CAJ | 학술논문

目的检测中低位直肠癌下切缘细胞角蛋白20(CK20)、基质金属蛋白酶(MMP)-7、MMP-9 mRNA的表达,探讨下切缘微转移与临床病理特征的相关性及安全的下切缘距离.方法选取行全直肠系膜切除术的中低位直肠癌患者共50例,采用反转录-聚合酶链反应(RT-PCR)方法检测直肠癌标本下切缘CK20、MMP-7、MMP-9 mRNA的表达.收集相关临床资料,随访肿瘤复发情况及时间.结果下切缘微转移组下切缘距肿瘤下缘的距离为(1.47±0.40) cm,下切缘无微转移组下切缘距肿瘤下缘的距离为(2.86±1.20) cm,差异有统计学意义(P＜0.05).距离超过2.2cm的下切缘未见微转移.下切缘微转移组肿瘤的TNM分期、淋巴脉管侵犯、神经侵犯、淋巴结转移率及环周切缘(CRM)阳性率较无微转移组更高(P＜0.05),肿块直径更大(P＜0.05);两组之间KRAS、NRAS基因突变及微卫星DNA不稳定性差异无统计学意义(P＞0.05).结论直肠癌下切缘的微转移是术后复发的重要因素,中低位直肠癌患者的安全下切缘距离至少应为2.5cm.临床上对于分期较晚、病灶较大的患者,下切缘应该保证更安全的切缘距离.
목적 검측중저위직장암하절연세포각단백20(CK20)、기질금속단백매(MMP)-7、MMP-9 mRNA적표체,탐토하절연미전이여림상병리특정적상관성급안전적하절연거리.방법 선취행전직장계막절제술적중저위직장암환자공50례,채용반전록-취합매련반응(RT-PCR)방법검측직장암표본하절연CK20、MMP-7、MMP-9 mRNA적표체.수집상관림상자료,수방종류복발정황급시간.결과 하절연미전이조하절연거종류하연적거리위(1.47±0.40) cm,하절연무미전이조하절연거종류하연적거리위(2.86±1.20) cm,차이유통계학의의(P＜0.05).거리초과2.2cm적하절연미견미전이.하절연미전이조종류적TNM분기、림파맥관침범、신경침범、림파결전이솔급배주절연(CRM)양성솔교무미전이조경고(P＜0.05),종괴직경경대(P＜0.05);량조지간KRAS、NRAS기인돌변급미위성DNA불은정성차이무통계학의의(P＞0.05).결론 직장암하절연적미전이시술후복발적중요인소,중저위직장암환자적안전하절연거리지소응위2.5cm.림상상대우분기교만、병조교대적환자,하절연응해보증경안전적절연거리.
Objective To explore the expression of creatine kinase 20 (CK20),matrix metalloproteinase (MMP)-7 and MMP-9 in the micrometastasis in distal margin of middle and low rectal cancer,and study the relationship between micrometastasis in distal margin and clinicopathological characteristics.Methods Fifty cases of middle and low rectal cancer were tested for CK20,MMP-7 and MMP-9 using reverse transcriptase-polymerase chain reaction (RT-PCR).Results The average distance was 1.47 ± 0.40 cm in distal margin with micrometastasis,but it was 2.86 ± 1.2 cm in distal margin without micrometastasis (P ＜ 0.05).TNM staging,lymphatic vascular invasion,nerve invasion,lymph node metastasis rate and rate of CRM in distal margin with micrometastasis were higher and tumor diameter was bigger than distal margin without micrometastasis (P ＜ 0.05).Between two groups,KRAS,NRAS mutation and microsatellite DNA instability had no obvious difference (P ＞ 0.05).Conclusion Distal margin with micrometastasis had effect on postoperative recurrence and metastasis in patients with middle and low rectal cancer.The safe distance of the patients with low rectal cancer in distal margin should be 2.5 cm,and for patients with advanced disease,larger lesions,lymphatic vessels and nerve invasion,if the safe distance of 2.5 cm can' t be guaranteed,preventive local radiotherapy postoperation is recommended to reduce local recurrence and metastasis.