切换至 "中华医学电子期刊资源库"

中华结直肠疾病电子杂志 ›› 2018, Vol. 07 ›› Issue (03) : 246 -251. doi: 10.3877/cma.j.issn.2095-3224.2018.03.010

所属专题: 文献

论著

pMMR和MSS表型的Ⅱ期普危结肠癌、高位直肠癌单药辅助化疗的探讨
宫爱民1, 任明智2, 孙静阳3, 刘斌1, 赵长林2,(), 张晓飞2, 王俊松2   
  1. 1. 116021 大连大学附属新华医院肛肠二科
    2. 116021 大连大学附属新华医院胃肠肿瘤科/大连结肠与直肠癌诊疗基地
    3. 116021 大连大学附属新华医院病理科
  • 收稿日期:2017-07-30 出版日期:2018-06-25
  • 通信作者: 赵长林

Discussion of pMMR and MSS phenotype stage II colon cancer, upper rectal cancer patients with general risk by adjuvant chemotherapy

Aimin Gong1, Mingzhi Ren2, Jingyang Sun3, Bin Liu1, Changlin Zhao2,(), Xiaofei Zhang2, Junsong Wang2   

  1. 1. Department of the Second Colorectal Cancer Surgery, Dalian University Affiliated Xinhua Hospital, Dalian 116021, China
    2. Department of Gastrointestinal Oncology / Dalian Colorectal Cancer Diagnosis and Treatment Base, Dalian University Affiliated Xinhua Hospital, Dalian 116021, China
    3. Department of Pathology, Dalian University Affiliated Xinhua Hospital, Dalian 116021, China
  • Received:2017-07-30 Published:2018-06-25
  • Corresponding author: Changlin Zhao
  • About author:
    Corresponding author: Zhao Changlin, Email:
引用本文:

宫爱民, 任明智, 孙静阳, 刘斌, 赵长林, 张晓飞, 王俊松. pMMR和MSS表型的Ⅱ期普危结肠癌、高位直肠癌单药辅助化疗的探讨[J/OL]. 中华结直肠疾病电子杂志, 2018, 07(03): 246-251.

Aimin Gong, Mingzhi Ren, Jingyang Sun, Bin Liu, Changlin Zhao, Xiaofei Zhang, Junsong Wang. Discussion of pMMR and MSS phenotype stage II colon cancer, upper rectal cancer patients with general risk by adjuvant chemotherapy[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2018, 07(03): 246-251.

目的

探讨Ⅱ期普危结肠癌、高位直肠癌患者在单药辅助化疗中是否获益。

方法

40例患者癌组织常规进行IHC检测MLH1、MSH2、MSH6、PMS2蛋白确定为pMMR表型后,分为辅助化疗组20例,再经PCR- MSI检测确定为MSS表型,给予雷替曲塞,剂量为3 mg/m2,21天重复的方案用4周期。采用按随访结果确定生存时间评价客观有效率。依据NCI-CTC3.0版毒性分级标准评价不良反应。非辅助化疗组20例作为对照。

结果

辅助化疗组客观有效率为95.0%(19/20),复发率为5.0%(1/20),非辅化组复发率15.0%(3/20),辅助化疗组复发率明显低于非辅助化疗组(χ2=5.556,P=0.0184)。辅助化疗组不良反应均为Ⅰ度和Ⅱ度,未发生心脏毒性;对血糖无影响。

结论

pMMR和MSS表型的Ⅱ期普危结肠癌、高位直肠癌患者采用雷替曲塞辅助化疗安全有效。

Objective

Explore stage II colon cancer, upper rectal cancer patients with general risk benefit from single agent adjuvant chemotherapy or not.

Methods

Forty cases of tumor tissues detected MLH1, MSH2, MSH6, PMS2 proteins by IHC test and confirmed as pMMR status. Twenty cases as adjuvant chemotherapy group confirmed as MSS phenotype by PCR who treated Raltitrexed which dose was 3 mg/m2, d1, ivgtt in 15 min, Q21d for 4 cycles. The survival time was determined according to the follow-up results, and the objective efficiency was evaluated. Adverse events were evaluated according to the NCI-TC3.0 version of toxicity classification criteria. The non-adjuvant chemotherapy group 20 cases were control.

Results

Adjuvant chemotherapy group objective effective rate was 95.0% (19/20), the recurrence rate was 5.0% (1/20), the control group recurrence rate 15.0% (3/20), adjuvant chemotherapy group recurrence rate was lower than control group (χ2=5.556, P=5.556). Adjuvant chemotherapy group only occurred I or II degree adverse events, no cardiac toxicity, no influence on blood sugar.

Conclusions

pMMR and MSS phenotype stage II colon cancer, upper rectal cancer patients with general risk using Raltitrexed single-agent adjuvant chemotherapy were safe and effective.

图1 Ⅱ期普危结直肠癌组织4种MMR蛋白表达。1A:MLH1;1B:MSH2;1C:MSH6;1D:PMS2均为弥漫阳性表达(×400)
图2 PCR-毛细管电泳法检测Ⅱ期普危结直肠癌MSI状态。2A为正常组织;2B为同源癌组织,与自身的正常组织相比较,癌组织中5个分子标记均未出现长度变异,均无位点偏移。判读为MSS,为MSS表型结直肠癌
表1 雷替曲塞单药辅助化疗的安全性和不良反应(n=20)
[1]
Siegel, Rebecca L, MiIIer, et al. Cancer statistics, 2016 [J]. CAA Cancer Journal for Clinicians, 2016, 66(1): 10-29.
[2]
Wang Yi, Wang Jie, Xu Dongkui, et al. Analysis of 18 cases of Stage l colorectal cancer: before and after local relapse and distant metastasis [J]. Chin J Colorec Dis(Electronic Edition), 2016, 5(6): 503-506.
[3]
蔡三军.结直肠肛管癌局部复发及远处转移. 循证结直肠肛管肿瘤学 [M]. 第1版.上海: 上海科学技术出版社, 2016, 400-454.
[4]
赵长林.结直肠癌肝转移转化治疗的相关问题[J/CD].中华普通外科学文献(电子版), 2014, 8(3), 6-9.
[5]
中华医学会外科分会胃肠外科学组, 中华医学会外科分会结直肠外科学组, 中国抗癌协会大肠癌专业委员会, 中国医师协会外科医师分会结直肠外科医师委员会, 中国医疗保健国际交流促进会结直肠癌肝转移治疗专业委员会.结直肠癌肝转移诊断和综合治疗指南(2016) [J]. 中华实用外科杂志, 2016, 36(8): 858-869.
[6]
Qin Yun, Liang Liping, Zheng Xingzheng, et al. Value of detection of DNA Mismatch repair proteins deficiency by immunohistochemistry in predicting tumor microsatellite status [J]. Chin J Pathol, 2015, 44(10): 704-708.
[7]
Clinical Practice Guidelines in Oncology (NCCN Guidelines®), Colon Cancer, Version 2, 2016[OL].

URL    
[8]
中华人民共和国卫生和计划生育委员会医政医管局, 中华医学会肿瘤学分会.结直肠癌诊疗规范(2015年版) [J]. 中华外科杂志, 2015, 53(12): 881-894.
[9]
结直肠癌诊疗指南, 2017版[OL].中国临床肿瘤学会(CSCO), 2016.12.
[10]
林秋兰, 赵丽华, 林竞, 等. MaxVision~(TM)即用型快速免疫组化一步法染色的病理应用 [J]. 诊断病理学杂志, 2008, 15(4): 344-344.
[11]
Alex AK, Siqueira S, Coudry R, et al. Response to Chemotherapy and Prognosis in Metastatic Colorectal Cancer With DNA Deficient Mismatch Repair [J]. Clin Colorectal Cancer, 2017, 16(3): 228-239.
[12]
石迎雪, 郑杰.系统筛查微卫星不稳定性结直肠癌的意义和策略 [J]. 中华病理学杂志, 2015, 44(1): 9-14.
[13]
Vilar E, Gruber SB. Microsatellite instability in colorectal cancer-the stable evidence [J]. Nat Rev Clin Oncol, 2010, 7(3): 53-162.
[14]
Bartley AN, Luthra R, Saraiya DS, et al. Identification of cancer patients withLynch syndrome: clinically significant discordances and problems in tissue-based mismatch repair testing [J]. Cancer prev Res(Phila), 2012, 5(2): 320-327.
[15]
Merok MA, Ahlquist T, Ryrvik EC, et al. Microstellite instability has a positive Prognostic impact on stagell colorectal cancer after complete resection: results from a large, consecutive Norwegian series [J]. Ann Oncol, 2013, 24(5): 1274-1282.
[16]
Clinical Practice Guidelines in Oncology (NCCN Guidelines®), Colon Cancer, Version 2, 2017[OL].

URL    
[17]
张学, 季加孚, 徐兵河 主译. 结直肠癌.肿瘤遗传咨询[M].第3版.北京: 人民卫生出版社, 2016, 165-152.
[18]
程志祥, 王科明. 化疗对肿瘤患者血糖的影响及其对策 [J]. 中国肿瘤临床, 2009, 36(20): 1194-1196.
[19]
Feng JP, Chen JG, Yuan XL, et al. Mpact of 5-fiuoro uracll on glucose metabolism and pancreatic pathology in rats [J]. Zhong hua Wei Chang Wai ke Za Zhi, 2010, 13(12): 935-938.
[20]
戴月秋, 陶莉, 胡夕春, 等.化疗对恶性肿瘤合并糖尿病患者血糖的影响 [J]. 临床肿瘤学杂志, 2008, 13(3): 254-257.
[1] 洪玮, 叶细容, 刘枝红, 杨银凤, 吕志红. 超声影像组学联合临床病理特征预测乳腺癌新辅助化疗完全病理缓解的价值[J/OL]. 中华医学超声杂志(电子版), 2024, 21(06): 571-579.
[2] 常小伟, 蔡瑜, 赵志勇, 张伟. 高强度聚焦超声消融术联合肝动脉化疗栓塞术治疗原发性肝细胞癌的效果及安全性分析[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 56-59.
[3] 徐逸男. 不同术式治疗梗阻性左半结直肠癌的疗效观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 72-75.
[4] 李代勤, 刘佩杰. 动态增强磁共振评估中晚期低位直肠癌同步放化疗后疗效及预后的价值[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 100-103.
[5] 许杰, 李亚俊, 冯义文. SOX新辅助化疗后腹腔镜胃癌D2根治术与常规根治术治疗进展期胃癌的近期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 647-650.
[6] 薛庆, 施赛叶, 徐雅文, 盛夏, 张芹芹. 追踪方法学联合失效模式与效应分析在膀胱灌注化疗患者中的应用[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(06): 553-559.
[7] 韩加刚, 王振军. 梗阻性左半结肠癌的治疗策略[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 450-458.
[8] 石阳, 于剑锋, 曹可, 翟志伟, 叶春祥, 王振军, 韩加刚. 可扩张金属支架置入联合新辅助化疗治疗完全梗阻性左半结肠癌围手术期并发症分析[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 464-471.
[9] 梁轩豪, 李小荣, 李亮, 林昌伟. 肠梗阻支架置入术联合新辅助化疗治疗结直肠癌急性肠梗阻的疗效及其预后的Meta 分析[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 472-482.
[10] 严虹霞, 王晓娟, 张毅勋. 2 型糖尿病对结直肠癌患者肿瘤标记物、临床病理及预后的影响[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 483-487.
[11] 赵磊, 刘文志, 林峰, 于剑, 孙铭骏, 崔佑刚, 张旭, 衣宇鹏, 于宝胜, 冯宁. 深部热疗在改善结直肠癌术后辅助化疗副反应及生活质量中的作用研究[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 488-493.
[12] 黄海洋, 邝永龙, 陈嘉胜. 基层医院结直肠肿瘤经自然腔道取标本手术30 例分析[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 510-518.
[13] 陈倩倩, 袁晨, 刘基, 尹婷婷. 多层螺旋CT 参数、癌胚抗原、错配修复基因及病理指标对结直肠癌预后的影响[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 507-511.
[14] 张颖, 赵鑫, 陈佳梅, 李雁. 术前化疗对CRS+HIPEC 治疗腹膜假黏液瘤预后影响的meta 分析[J/OL]. 中华临床医师杂志(电子版), 2024, 18(09): 826-835.
[15] 蔡晓雯, 李慧景, 丘婕, 杨翼帆, 吴素贤, 林玉彤, 何秋娜. 肝癌患者肝动脉化疗栓塞术后疼痛风险预测模型的构建及验证[J/OL]. 中华临床医师杂志(电子版), 2024, 18(08): 722-728.
阅读次数
全文


摘要