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中华结直肠疾病电子杂志 ›› 2018, Vol. 07 ›› Issue (03) : 207 -213. doi: 10.3877/cma.j.issn.2095-3224.2018.03.002

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青年专家论坛

微卫星状态对结肠癌术后辅助化疗决策的影响
王畅1,()   
  1. 1. 130021 吉林大学第一医院肿瘤中心
  • 收稿日期:2017-08-27 出版日期:2018-06-25
  • 通信作者: 王畅

The impact of microsatellite status on decision-making of adjuvant chemotherapy in colon cancer

Chang Wang1,()   

  1. 1. Cancer Center of The First Hospital of Jilin University, Changchun 130021, China
  • Received:2017-08-27 Published:2018-06-25
  • Corresponding author: Chang Wang
  • About author:
    Corresponding author: Wang Chang, Email:
引用本文:

王畅. 微卫星状态对结肠癌术后辅助化疗决策的影响[J/OL]. 中华结直肠疾病电子杂志, 2018, 07(03): 207-213.

Chang Wang. The impact of microsatellite status on decision-making of adjuvant chemotherapy in colon cancer[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2018, 07(03): 207-213.

结肠癌术后辅助化疗可延长患者生存、降低复发率及死亡率,如何筛选适合的患者进行治疗至关重要。当前,仅以疾病分期及临床病理高危因素来指导治疗已不能满足精准治疗的要求,联合应用肿瘤分子生物学相关指标才能更好的筛选患者、提高疗效。近年大量回顾性研究结果提示微卫星高度不稳定(MSI-H)或错配修复蛋白缺乏(dMMR)的结肠癌患者具有良好的预后,并且不能从单药氟尿嘧啶辅助化疗中获益,其可能是结肠癌术后辅助化疗决策制定的重要参考指标。本文对相关文献进行系统回顾与梳理,就微卫星状态对结肠癌预后、疗效预测以及辅助化疗决策的影响进行阐述。

It has been proved that adjuvant chemotherapy can improve overall survival, reduce the relapse rate and mortality in colon cancer. Screening out suitable patients to receive adjuvant chemotherapy is the key point. At present, the treatment strategy is almost based on the clinical stage and pathologic high risk factors and it cannot meet the requirements of precision therapy. Combined application of biomarker is helpful in screening patients and improving treatment efficacy. Recently multiple retrospective studies have shown that patients with microsatellite high instability or MMR-deficient CRCs have a more favorable prognosis, at the same time, do not benefit from treatment with adjuvant 5-fluorouracil chemotherapy. The microsatellite status maybe an important reference index and should be used to inform clinical decision-making for adjuvant chemotherapy. Through reviewing the literature, the impact of the microsatellite status on prognosis, predictive significance and decision-making of adjuvant chemotherapy in colon cancer has been expatiated in the paper.

[1]
Morris EJ, Maughan NJ, Forman D, et al. Who to treat with adjuvant therapy in Dukes B/stage II colorectal cancer? The need for high quality pathology [J]. Gut, 2007, 56(10): 1419-1425.
[2]
Dienstmann R, Salazar R, Tabernero J. Personalizing colon cancer adjuvant therapy: selecting optimal treatments for individual patients [J]. J Clin Oncol, 2015, 33(16): 1787-1796.
[3]
Benson AB, Schrag D, Somerfield MR, et al. American Society of Clinical Oncology recommendations on adjuvant chemotherapy for stage II colon cancer [J]. J Clin Oncol, 2004, 22(16): 3408-3419.
[4]
Gill S, Loprinzi CL, Sargent DJ, et al. Pooled analysis of fluorouracil-based adjuvant therapy for stage II and III colon cancer: Who benefits and by how much? [J]. J Clin Oncol, 2004, 22(10): 1797-1806.
[5]
Gray R, Barnwell J, McConkey C, et al. Adjuvant chemotherapy versus observation in patients with colorectal cancer: A randomised study [J]. Lancet, 2007, 370(9604): 2020-2029.
[6]
Bockelman C, Engelmann BE, Kaprio T, et al. Risk of recurrence in patients with colon cancer stage II and III: a systematic review andmeta-analysis of recent literature [J]. Acta Oncol, 2015, 54(1): 5-16.
[7]
Twelves C, Wong A, Nowacki MP, et al. Capecitabine as adjuvant treatment for stage III colon cancer [J]. N Engl J Med, 2005, 352(26): 2696-2704.
[8]
André T, Boni C, Mounedji-Boudiaf L, et al. Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer [J]. N Engl J Med, 2004, 350(23): 2343-2351.
[9]
Yothers G, O′Connell MJ, Allegra CJ, et al. Oxaliplatin as adjuvant therapy for colon cancer: Updated results of NSABP C-07 trial, including survival and subset analyses [J]. J Clin Oncol, 2011, 29(28): 3768-3774.
[10]
Haller DG, Tabernero J, Maroun J, et al. Capecitabine plus oxaliplatin compared with fluorouracil and folinic acid as adjuvant therapy for stage III colon cancer [J]. J Clin Oncol, 2011, 29(11): 1465-1471.
[11]
司徒汪敏, 郑树.微卫星不稳定与Ⅱ期结直肠癌化疗的相关性探讨 [J]. 中华胃肠外科杂志, 2010, 13(12): 953-955.
[12]
Deligezer U, Yaman F, Erten N, et al. Frequent copresence of methylated DNA and fragmented nucleosomal DNA in plasma of lymphoma patients [J]. Clin Chim Acta, 2003, 335(12): 89-94.
[13]
张相国, 陈志仁. 微卫星不稳定与恶性肿瘤的研究进展 [J]. 中国医疗前沿, 2013, 18(13): 16-17.
[14]
Rui L, Tong S, Zhong LK, et al. Research progress of microsatellite instability′s judging prognosis and response to chemotherapy in colorectal cancer [J]. Chin J Clin Oncol, 2013, 40(4): 239-242.
[15]
Boland CR, Thibodeau SN, Hamilton SR, et al. A National Cancer Institute workshop on microsatellite instability for cancer detection and familial predisposition: development of international criteria for the determination of microsatellite instability in colorectal cancer [J]. Cancer Res, 1998, 58(22): 5248-5257.
[16]
Buhard O, Cattaneo F, Wong YF, et al. Multipopulation analysis of polymorphisms in five mononucleotide repeats used to determine the microsatellite instability status of human tumors [J]. J Clin Oncol, 2006, 24(2): 241-251.
[17]
Pino MS, Chung DC. Microsatellite instability in the management of colorectal cancer [J]. Expert Rev Gastroenterol Hepatol, 2011, 5(3): 385-399.
[18]
National Comprehensive Cancer Network: NCCN Guidelines: Colon Cancer, Version 2.2017.

URL    
[19]
Bertagnolli MM, Niedzwiecki D, Compton CC, et al. Microsatellite instability predicts improved response to adjuvant therapy with irinotecan, fluorouracil, and leucovorin in stage III colon cancer: Cancer and Leukemia Group B Protocol 89803 [J]. J Clin Oncol, 2009, 27(11): 1814-1821.
[20]
Roth AD, Tejpar S, Delorenzi M, et al. Prognostic role of KRAS and BRAF in stage II and III resected colon cancer: results of the translational study on the PETACC-3, EORTC 40993, SAKK 60-00 trial [J]. J Clin Oncol, 2010, 28(3): 466-474.
[21]
Hutchins G, Southward K, Handley K, et al. Value of mismatch repair, KRAS, and BRAF mutations in predicting recurrence and benefits from chemotherapy in colorectal cancer [J]. J Clin Oncol, 2011, 29(10): 1261-1270.
[22]
Klingbiel D, Saridaki Z, Roth AD, et al.Prognosis of stage II and III colon cancer treated with adjuvant 5-fluorouracil or FOLFIRI in relation to microsatellite status: results of the PETACC-3 trial [J]. Ann Oncol, 2015, 26(1): 126-132.
[23]
Frank A, Sinicrope. DNA mismatch repair and adjuvant chemotherapy in sporadic colon cancer [J]. Nat Rev Clin Oncol, 2010, 7(3): 174-177.
[24]
Kawakami H, Zaanan A, Sinicrope FA. Microsatellite instability testing and its role in the management of colorectal cancer [J]. Curr Treat Options Oncol, 2015, 16(7): 30.
[25]
Gryfe R, Kim H, Hsieh ET, et al. Tumor microsatellite instability and clinical outcome in young patients with colorectal cancer [J]. N Engl J Med, 2000, 342(2): 69-77.
[26]
Popat S, Hubner R, Houlston RS. Systematic review of microsatellite instability and colorectal cancer prognosis [J]. J Clin Oncol, 2005, 23(3): 609-618.
[27]
Benatti P, Gafà R, Barana D, et al. Microsatellite instability and colorectal cancer prognosis [J]. Clin Cancer Res, 2005, 11(23): 8332-8340.
[28]
Sinicrope FA, Foster NR, Thibodeau SN, et al. DNA mismatch repair status and colon cancer recurrence and survival in clinical trials of 5-fluorouracil-based adjuvant therapy [J]. J Natl Cancer Inst, 2011, 103(11): 863-875.
[29]
Bertagnolli MM, Redston M, Compton CC, et al. Microsatellite instability and loss of heterozygosity at chromosomal location 18q: prospective evaluation of biomarkers for stages II and III colon cancer-- a study of CALGB 9581 and 89803 [J]. J Clin Oncol, 2011, 29(23): 3153-3162.
[30]
Merokl MA, Ahlquist TE, RФyrvik EC, et al. Microsatellite instability has a positive prognostic impact on stage . colorectal cancer after complete resection: results from a large, consecutive Norwegian series [J]. Annals of Oncology, 2013, 24(5): 1274-1282.
[31]
Sargent DJ, Shi Q, Yothers G, et al. Prognostic impact of deficient mismatch repair (dMMR) in 7, 803 stage II/III colon cancer (CC) patients (pts): A pooled individual pt data analysis of 17 adjuvant trials in the ACCENT database [J]. J Clin Oncol, 2014, 32(suppl; abstr 3507): 5s.
[32]
Sinicrope FA, Mahoney MR, Smyrk TC, et al. Prognostic Impact of Deficient DNA Mismatch Repair in Patients With Stage III Colon Cancer From a Randomized Trial of FOLFOX-Based Adjuvant Chemotherapy [J]. J Clin Oncol, 2013, 31(29): 3664-3672.
[33]
Kim JE, Hong YS, Kim HJ, et al. Defective mismatch repair status was not associated with DFS and OS in stage II colon cancer treated with adjuvant chemotherapy [J]. Ann Surg Oncol, 2015, 22(Suppl 3): S630-637.
[34]
Carethers JM, Chauhan DP, Fink D, et a1.Mismatch repair proficiency and in vitro response to 5-fluorouracil [J]. Gastroenterology, 1999, 117(1): 123-131.
[35]
Arnold CN, Goel A, Boland CR. Role of hMLH1 promoter hypermethylation in drug resistance to 5-fluorouracil in colorectal cancer cell lines [J]. Int J Cancer, 2003, 106(1): 66-73.
[36]
Ribic CM, Sargent DJ, Moore MJ, et al. Tumor microsatellite-instability status as a predictor of benefit from fluorouracil-based adjuvant chemotherapy for colon cancer [J]. N Engl J Med, 2003, 349(3): 247-257.
[37]
R Jover, P Zapater, A Castells, et al. Mismatch repair status in the prediction of benefit from adjuvant fluorouracil chemotherapy in colorectal cancer [J]. Gut, 2006, 55(6): 848-855.
[38]
Sargent DJ, Marsoni S, Monges G, et al. Defective mismatch repair as a predictive marker for lack of efficacy of fluorouracil-based adjuvant therapy in colon cancer [J]. J Clin Oncol, 2010, 28(20): 3219-3226.
[39]
Webber EM, Kauffman TL, O′Connor E, et al. Systematic review of the predictive effect of MSI status in colorectal cancer patients undergoing 5FU-based chemotherapy [J]. BMC Cancer, 2015, 15: 156.
[40]
Labianca R, Nordlinger B, Beretta GD, et al. Early colon cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up [J]. Ann Oncol, 2013, 24(suppl 6): vi64-72.
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