distant metastasis, and TD (P>0.05). ConclusionsMesenteric TD is an indicator of poor prognosis of colorectal cancer,and may be equivalent metastatic-positive lymph nodes to staging in non-mucinous adenocarcinoma. Loss of MMR proteins expression is an important cause of juvenile, low-differentiation, mucotic colorectal cancer.
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