微卫星不稳定状态对散发性直肠癌预后影响.docVIP

微卫星不稳定状态对散发性直肠癌预后影响 　 作者：孟文建 孙晓峰 田超 王玲 于永扬 辜俊 夏庆杰 周总光 【摘要】 目的 研究汉族人散发性直肠癌的微卫星不稳定状态(microsatellite instability,MSI)及其与临床病理学和预后的关系。方法 应用PCR扩增患者肿瘤组织和对应正常组织的DNA，分析微卫星不稳定状态，并采用单因素、多因素分析评估预后。结果 MSI分为高频率微卫星不稳定(microsatellite instabilityhigh,MSIH)、低频率微卫星不稳定(microsatellite instabilitylow,MSIL)、微卫星稳定(microsatellite stability,MSS)。93例直肠癌患者中，MSIH 11例(12%)，MSIL和MSS分别为23例(25%)和59例(63%)。与MSIL和MSS相比，大多数MSIH为高分化肿瘤、患者年龄小、术前CEA水平高、总的生存率高。结论 在汉族人群散发性直肠癌中，MSIH发生率高，且MSI是一个相对较好的预后预测指标。 【关键词】 微卫星不稳定； 直肠肿瘤； 散发性 【Abstract】 Objective To investigate the relationship between microsatellite instability (MSI) status and clinicopathological features and prognosis of sporadic rectal cancer in Chinese Han population. Methods DNAs from freshfrozen paired samples of tumors and corresponding normal tissue from 93 rectal cancer patients were analyzed for MSI by PCR amplification. Cox proportional hazards model was used to assess prognostic significance. Results Eleven (12%) tumors in our study were highfrequency MSI (MSIH), 23 (25%) were lowfrequency MSI (MSIL) and 59 (63%) were microsatellite stable (MSS). Compared with MSIL and MSS tumors, most of the MSIH tumors were found in young patients, had high grade of differentiation and high level of preoperative serum carcinoembryonic antigen. The survival rates of rectal cancer patients with MSIH were higher than those with MSIL or MSS (RR, 2.373; 95% CI, 1.351 to 4.167, Plt;0.01). Conclusions There is high incidence of MSIH in sporadic rectal carcinoma in Chinese Han population. MSI is a comparatively good prognostic factor of sporadic rectal carcinoma. 【Key words】 Microsatellite instability; Rectal cancer; Sporadic 在国内，肿瘤引起的死亡中结直肠癌居第5位，并且有上升的趋势。过去30多年由于技术的进步使其病死率有所下降，但总的预后仍然很差。微卫星不稳定状态(microsatellite instability，MSI)的评估能为结直肠肿瘤提供有用的预后信息［1］。本研究旨在通过检测汉族人散发性直肠癌的微卫星不稳定状态，研究其与临床病理学和预后的关系。 1 材料与方法 1.1 临床资料 收集2002-2005年四川大学华西医院胃肠外科经手术切除的102例汉族患者直肠癌标本中的肿瘤组织与正常直肠黏膜组织。基于缺乏相关家族史，经详细询问，均被认为散发性。根据文献［2］，怀疑具有遗传性非息肉病性大肠癌的患者被排除。入选病例术前均未行放、化疗。10