伴有错配修复缺陷的病理Ⅱ期结直肠癌临床病理特征分析及生存分析
The analysis of clinicopathological characteristics and survival of pathological stage Ⅱ colorectal cancer with mismatch repair deficiency status
程璞 1郑朝旭1
作者信息
- 1. 100021 北京,国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院结直肠外科
- 折叠
摘要
目的 探究伴有错配修复缺陷(dMMR)的病理Ⅱ期结直肠癌患者临床病理特征及其生存分析.方法 纳入2011年1月至2017年12月在中国医学科学院肿瘤医院接受手术治疗后经病理免疫组化检查确诊伴有dMMR的病理Ⅱ期结直肠癌患者的临床病理资料.随后进行关于5年总体生存期(OS)和无病生存期(DFS)的单因素及多因素Cox分析,明确影响伴有dMMR的病理Ⅱ期结直肠癌患者生存的相关影响因素.结果 共纳入70例伴有dMMR的病理Ⅱ期结直肠癌患者,全组患者中40例(57％)为男性、45例(64％)年龄＜60岁、64例(91％)患者身体质量指数≥18.5 kg/m2、主要为结肠癌(52例,74％);大多数为癌胚抗原(CEA)(53例,76％)及CA19-9(60例,86％)阴性患者;39例(56％)肿瘤大小＞5 cm;腺癌(51例,73％)是占据比例最多的病理类型并且主要为中分化(39例,56％);60例(86％)患者为病理T3期;43例(61％)患者未行辅助化疗以及有44例(63％)患者临床淋巴结分期为cN+期;全组中位病理淋巴结大小为0.70 cm;中位检出淋巴结个数为25.50个.单因素及多因素Cox分析表明肿瘤位置(5年OS:HR:0.097,95％CI:0.019～0.481,P=0.004;5 年 DFS:HR:0.206,95％CI:0.058～0.733,P=0.015)及临床淋巴结分期(5 年 OS:HR:0.171,95％CI:0.034～0.852,P=0.031;5 年 DFS:HR:0.131,95％CI:0.028～0.620,P=0.010)是伴有dMMR的病理Ⅱ期结直肠癌患者5年OS及DFS的独立影响因素.结论 伴有dMMR的病理Ⅱ期结直肠癌发病年龄较轻并且病期偏早、多位于结肠、肿瘤偏大及患者身体质量指数较高、肿瘤标志物多为阴性并且大多未行术后辅助化疗,除此以外,临床淋巴结分期多为cN+期.生存分析也表明肿瘤位置及临床淋巴结分期是5年OS及DFS的独立影响因素.
Abstract
Objective To analyze the clinicopathological characteristics and survival of pathological stage Ⅱ colorectal cancer with mismatch repair deficiency(dMMR)status.Methods The pathological stage Ⅱ colorectal cancer with dMMR diagnosed with pathologically immunohistochemistry staining after surgery from January 2011 to December 2017 were enrolled.The clinicopathological characteristics of these patients were statistically analyzed.Subsequently,the univariate and multivariate Cox regression analysis about 5-year overall survival(OS)and disease free survival(DFS)were conducted.Results A total of 70 patients with pathological stage Ⅱ CRC with dMMR were included.The majority of the patients were male(40 cases,57％)and under 60 years old(45 cases,64％).64 patients(91％)had a body mass index(BMI)of 18.5 kg/m2.Tumors located in the colon accounted for 52 cases(74％).Carcinoembryonic antigen(CEA)negative and CA19-9 negative were observed in 53 cases(76％)and 60 cases(86％),respectively.Tumor size was larger than 5 cm in 39 cases(56％).Adenocarcinoma(51 cases,73％)was the most common pathological type,predominantly moderately differentiated(39 cases,56％).Pathological stage T3 was observed in 60 patients(86％).Forty-three patients(61％)did not receive adjuvant chemotherapy,and 44 patients(63％)had clinically positive lymph node stage(cN+stage).The median size of the examined lymph nodes in the entire group was 0.70 cm.The median number of detected lymph nodes was 25.50.Univariate and multivariate Cox analysis showed that tumor location(5-year OS:HR:0.097,95％CI:0.019～0.481,P=0.004;5-year DFS:HR:0.206,95％CI:0.058～0.733,P=0.015)and clinical lymph node stage(5-year OS:HR:0.171,95％CI:0.034～0.852,P=0.031;5-year DFS:HR,0.131,95％CI:0.028～0.620,P=0.010)were independent influencing factors for 5-year OS and DFS of pathological stage Ⅱ colorectal cancer with dMMR.Conclusion Pathological stage Ⅱ colorectal cancer with dMMR tend to be younger and have earlier-stage disease.The tumors are more commonly located in the colon,larger in size,and the patients have a higher BMI.Tumor markers are usually negative,and adjuvant chemotherapy is not commonly administered.Additionally,clinical lymph node stage often shows cN+stage.Survival analysis about 5-year OS and DFS demonstrates that tumor location and clinical lymph node stage are independent influencing factors.
关键词
结直肠肿瘤/错配修复缺陷/临床病理特征/生存分析Key words
Colorectal neoplasms/Mismatch repair deficiency/Clinicopathological characteristics/Survival analysis引用本文复制引用
基金项目
中国癌症基金会北京希望马拉松专项基金(LC2021A23)
出版年
2024
NETL
NSTL
万方数据