Signet ring cell carcinoma of the colorectum: correlations between microsatellite instability, clinicopathologic features and survival
Signet ring cell carcinoma of the colorectum: correlations between microsatellite instability, clinicopathologic features and survival
复制标题
DOI：
10.1038/modpathol.3800298
复制
发表时间：
2005-02-01
期刊：
影响因子：
7.5
通讯作者：
Smyrk, TC
中科院分区：
文献类型：
--
作者：
Kakar, S;Smyrk, TC
微卫星不稳定性结直肠癌具有特征性的临床病理学特征，其特征是右侧淋巴细胞丰富的肿瘤，其预后优于微卫星稳定性（MSS）癌。在微卫星不稳定性高的癌症中，粘液癌和印戒细胞癌都是高比例的。粘液性微卫星不稳定性高的癌症的临床病理特征与总体微卫星不稳定性高的癌症相似，但尚不清楚印戒细胞癌是否也是如此，特别是考虑到印戒组织学是一个有据可查的不良预后因素。我们记录了72例结直肠印戒细胞癌患者的年龄、性别、肿瘤大小、部位、分级、分期、组织学类型、生长方式、克罗恩样反应、血管浸润和肿瘤浸润淋巴细胞。通过聚合酶链反应和hMLH 1，hMSH 2和hMSH 6的免疫组化染色相结合的微卫星不稳定性进行了测定。不稳定性>30%的信息标记物和/或hMLH 1或hMSH 2表达缺失的肿瘤被指定为微卫星不稳定性高;所有其他被归类为MSS。共有22例（31%）印戒细胞癌微卫星不稳定性高。与MSS印戒细胞癌相比，它们更可能发生在右侧（81 vs 45%，P=0.005），并影响女性（59 vs 28%，P = 0.03）的老年患者（68 vs 26%，P = 0.0007）。在微卫星不稳定性高的情况下，克罗恩样反应（45 vs 16%，P=0.02）和肿瘤浸润淋巴细胞计数高（32 vs 8%，P=0.03）更常见。微卫星不稳定性高与MSS患者的5年生存率无显著差异（41 vs 34%，P=0.3）。总之，大约三分之一的结直肠印戒癌是微卫星不稳定性高的。微卫星不稳定性高的印戒癌与其他微卫星不稳定性高的癌症有共同的临床病理特征：年龄较大，女性占优势，右侧位置，克罗恩样反应和大量的肿瘤浸润淋巴细胞。微卫星不稳定状态似乎不是结直肠印戒细胞癌生存的重要预测因子。
Colorectal cancer with microsatellite instability has a characteristic clinicopathologic profile, featuring right-sided, lymphocyte-rich tumors with a better prognosis than microsatellite stable (MSS) carcinoma. Mucinous and signet ring cell carcinomas are both over-represented among microsatellite instability-high cancers. The clinicopathologic features of mucinous microsatellite instability-high cancer parallel those of the overall microsatellite instability-high set, but it is not known whether the same is true for signet ring cell carcinoma, particularly given the fact that signet ring histology is a well-documented adverse prognostic factor. We recorded age, sex, tumor size, site, grade, stage, histologic pattern, growth pattern, Crohn-like reaction, vascular invasion and tumor-infiltrating lymphocytes in 72 resected signet ring cell carcinomas of the colorectum. Microsatellite instability was determined by a combination of polymerase chain reaction and immunohistochemical stains for hMLH1, hMSH2 and hMSH6. Tumors with instability at >30% of informative markers and/or loss of hMLH1 or hMSH2 expression were designated microsatellite instability-high; all others were classified as MSS. A total of 22 (31%) signet ring cell carcinomas were microsatellite instability-high. Compared to MSS signet ring cell carcinoma, they were more likely to be right-sided (81 vs 45%, P=0.005) and to affect older patients (68 vs 26%, P=0.0007) of female sex (59 vs 28%, P=0.03). Crohn-like reaction (45 vs 16%, P=0.02) and high tumor infiltrating lymphocyte counts (32 vs 8%, P=0.03) were more common in the microsatellite instability-high setting. There was no significant difference in 5-year survival in microsatellite instability-high vs MSS patients (41 vs 34%, P=0.3). In conclusion, approximately one-third of signet ring carcinomas of the colorectum are microsatellite instability-high. Microsatellite instability-high signet ring carcinomas share clinicopathologic features with other microsatellite instability-high cancers: older age group, female preponderance, right-sided location, Crohn-like reaction and numerous tumor-infiltrating lymphocytes. Microsatellite instability status does not appear to be a significant predictor of survival in signet ring cell carcinoma of the colorectum.