论文部分内容阅读
目的:探讨微卫星不稳定性与R0切除术后行辅助化疗的高危Ⅱ期结肠癌患者临床预后的关系,为结肠癌的个体化治疗提供依据。方法:选择47例高危Ⅱ期结肠癌患者,均行R0切除及5-氟尿嘧啶为基础的辅助化疗。应用显微切割联合聚合酶链反应及毛细管电泳技术检测和比较肿瘤细胞及其正常腺上皮细胞的微卫星状态,分析其不稳定性与患者临床病理特征及预后的关系。结果:高频微卫星不稳定性的发生率为36.17%(17/47),低频微卫星不稳定性为27.66%(13/47),微卫星稳定为36.17%(17/47)。高频微卫星不稳定性与患者的性别、年龄、肿瘤部位和肿瘤组织学分级无关。高频微卫星不稳定性表达与患者的无病生存期(P=0.298)、总生存期(P=0.667)无关。多因素Cox回归分析结果提示,低分化肿瘤组织学分级(P=0.003)、受检测的淋巴结数目<11个(P=0.027)是独立的预后不良因素。结论:对于R0切除的高危Ⅱ期结肠癌患者,高频微卫星不稳定性不能作为辅助化疗后的预后指标,肿瘤组织学分级和受检测淋巴结数目是独立的预后指标。
Objective: To investigate the relationship between microsatellite instability and clinical prognosis of high-risk stage Ⅱ colon cancer after adjuvant R0 resection and to provide a basis for individualized treatment of colon cancer. Methods: Forty-seven patients with high-risk stage II colon cancer were selected and underwent R0 resection and 5-fluorouracil-based adjuvant chemotherapy. Microdissection combined with polymerase chain reaction and capillary electrophoresis were used to detect and compare the microsatellite status of tumor cells and their normal glandular epithelial cells. The relationship between their instability and clinicopathological characteristics and prognosis was analyzed. Results: The incidence of high frequency microsatellite instability was 36.17% (17/47), low frequency microsatellite instability was 27.66% (13/47) and microsatellite stability was 36.17% (17/47). High-frequency microsatellite instability has nothing to do with the patient’s gender, age, tumor location and tumor histological grade. High-frequency microsatellite instability expression was associated with disease-free survival (P = 0.298) and overall survival (P = 0.667). Multivariate Cox regression analysis suggested that poorly differentiated tumors were histologically graded (P = 0.003), and the number of detected lymph nodes <11 (P = 0.027) was an independent prognostic factor. CONCLUSION: High-frequency microsatellite instability can not be used as a prognostic indicator for adjuvant chemotherapy in R0 resected high-risk stage II colon cancer patients. Tumor histological grade and the number of lymph nodes examined are independent predictors of outcome.