CAJ | 학술논문

目的检测结直肠癌患者门静脉血液、原发癌组织及肝转移灶中K-ras基因突变,探讨K-ras突变与结直肠癌肝转移的关系.方法采用实时荧光定量聚合酶链反应(PCR)技术和基因测序技术检测48例结直肠癌患者门静脉血液、原发肿瘤组织、相应的癌旁肠黏膜以及8例肝转移灶组织中K-ras基因突变.结果 48例结直肠癌组织中17例(35.4%)发现K-ras基因突变,48例癌旁黏膜中4例(8.3%)发现K-ras基因突变,明显低于癌组织的基因突变率(P＜0.05).48例结直肠癌患者中16例(33.3%)门静脉血中发现K-ras基因突变,与癌组织的基因突变率差异无统计学意义(P＞0.05).有肝转移患者门静脉血中K-ras基因突变率(7/10,70.0%)明显高于无肝转移者(9/38,23.7%,P＜0.05).16例门静脉血存在K-ras基因突变者,其相应的肿瘤组织中均发现K-ras突变.而结直肠癌组织中无K-ras基因突变者,患者门静脉血及癌旁黏膜无基因突变.8例同时性肝转移患者中5例门静脉血发现K-ras基因突变,且其相应的肝转移灶组织也发现相同的K-ras突变.2例异时性肝转移患者门静脉血检测到K-ras基因突变,手术时无肝转移,但分别于术后第6个月和第9个月经CT检查证实有肝转移.原发肿瘤组织K-ras基因突变类型与门静脉血、肝脏转移灶的K-ras基因突变一致,即K-ras基因12密码子GGT突变为GAT或GTT.结论结直肠原发癌组织和患者门静脉血有K-ras基因的突变,预示着肿瘤可能有肝脏转移.
목적 검측결직장암환자문정맥혈액、원발암조직급간전이조중K-ras기인돌변,탐토K-ras돌변여결직장암간전이적관계.방법 채용실시형광정량취합매련반응(PCR)기술화기인측서기술검측48례결직장암환자문정맥혈액、원발종류조직、상응적암방장점막이급8례간전이조조직중K-ras기인돌변.결과 48례결직장암조직중17례(35.4%)발현K-ras기인돌변,48례암방점막중4례(8.3%)발현K-ras기인돌변,명현저우암조직적기인돌변솔(P＜0.05).48례결직장암환자중16례(33.3%)문정맥혈중발현K-ras기인돌변,여암조직적기인돌변솔차이무통계학의의(P＞0.05).유간전이환자문정맥혈중K-ras기인돌변솔(7/10,70.0%)명현고우무간전이자(9/38,23.7%,P＜0.05).16례문정맥혈존재K-ras기인돌변자,기상응적종류조직중균발현K-ras돌변.이결직장암조직중무K-ras기인돌변자,환자문정맥혈급암방점막무기인돌변.8례동시성간전이환자중5례문정맥혈발현K-ras기인돌변,차기상응적간전이조조직야발현상동적K-ras돌변.2례이시성간전이환자문정맥혈검측도K-ras기인돌변,수술시무간전이,단분별우술후제6개월화제9개월경CT검사증실유간전이.원발종류조직K-ras기인돌변류형여문정맥혈、간장전이조적K-ras기인돌변일치,즉K-ras기인12밀마자GGT돌변위GAT혹GTT.결론 결직장원발암조직화환자문정맥혈유K-ras기인적돌변,예시착종류가능유간장전이.
Objective To detect mutations of K-ras oncogene in portal vein blood of patients with colorectal cancer, and to find out the relationship between mutated K-ras oncogene and liver metastases in colorectal cancer. Methods Forty-eight patients with colorectal cancer were screened for the mutations of K-ras oncogene in tissue samples from their tumors, portal vein blood, proximally adjacent mucosa and 8metastatic liver biopsies by real-time fluorescence quantitative polymerase chain reaction (PCR) and DNA sequencing. The results were analyzed with their clinical data. Results Sixteen of the 48 patients with colorectal cancer had K-ras point mutations at codon 12 in their portal vein blood, and 17 of 48 patients had K-ras mutations in their primary tumors, but only 4 of 48 patients had K-ras mutations in proximally adjacent mucosa. There was no significant difference in rate of K-ras mutation between tumor tissues and portal vein blood (P ＞ 0. 05 ), but significant difference was found between the tumor tissue and the proximally adjacent mucosa ( P ＜0. 05 ). The rate of K-ras mutations in portal vein blood of colorectal cancer with liver metastases (70. 0% ) was higher than that of without liver metastases (23.7%). Sixteen cases of mutated K-ras in portal vein blood showed mutations in tumor tissues. Patients without mutated K-ras in tumor tissue had no mutations in their portal vein blood and proximally adjacent mucosa. In 5 of 8 patients with simultaneous liver metastasis, mutated K-ras oncogenes were detected in portal vein blood, and the type of K-ras mutation detected in the tumor tissue was accord with that in metastatic liver biopsies. Two patients with mutated K-ras detected in their portal vein blood had no liver metastases during perioperation, but liver metastases were diagnosed by CT at the postoperative month 6 and 9 respectively. The main types of K-ras mutations at codon 12 included GGT to GAT and GGT to GTT. No one had point mutation at codon 13. Conclusion Mutated K-ras detected in both cancer tissue and portal vein blood may indicate livermetastases from colorectal cancer.