错配修复蛋白在左、右半结肠癌组织中的表达差异及其临床意义

Difference of expression and clinical significance of mismatch repair proteins in left and right colon cancer tissues

目的:探讨错配修复(mismatch repair,MMR)蛋白在左半结肠癌(left colon cancer,LCC)和右半结肠癌(right colon cancer,RCC)组织中的表达及其临床意义。方法:收集2014年01月至2017年12月间在我院接受手术治疗的368例结肠癌患者的临床病理资料,根据肿瘤原发部位分为LCC组与RCC组,分析MMR蛋白在LCC、RCC组织中的表达是否存在显著差异,同时探讨LCC、RCC的临床病理特征,并分析MMR蛋白对LCC、RCC预后的指导意义。结果:368例结肠癌组织中dMMR为25.8%。单因素分析结果显示,在不同肿瘤部位MMR蛋白的表达有显著性差异(P<0.05),RCC组中dMMR为17.4%,明显高于LCC组的8.4%;另外LCC、RCC在肿瘤直径、分化程度、组织学类型上存在统计学差异(均P<0.05)。进一步Logistic多因素分析发现:肿瘤直径≥5 cm(OR=1.762,95%CI:1.144~2.713,P=0.010)、dMMR(OR=2.672,95%CI:1.617~4.417,P=0.000)均为RCC的独立相关因素。Kaplan-Meier生存分析显示,dMMR组患者的OS显著高于pMMR组患者(P=0.035);经肿瘤部位分层分析发现,RCC组中dMMR患者的OS显著高于pMMR患者(P=0.004),但在LCC组中dMMR患者与pMMR患者的OS无显著性差异(P=0.951)。结论:RCC中dMMR发生率明显高于LCC,且仅在RCC中提示着较好的预后作用,而在LCC中无预后指示作用。

Objective:To investigate the expression of mismatch repair(MMR)protein in left colon cancer(LCC)and right colon cancer(RCC)and its clinical significance.Methods:The clinicopathological data of 368 colon cancer patients who underwent surgical treatment in our hospital from January 2014 to December 2017 were collected.According to the primary tumor site,they were divided into LCC group and RCC group,and the MMR protein was analyzed.Whether there were significant differences in the expression of left and right colon cancer tissues,the clinicopathological characteristics of left and right colon cancers were discussed at the same time,and the guiding significance of MMR protein to the prognosis of left and right colon cancers was analyzed.Results:The incidence rate of dMMR in 368 colon cancer tissues was 25.8%.The results of single factor analysis showed that the incidence of MMR protein in different tumor sites was significantly different(P<0.05).The expression rate of dMMR in RCC group was 17.4%,which was significantly higher than the 8.4%of the LCC group.In addition,there were statistical differences in tumor diameter,differentiation degree,and histological type between LCC and RCC(all P<0.05).Logistic multivariate analysis found that tumor diameter≥5 cm(OR=1.762,95%CI:1.144~2.713,P=0.010),dMMR(OR=2.672,95%CI:1.617~4.417,P=0.000)were independent factors related to RCC.Kaplan-Meier survival analysis showed that the OS of the dMMR group was significantly higher than that of the pMMR group(P=0.035).After stratified analysis of tumor location,the OS of dMMR patients in the RCC group was significantly higher than that of pMMR patients(P=0.004),but in the LCC group,there was no significant difference in OS between dMMR patients and pMMR patients(P=0.951).Conclusion:The incidence of dMMR in RCC is significantly higher than that in LCC,and it only suggests a better prognostic effect in RCC,but no prognostic indicator in LCC.