MSH2、MLH1、MSH6和PMS2对直肠癌的诊断价值及预后预测效能

The Diagnostic Value and Prognostic Predictive Efficacy of MSH2,MLH1,MSH6,and PMS2 in Rectal Cancer

目的:探讨MSH2、MLH1、MSH6和PMS2相关错配修复蛋白对直肠癌的诊断价值及预后预测效能。方法:选取我院2020年1月—2022年12月治疗的78例直肠癌患者作为观察组,另选取同期收治的78例直肠良性肿瘤患者作为对照组。取所有患者肿瘤组织进行免疫组化检验,检测错配修复蛋白MSH2、MLH1、MSH6、PMS2表达情况。建立受试者工作特征曲线(ROC),分析MSH2、MLH1、MSH6、PMS2对直肠癌的诊断价值。所有直肠癌患者依照其病变程度均采取积极的手术、化疗及靶向治疗,对观察组患者进行1年随访,将发生新的转移灶、复发灶及死亡的20例患者判定为预后不良,设为预后不良组,其余58例患者设为预后良好组,建立logistic回归分析模型,以预后情况作为因变量,分析MSH2、MLH1、MSH6、PMS2对直肠癌预后预测价值。结果:观察组患者MSH2、MLH1、MSH6、PMS2阳性率及缺失率明显高于对照组(P<0.05);通过绘制ROC曲线,分析MSH2、MLH1、MSH6、PMS2对直肠癌的诊断效能,结果显示,错配修复蛋白MSH2、MLH1、MSH6、PMS2联合对直肠癌的诊断敏感度为72.78%,特异度为85.37%,联合诊断明显高于单一指标诊断(P<0.05);对比预后良好组和预后不良组患者的性别、年龄、BMI、肿瘤位置、肿瘤直径差异无统计学意义(P>0.05),预后良好组与预后不良组患者TNM分期、组织分化程度、MSH2缺失率、MLH1、MSH6、PMS2阳性率与缺失率对比差异显著(P<0.05);结果显示,TNM分期、组织分化程度、MSH2缺失率、MLH1、MSH6、PMS2阳性率与缺失率为直肠癌预后独立影响因素(P<0.05)。结论:直肠癌患者肿瘤组织内可发现大量错配修复蛋白MSH2、MLH1、MSH6和PMS2阳性表达及表达缺失情况,错配修复蛋白可辅助提升直肠癌诊断敏感度与特异度,且可用于预测患者预后水平。

Objective:To explore the diagnostic value and prognostic predictive efficacy of mismatch repair proteins related to MSH2,MLH1,MSH6,and PMS2 in rectal cancer.Methods:78 patients diagnosed with rectal cancer admitted to our hospital between January 2020 and December 2022 were selected as the observation group.In addition,78 patients with benign rectal tumors admitted during the same period were selected as the control group.Take all tumor tissues from patients for immunohistochemical testing to assess the expression of mismatch repair proteins MSH2,MLH1,MSH6,and PMS2.Establish a receiver operating Characteristics curve(ROC)to analyze the diagnostic value of MSH2,MLH1,MSH6,and PMS2 for rectal cancer.All rectal cancer patients were treated with active surgery,chemotherapy,and targeted therapy based on their degree of lesion.Patients in the observation group will be followed up for 1 year,20 patients with new metastases,relapses,and deaths were judged as poor prognosis and set as poor prognosis group.The others 58 patients were set as good prognosis group.A logistic regression analysis model was established to analyze the predictive value of MSH2,MLH1,MSH6,and PMS2 for rectal cancer prognosis,with prognosis as the dependent variable.Results:The positive and missing rates of MSH2,MLH1,MSH6,and PMS2 in the observation group were significantly higher than those in the control group(P<0.05).By plotting the ROC curve,the diagnostic efficacy of MSH2,MLH1,MSH6,and PMS2 in rectal cancer was analyzed.The results showed that the combination of mismatch repair proteins MSH2,MLH1,MSH6,and PMS2 had a diagnostic sensitivity of 72.78%and a specificity of 85.37%for rectal cancer,and the combined diagnosis was significantly higher than the single indicator diagnosis(P<0.05).Gender,age,BMI,tumor location and tumor diameter were compared between the poor prognosis group and the good prognosis group,and the corresponding differences were not statistically significant(P>0.05).However,there was a significant difference in TNM staging,tissue differentiation,MSH2 deletion rate,MLH1,MSH6,and PMS2 positivity and deletion rate between the good prognosis group and the poor prognosis group(P<0.05).The results showed that TNM staging,degree of tissue differentiation,MSH2 deficiency rate,MLH1,MSH6,PMS2 positive rate and deficiency rate were independent prognostic factors for rectal cancer(P<0.05).Conclusion:A large number of mismatch repair proteins MSH2,MLH1,MSH6,and PMS2 positive and missing expressions can be found in the tumor tissue of rectal cancer patients.Mismatch repair proteins can assist in improving the diagnostic sensitivity and specificity of rectal cancer,and can be used to predict the prognosis of patients.