CAJ | 학술논문

目的探讨DNA错配修复(MMR)与Ⅱ～Ⅲ期结肠癌预后和术后接受氟尿嘧啶单药辅助治疗疗效的相关性.方法收集172例结肠癌根治术患者的肿瘤组织标本,采用免疫组化法检测MLH1、MSH2、MSH6和PMS2蛋白的表达情况,比较MMR缺失(dMMR)和MMR完整(pMMR)患者的生存情况.结果 172例结肠癌患者中,dMMR 38例(22.1％),pMMR 134例(77.9％).115例单纯手术患者中,dMMR患者的5年无病生存率和5年总生存率分别为84.0％和88.0％,pMMR患者的5年无病生存率和5年总生存率分别为60.0％和66.7％ (P =0.034,P=0.040).38例dMMR患者中,单纯手术组的5年无病生存率(84.0％)明显高于术后氟尿嘧啶单药辅助治疗组(53.8％,P=0.038).134例pMMR患者中,术后氟尿嘧啶单药辅助治疗组的5年总生存率(86.4％)明显优于单纯手术组患者(66.7％,P=0.012).结论 MMR状态与结肠癌预后有关,dMMR是结肠癌预后较好的生物指标.MMR状态与能否从术后氟尿嘧啶治疗中获益有关,pMMR患者能从术后氟尿嘧啶辅助治疗中获益,而dMMR患者不能从术后氟尿嘧啶辅助治疗中获益.
목적 탐토DNA착배수복(MMR)여Ⅱ～Ⅲ기결장암예후화술후접수불뇨밀정단약보조치료료효적상관성.방법 수집172례결장암근치술환자적종류조직표본,채용면역조화법검측MLH1、MSH2、MSH6화PMS2단백적표체정황,비교MMR결실(dMMR)화MMR완정(pMMR)환자적생존정황.결과 172례결장암환자중,dMMR 38례(22.1％),pMMR 134례(77.9％).115례단순수술환자중,dMMR환자적5년무병생존솔화5년총생존솔분별위84.0％화88.0％,pMMR환자적5년무병생존솔화5년총생존솔분별위60.0％화66.7％ (P =0.034,P=0.040).38례dMMR환자중,단순수술조적5년무병생존솔(84.0％)명현고우술후불뇨밀정단약보조치료조(53.8％,P=0.038).134례pMMR환자중,술후불뇨밀정단약보조치료조적5년총생존솔(86.4％)명현우우단순수술조환자(66.7％,P=0.012).결론 MMR상태여결장암예후유관,dMMR시결장암예후교호적생물지표.MMR상태여능부종술후불뇨밀정치료중획익유관,pMMR환자능종술후불뇨밀정보조치료중획익,이dMMR환자불능종술후불뇨밀정보조치료중획익.
Objective To investigate the role of DNA mismatch repair (MMR) as a prognostic indicator of radical resection and a predictor of fluorouracil-based adjuvant therapy benefit in patients with stage Ⅱ/Ⅲ colon cancer.Methods The clinicopathological characteristics of 172 patients with stage Ⅱ/Ⅲ colon cancer who underwent radical resection were retrospectively analyzed.Immunohistochemical staining was used to detect the expression of DNA mismatch repair (MLH1/MSH2/MSH6/PMS2) in the tumor tissues.Results Among a total of 172 patients,there were 38 (22.1％) cases with defective DNA mismatch repair (dMMR) and 134 (77.9％) cases with proficient DNA mismatch repair (pMMR).Among the 115 patients who did not receive adjuvant chemotherapy,those with tumor displaying dMMR had a better 5-year overall survival (OS) rate and disease-free survival (DFS) rate than the patients with proficient DNA mismatch repair (pMMR) (88.0％ vs.66.7％,P =0.040 ; 84.0％ vs.60.0％,P =0.034).The benefit of adjuvant chemotherapy differed significantly according to the MMR status.Adjuvant 5-Fu chemotherapy improved the 5-year overall survival rate among 134 patients with pMMR (86.4％) than that in patients treated by surgery alone (66.7％,P =0.012).By contrast,there was no benefit of adjuvant 5-Fu chemotherapy in the patients with dMMR (61.5％ vs.86.4％,P =0.062),which was even more clear the 5-year disease-free survival rate (53.8％ vs.84.0％,P =0.038).Conclusions MMR status is a predictor of the benefit of adjuvant chemotherapy with fluorouracil in stage Ⅱ/Ⅲ colon cancer.Patients with stage Ⅱ/Ⅲ colon cancer displaying dMMR have a better prognosis than those with pMMR.