微卫星不稳定性与Ⅱ期和Ⅲ期结肠癌患者的临床病理特征及预后的关系

Association of microsatellite instability with clinicopathological features and prognosis of colon cancer patients

目的:探讨微卫星不稳定性(microsatellite instability,MSI)状态与Ⅱ期和Ⅲ期结肠癌患者的临床病理特征及预后的关系。方法:回顾性选取2016年12月至2018年11月在青岛大学附属医院接受手术切除原发灶的Ⅱ期和Ⅲ期结肠癌患者292例,检测其MSI状态,将两组患者按照1∶1匹配,应用χ2检验、Logistic回归、COX回归分析MSI状态与Ⅱ期和Ⅲ期结肠癌患者的临床病理特征及预后的关系。结果:高度MSI的风险在年轻患者(OR=0.340,95%CI:0.126~0.921,P=0.034)、肿瘤于右半结肠(OR=7.985,95%CI:3.040~20.973,P<0.001)、病理倾向于黏液腺癌(OR=4.285,95%CI:1.495~12.284,P=0.007)、分化更差(OR=4.848,95%CI:1.597~14.716,P=0.005)、N0分期(OR=0.235,95%CI:0.077~0.719,P=0.011)的结肠癌患者中增加。微卫星稳定组结肠癌患者总生存率(66.7%)与MSI-H组总生存率(86.9%)差异有统计学意义(P=0.003),COX回归分析显示MSI状态(HR=0.367,95%CI:0.151~0.891,P=0.027)是影响结肠癌患者预后的独立因素。结论:在Ⅱ期和Ⅲ期结肠癌中,MSI-H肿瘤具有其独特的临床病理学特征,MSI状态可以为患者的预后评估提供依据。

ObjectiveTo investigate the relationship between microsatellite instability(MSI),and clinicopathological features,prognosis in patients with stageⅡandⅢcolon cancer.MethodsPatients undergoing surgical resection for stageⅡandⅢcolonic tumor in the Affiliated Hospital of Qingdao University from Dec 2016 to Nov 2018 were enrolled.All the 292 patients were with stageⅡandⅢcolon cancer and MSI status.Propensity score matching method was used to match the two groups of patients according to 1:1.χ^(2)analysis,Logistic Regression and COX regression was used to analyse the relationship between MSI status,the clinicopathological features and prognosis.ResultsThe risk of MSI-H in young patients(OR=0.340,95%CI:0.126~0.921,P=0.034),right-sided colon cancer(OR=7.985,95%CI:3.040-20.973,P<0.001),mucinous adenocarcinoma(OR=4.285,95%CI:1.495-12.284,P=0.007),poorer differentiation(OR=4.848,95%CI:1.597-14.716,P=0.005),N0 staging(OR=0.235,95%CI:0.077-0.719,P=0.011)increased.The total OS of colon cancer patients in the MSS group(66.7%)and the MSI-H group(86.9%)were statistically different(P=0.003).The MSI status(HR=0.367,95%CI:0.151-0.891,P=0.027)is an independent factor affecting the prognosis of patients.ConclusionsIn stageⅡandⅢcolon cancer,patients with MSI-H have a better prognosis.MSI status is prognosis relevant factor for colon cancer patients.