267例错配修复状态缺失/高度微卫星不稳定表型结直肠肿瘤临床病理特征及亚组分析

Clinicopathologic characteristics and subgroup analysis in 267 cases d MMR/MSI-H colorectal cancer

目的探讨错配修复状态缺失/高度微卫星不稳定(dMMR/MSI-H)表型结直肠癌临床病理特征及亚组分析。方法回顾性分析2016年5月至2022年8月在广东省中医院医院就诊的267例dMMR/MSI-H表型结直肠癌的临床病理资料并进行交叉亚组分析。结果男女患者分别为139和128例,平均年龄为(59.8±16.0)岁。MLH1和PMS2同时表达缺失率为58.1%(154/265),MSH2和MSH6同时表达缺失率18.5%(49/265),90例(33.7%)发生区域淋巴结转移。亚组分析提示右半结肠肿瘤分化程度更差,脉管浸润率更高;淋巴结转移患者分化更差,T3~4期率更高,神经脉管浸润和癌结节出现率更高;肿瘤长径≥8 cm患者区域淋巴结转移率更高,分化更差,T3~4期率更高,脉管浸润和癌结节出现率更高;分化差患者T3~4期率更高,脉管浸润和癌结节出现率更高;T分期晚患者神经脉管浸润和癌结节出现率更高。结论dMMR/MSI-H表型结直肠癌具有独特的临床病理特征,且相互间存在紧密关联。

Objective To investigate the clinicopathological characteristics of dMMR/MSI-H colorectal cancer and their relationship.Method The clinicopathological data of 267 patients with dMMR/MSI-H phenotype colorectal cancer treated in Guangdong Hospital of Traditional Chinese Medicine from May2016 to August 2022 were retrospectively analyzed and cross subgroup analysis was performed.Result 139male and 128 female patients were included with an average age of(59.8±16.0)years.The common loss rate of simultaneous expression of MLH1 and PMS2 was 58.1%(154/265),the loss rate of simultaneous expression of MSH2 and MSH6 was 18.5%(49/265),and 90 cases(33.7%)developed regional lymph node metastasis.Subgroup analysis showed that the differentiation of right colon tumors was worse and the vascular invasion rate was higher;Patients with lymph node metastasis had worse differentiation,higher T3-T4stage rate,higher neurovascular invasion and higher incidence of cancer nodules;Patients with tumor length≥8 cm had higher regional lymph node metastasis rate,worse differentiation,higher T3-T4stage rate,higher vascular invasion and higher incidence of cancer nodules;Patients with poor differentiation had a higher rate of stage T3-T4,vascular invasion and cancer nodules;The incidence of neurovascular invasion and cancer nodules was higher in patients with late T stage.Conclusion Colorectal cancer with d MMR/MSI-H phenotype has unique clinicopathological characteristics and is closely related to each other.