左右半结肠癌生物学特征的差异及常用病理标志的临床意义

Differences in biological characteristics of left-and right-sided colon cancers and clinical significance of common pathological markers

目的比较左右半结肠癌生物学特征的差异,探讨常用病理标志的临床意义。方法回顾性分析中大医院和南京江北人民医院2014年1月至2015年12月首诊的73例左半结肠癌患者及67例右半结肠癌患者的临床资料,并对患者进行为期1~3年的随访,截止时间为2018年5月,分析不同半侧结肠癌患者生物学特征的差异及常用病理标志的临床意义。结果左半结肠癌发病人群以男性(64.38%)为主,右半结肠癌以女性(56.72%)为主(P<0. 05);而在年龄及家族史方面差异无统计学意义(P>0.05)。左半结肠癌患者血便、大便习惯改变等症状发生率较右半结肠癌高,而腹痛、消瘦+贫血等症状发生率较右半结肠癌低(P<0.05,P<0.01),两组患者病史长度比较差异无统计学意义(P>0.05)。左半结肠癌以中分化腺癌为主,右半结肠癌以中、低分化腺癌为主;右半结肠黏液型比例及肿瘤最大径≥5 cm者比例较左半结肠癌高,溃疡型比例较左半结肠癌低(P<0.01,P<0.05),两组肿瘤分期、组织浸润、神经侵犯、脉管内癌栓等方面的比较差异无统计学意义(P>0.05)。术后随访1~3年,左、右半结肠癌患者预后不良率分别为16.44%、11.94%(P>0. 05),1年死亡率分别为1.37%、1.49%(P>0. 05)。常用病理标志中,左、右半结肠癌患者DNA错配修复基因蛋白MLH1、MSH2及P53等免疫组化指标表达程度比较差异明显(P<0.05),而两组患者环氧合酶(COX)-2、血管内皮生长因子(VEGF)、人表皮生长因子受体(HER)-2、表皮生长因子受体(EGFR)及Ki-67等指标阳性表达率比较无统计学意义(P>0.05),两组患者均伴有COX-2、EGFR较高阳性表达。结论左、右半结肠癌患者在性别、临床症状、病理类型等方面存在差异,均高表达COX-2、EGFR,左半结肠癌患者MLH1、MSH2、P53表达程度显著高于右半结肠癌患者,这对分子标志物指导下的结肠癌精准治疗具有重要意义。

Objective To compare the biological characteristics of left-and right-sided colon cancers and explore the clinical significance of commonly used pathological markers. Methods A retrospective analysis was performed on the clinical data of 73 patients with left-sided colon cancer( group A) and 67 patients with right-sided colon cancer( group B),who were first diagnosed in Zhongda Hospital and Jiangbei People’ s Hospital from January 2014 to December 2015. The biological characteristics and the clinical significance of common pathological markers were compared between two groups.Results There was a significant difference in gender between two groups( P<0. 05). The majority of patients with leftsided colon cancer were males( 64. 38%),and the majority of patients with right-sided colon cancer were females( 56. 72%). There were no significant differences in age and family history( all P>0. 05). Compared to patients with rightsided colon cancer,The incidence rates of bloody stool and change of stool habits were higher,while the incidence rates of abdominal pain,emaciation and anemia were less in left-sided colon cancer patients compared to right-sided colon cancer patients( all P<0. 05). There was no significant difference in the length of disease history between two groups( P>0. 05).Left-sided colon cancer was mainly composed of moderately differentiated adenocarcinoma,and right-sided colon cancer was mainly composed of moderately and poorly differentiated adenocarcinoma. Compared with left-sided colon cancer,the proportion of mucinous type and tumor’ s maximum diameter ≥ 5 cm was significantly higher,and the proportion of ulcerative type was lower in right-sided colon cancer( all P<0. 05). There were no significant differences in tumor staging,tissue infiltration,nerve invasion,intravascular cancer thrombus between two groups( all P > 0. 05). During 1 to 3 years postoperative follow-up,the poor prognosis rates of patients with left-sided and right-sided colon cancers were 16. 44% and11. 94% respectively( P>0. 05),and 1-year mortality rates were 1. 37% and 1. 49%,respectively( P>0. 05). There were significant differences in expression levels of immunohistochemical markers such as MutL-homo-logue1( MLH1),MSH2 and P53 between two groups( all P < 0. 05),but no differences in the positive levels of cyclooxygenase( COX-2),vascular endothelial growth factor( VEGF),human epidermal growth factor receptor 2( HER-2),estimated glomerular filtration rate( EGFR),Ki-67,etc.( all P>0. 05). All patients were accompanied by high expressions of COX-2 and EGFR. Conclusions There are significant differences in gender,clinical symptoms and pathological types between left-and right-sided colon cancer patients,and all patients are associated with high expressions of COX-2 and EGFR. The expression levels of MLH1,MSH2 and P53 in left-sided colon cancer are significantly higher than those in right-sided colon cancer,which is of great significance for the precise treatment of colon cancer guided by molecular markers.