管状腺癌伴有黏液腺癌分化结直肠癌临床病理与免疫组织化学特征

Clinicopathological and immunohistochemical characteristics of tubular adenocarcinoma with mucinous adenocarcinoma differentiation in colorectal cancer

目的探讨管状腺癌伴有黏液腺癌分化的结直肠癌(CRC)临床病理及免疫组织化学特征。方法选取芜湖市第一人民医院自2018年1月至2022年6月收治的181例CRC患者为研究对象。根据不同病理类型将其分为管状腺癌伴有黏液腺癌分化CRC组(n=33)、黏液腺癌组(n=17)、管状腺癌组(n=131)。采用免疫组织化学法检测并比较3组患者错配修复蛋白(MMRP)、P53等表达情况。记录并比较3组患者各项临床病理特征及复发/转移发生率。结果管状腺癌伴有黏液腺癌分化CRC组患者肿瘤最大径≥4.5 cm、发生在右半结肠比例均高于管状腺癌组,P53阳性表达比例低于管状腺癌组,差异均有统计学意义(P<0.05)。管状腺癌伴有黏液腺癌分化CRC组与黏液腺癌组患者年龄、性别、肿瘤最大径、发生部位、肿瘤浸润深度、淋巴结转移、脉管侵犯、P53表达及MMRP缺失比较,差异均无统计学意义(P>0.05)。黏液腺癌组患者肿瘤最大径≥4.5 cm、发生在右半肠、肿瘤浸润深度为T_(3)+T_(4)比例高于管状腺癌组,P53阳性表达比例低于管状腺癌组,差异均有统计学意义(P<0.05)。管状腺癌伴有黏液腺癌分化CRC、黏液腺癌、管状腺癌患者复发/转移发生率分别为14.81%(4/27)、14.29%(2/14)、7.70%(9/117),两两比较,差异均无统计学意义(P>0.05)。结论管状腺癌伴有黏液腺癌分化CRC与黏液腺癌均好发于右半结肠,肿瘤较大,P53突变率较低,以上特征均与是否含有黏液相关,与黏液量是否>50%无关。

Objective To investigate the clinicopathological and immunohistochemical characteristics of colorectal cancer(CRC)with tubular adenocarcinoma accompanied by mucinous adenocarcinoma differentiation.Methods A total of 181 CRC patients admitted to First People′s Hospital of Wuhu from January 2018 to June 2022 were selected as the research subjects.According to different pathological types,they were divided into tubular adenocarcinoma with mucinous adenocarcinoma differentiation CRC group(n=33),mucinous adenocarcinoma group(n=17)and tubular adenocarcinoma group(n=131).Immunohistochemistry was used to detect and compare the expression of mismatch repair protein(MMRP)and P53 in 3 groups.The clinicopathological features and incidence of recurrence/metastasis in 3 groups were recorded and compared.Results The CRC group with tubular adenocarcinoma and mucinous adenocarcinoma differentiation had higher tumor maximum diameter≥4.5 cm,higher proportion of tumors occurring in right colon,and lower P53 positive expression ratio than the tubular adenocarcinoma group,the differences were statistically significant(P<0.05).There were no significant differences in age,gender,tumor size,location,depth of tumor invasion,lymph node metastasis,vascular invasion,P53 expression and MMRP loss between CRC group and mucinous adenocarcinoma group(P>0.05).In the mucinous adenocarcinoma group,the proportion of tumor maximum diameter≥4.5 cm,tumor invasion depth of T_(3)+T_(4)in the right half intestine was higher than that in the tubular adenocarcinoma group,and the positive expression of P53 was lower than that in the tubular adenocarcinoma group,with statistical significance(P<0.05).The incidence of recurrence/metastasis of CRC,mucinous adenocarcinoma and tubular adenocarcinoma with mucinous adenocarcinoma was 14.81%(4/27),14.29%(2/14)and 7.70%(9/117),respectively,with no statistical significance(P>0.05).Conclusion Tubular adenocarcinoma accompanied by mucinous adenocarcinoma differentiation both CRC and mucinous adenocarcinoma tend to occur in the right colon,with large tumors and low P53 mutation rate.All the above characteristics are related to the presence of mucus,but not the presence of mucus>50%.