Ⅱ期结肠癌组织中微卫星不稳定状态及其与患者预后的关系

Status and clinical value of microsatellite instability in stage Ⅱ colon cancer

目的探讨Ⅱ期结肠癌组织中微卫星不稳定（microsatellite instability，MSI）状态及其与患者预后的关系。方法回顾性分析北京大学肿瘤医院行根治性手术而未接受辅助化疗的120例Ⅱ期结肠癌患者的临床病理资料。同时检测手术切除标本的MSI表达状态，分析MSI与患者预后及其临床病理因素的关系。结果本组120例Ⅱ期结肠癌患者中，微卫星高度不稳定的发生率为20．8％。MSI状态与肿瘤的分化程度相关（χ^2=9．69，P=0．021），与肿瘤的复发转移无关（P=0．584）。MSI状态与Ⅱ期结肠癌患者5年无疾病生存时间和总生存时间均无关（均P〉0．05）。结论Ⅱ期结肠癌组织中MSI状态与肿瘤分化程度相关，但是还不能作为Ⅱ期结肠癌患者预后的评价指标。

Objective To evaluate the prognostic value of microsatellite instability （MSI） in stage Ⅱ colon cancer patients. Methods 120 stage Ⅱ colon cancer patients underwent radical resection in the Department of Colorectal Surgery, Beijing Cancer Hospital from 2000 to 2007. Tissue samples were collected and DNA was extracted for MSI determination using PCR following the Pentaplex panel. Clinical parameters were also combined and analyzed statistically to explore the association between MSI status and clinical parameters. Results The incidence of high frequency of microsatellite instability （MSI-H） was 20. 8 % in these 120 stage Ⅱ colon cancer patients. There was a significant correlation between the status of MSI and tumor differentiation （χ^2 = 9. 69, P = 0. 021 ） ; However MSI status was demonstrated to be a prognostic factor for disease free survival or overall survival （ all P 〉 0. 05 ）. Nor was MSI status associated with tumor relapse or metastasis. Age and preoperative serum CEA level were identified as independent factors for DFS by Cox regression. Conclusion In stage Ⅱ colon cancer patients, MSI status correlates with tumor differentiation, but is not a prognostic factor.