老年结直肠癌患者MLH1和PMS2错配修复基因表达情况和临床病理特征分析

Analysis of association of MLH1 and PMS2 gene expression with clinicopathological features in elderly patients with colorectal cancer

目的分析老年结直肠癌患者的MLH1和PMS2错配修复基因表达情况,并分析其对临床病理特征的影响。方法本研究为单中心回顾性队列研究。连续性纳入2014年1月至2018年12月北京医院诊治的老年结直肠癌患者,按照MLH1和PMS2基因表达缺失情况分MLH1组(65例)和PMS2组(80例),比较两组与MLH1和PMS2基因正常表达患者的临床病理特征。结果 MHL1蛋白表达缺失患者中,男性、女性相似,少部分(16.9%)患者有肿瘤家族史,病理提示病变多为中分化(63.1%)和低中分化(24.6%),T分期多为T4(44.6%)和T3(27.7%),N分期多为N0(61.5%),M分期多为M0(89.2%),TNM分期多为Ⅲ期,病变多位于升结肠(61.5%)。与MHL1正常表达的患者比较,MHL1蛋白表达缺失组的年龄较小[(74.6±8.8)岁比(77.3±6.2)岁,t=-2.072,P=0.040],但肿瘤最长径较大[(5.7±2.3)cm比(4.4±1.3)cm,t=3.753,P<0.001],两组的病变分化程度、T分期和肿瘤部位均有明显差别(均P<0.05)。结论老年MLH1和PMS2基因表达缺失的结直肠癌患者的发病年龄早、肿瘤进展快,分化程度低,且与病理分期有关。

Objective To analyze the expression of mismatch repair genes MLHl and PMS2 in elderly colorectal cancer patients and its association with the clinicopathological features.Methods This study was a single-center retrospective cohort study,According to the loss of MLHl and PMS2 gene expression,elderly patients with colorectal cancer admitted to Beijing Hospital from January 2014 to December 2018 were consecutively enrolled and divided into the MLH1 group(n=65)and the PMS2 group(n=80).Pathological features were compared between the MLH1 group,the PMS2 group and patients with normal MLH1l and PMS2 gene expression.Results Among patients with the loss of MHL1 protein expression,pathological features were similar in males and females.A minority of patients(16.9%)had a family history of tumors.Most lesions were either moderately differentiated(63.1%)or poorly differentiated(24.6%).Regarding staging,44.6%were in stage T4,27.7%were in stage T3,61.5%were in N0,89.2%were in MO,and most patients were in TNM stageⅢl.Lesions were mostly located in the ascending colon(61.5%).Compared with patients with normal expression of MHL1,patients with the loss of MHL1 protein expression were younger[(74.6±8.8)years old vs.(77.3±6.2)years old,t=-2.072,P=0.040]and had greater maximal tumor length[(5.7±2.3)cm vs.(4.4±1.3)cm,t=3.753,P<0.001],and there were significant differences in lesion differentiation,T staging and tumor location between the two groups(P<0.05).Conclusions Loss of MLHl or PMS2 gene expression in elderly colorectal cancer patients is associated with an early age of onset,rapid tumor progression,poor differentiation,and pathological staging.