基础医学与临床 ›› 2010, Vol. 30 ›› Issue (3): 252-257.

• 研究论文 • 上一篇    下一篇

根据临床病理学特征鉴别无家族史MSI-H大肠癌

孟晓明 盛剑秋 武子涛 付蕾 安贺娟 韩英 李世荣   

  1. 北京军区总医院 北京军区总医院
  • 收稿日期:2009-12-04 修回日期:2009-12-11 出版日期:2010-03-05 发布日期:2011-05-04
  • 通讯作者: 盛剑秋

Clinicopathological features identify nonfamilial MSI-H colorectal cancer

Xiao-ming MENG, Jian-qiu SHENG, Zi-tao WU, Lei FU, He-juan AN, Ying HAN, Shi-rong LI   

  1. General Hospital of Beijing Military Command of Chinese PLA General Hospital of Beijing Military Command of Chinese PLA
  • Received:2009-12-04 Revised:2009-12-11 Online:2010-03-05 Published:2011-05-04
  • Contact: Jian-qiu SHENG,

摘要: 目的 根据修订的Bethesda指南,分析无家族史大肠癌患者的病理学特征和微卫星不稳定检测结果的关系,探讨无家族史高度微卫星不稳定(MSI-H)大肠癌的临床病理学特征。方法 纳入150例无家族史大肠癌患者,选取5个标准位点(BAT25、BAT26、D2S123、D5S346、D17S250)进行免疫荧光PCR,以GeneMapper软件分析PCR产物;收集患者年龄、性别及肿瘤部位信息;光学显微镜观察多种病理特征(分化程度、黏蛋白分化、组织学异质性及类Crohn反应);免疫组化方法检测肿瘤浸润淋巴细胞CD4+和CD8+的表达。Logistic逐步回归分析产生回归方程,依据病理特征计算MSI-H表型的概率。结果 无家族史大肠癌中MSI-H表型为13.33%;低分化、组织学异质性、类Crohn反应和TILs是MSI-H表型大肠癌的独立鉴别因子,Logistic回归方程鉴别MSI-H表型大肠癌的敏感性为70.0%,特异性为99.2%,总准确率为95.3%。结论 MSI-H表型构成了一个病理学特异的无家族史大肠癌类型,根据临床病理学特征能够有效地检出MSI-H表型大肠癌。

关键词: 微卫星不稳定, 遗传性非息肉病性结直肠癌, 大肠癌, 临床病理学, 肿瘤浸润淋巴细胞

Abstract: Objective According to the revised Bethesda guidelines, the relationship between clinicopathological features and microsatellite instability (MSI) testing in nonfamilial colorectal cancers patients was analyzed, Our aim was to identify clinicopathological features that identify high MSI (MSI-H).Methods We enrolled 150 patients, standard microsatellite loci (BAT25、BAT26、D2S123、D5S346、D17S250) were amplified by polymerase chain reaction(PCR)with fluorescent primers, and the PCR products were analyzed by GeneMapper software; age at diagnosis, gender and site, were obtained; various pathological features(tumor grade, mucinous differentiation, histologic heterogeneity, Crohn's-like response) were observed by light microscope; the express of tumor infiltrating lymphocytes(CD4+ and CD8+) was detected by immunohistochemistry. Using a stepwise logistic regression model, a formula was generated that could be used to calculate the probability of a colorectal carcinoma being MSI-H based on pathological features. Results Among 150 cancers, MSI-H was 13.33%;Independent identifier were poor differentiation, histologic heterogeneity , Crohn's-like reaction and tumor-infiltrating lymphocytes, logistic regression formula has a sensitivity of 70.0% and a specificity of 99.2% and a accurate ratio of 95.3% for MSI-H. Conclusions MSI-H phenotype cancer is a type of nonfamilial colorectal cancer with specific pathological features, Clinicopathological features can identify efficiently MSI-H colorectal cancers.

Key words: microsatellite Instability(MSI), hereditary nonpolyposis colorectal cancer(HNPCC), colorectal carcinoma, clinicopathological, tumor infiltrating lymphocytes (TILs)