K-ras基因突变与微卫星不稳定性结肠癌患者病理分期及生存率的关系

Relationship between K-ras gene mutation and microsatellite instability colon cancer pathological staging and survival rate

目的探讨K-ras基因突变与微卫星不稳定性(MSI)结肠癌患者病理分期及生存率的关系。方法选取2016年6月至2018年6月在上海交通大学医学院附属瑞金医院进行结肠癌外科手术的120例患者。采用聚合酶链反应检测结肠癌组织中K-ras基因突变,采用免疫组织化学方法检测结肠癌组织中MSI变化情况。出院后随访2年,观察K-ras基因突变与MSI患者临床特征及生存率的关系。结果 120例结肠癌患者中MSI 36例,微卫星稳定(MSS) 84例,MSI患者K-ras基因突变型比例明显低于MSS患者[33.3%(12/36)比60.7%(51/84)],差异有统计学意义(P <0.05)。36例MSI患者中高频MSI(MSI-H) 10例,低频MSI(MSI-L) 26例。MSI-H患者K-ras基因突变型比例明显低于MSI-L患者[2/10比38.5%(10/26)],差异有统计学意义(P <0.05)。MSI结肠癌患者K-ras基因突变与TNM分期Ⅲ~Ⅳ期及癌胚抗原表达升高相关(均P <0.05)。K-ras基因野生型与突变型MSI患者随访2年生存率比较差异无统计学意义(P>0.05)。结论 MSI结肠癌患者存在K-ras基因突变,与患者TNM分期Ⅲ~Ⅳ期及癌胚抗原表达升高相关,对患者生存率无明显影响。

Objective To explore the relationship between K-ras gene mutation and microsatellite instability( MSI) colon cancer pathological staging and survival rate. Methods From June 2016 to June 2018,120 patients undergoing colon cancer surgery in Ruijin Hospital,School of Medicine,Shanghai Jiaotong University were selected. The mutation of K-ras gene was detected by polymerase chain reaction,and the change of MSI was detected by immunohistochemistry. After discharge for 2 years,the relationship between K-ras gene mutation and clinical characteristics and survival rate of MSI patients was observed. Results There were 36 cases of MSI and84 cases of microsatellite stable( MSS) in 120 patients with colon cancer. The proportion of K-ras gene mutation in MSI patients was significantly lower than that in MSS patients[33. 3%( 12/36) vs 60. 7%( 51/84) ]( P < 0. 05).In 36 cases of MSI,10 cases had high frequency MSI( MSI-H) and 26 cases had low frequency MSI( MSI-L).The proportion of K-ras gene mutation in MSI-H patients was significantly lower than that in MSI-L patients[2/10 vs38. 5%( 10/26) ]( P < 0. 05). The K-ras gene mutation in MSI colon cancer patients was associated with TNM stage Ⅲ-Ⅳ and carcinoembryonic antigen( CEA) expression increase( both P < 0. 05). There was no significant difference in the survival rate between the K-ras gene wild type and mutant type in MSI patients during 2 years follow-up period( P > 0. 05). Conclusion There are K-ras gene mutations in patients with MSI colon cancer,which are related to the TNM stage Ⅲ-Ⅳ and the increase of CEA,and have no significant effect on the survival rate of patients.