Pathology features in Bethesda guidelines predict colorectal cancer microsatellite instability: A population-based study
Pathology features in Bethesda guidelines predict colorectal cancer microsatellite instability: A population-based study
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DOI：
10.1053/j.gastro.2007.04.044
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发表时间：
2007-07-01
期刊：
影响因子：
29.4
通讯作者：
Jass, Jeremy R.
中科院分区：
文献类型：
--
作者：
Jenkins, Mark A.;Hayashi, Shinichi;Jass, Jeremy R.
背景与目的：修订后的Bethesda Lynch综合征指南推荐对50岁以前确诊的所有结直肠癌患者进行微卫星不稳定性(MSI)检测，以及对50岁至59岁之间有特殊病理特征的结直肠癌患者进行微卫星不稳定性检测。我们的目的是确定独立预测高MSI(MSI-H)的病理和其他特征。方法：对1098例60岁前确诊的以人群为基础的结直肠癌患者的档案组织进行MSI检测。获得诊断时的病理特征、部位和年龄。采用多元Logistic回归来确定每个特征的预测值，用比数比(OR)来衡量，由此开发出一个评分系统(MsPath)来估计结直肠癌为MSI-H的概率。结果：15%的肿瘤(162例)为MSI-H。独立的预测因素是肿瘤浸润性淋巴细胞(OR，9.1；95%可信区间，5.9-14.1)、近端亚部位(OR，4.7；95%CI，3.1-7.3)、粘液组织学(OR，2.8；95%CI，1.7-4.8)、低分化(OR，1.9；95%CI，1.2-3.1)、克罗恩样反应(OR，1.9；95%CI，1.2-3.1)；95%可信区间1.2~2.9)，50岁以前诊断(OR=1.9；95%可信区间1.3~2.9)。MsPath评分<1.0对MSI-H的敏感性为93%，特异性为55%。结论：个体结直肠癌发生的概率.MsPath评分可以很好地预测癌症是MSI-H。对于60岁前MSPath评分为1(约50%)的患者，检测肿瘤中的DNA错配修复缺失或胚系错配修复突变几乎没有价值。病理学可以识别几乎所有在60岁之前诊断的MSI-H结直肠癌。
Background & Aims: The revised Bethesda guidelines for Lynch syndrome recommend microsatellite instability (MSI) testing all colorectal cancers in patients diagnosed before age 50 years and colorectal cancers diagnosed in patients between ages 50 and 59 years with particular pathology features. Our aim was to identify pathology and other features that independently predict high MSI (MSI-H). Methods: Archival tissue from 1098 population-based colorectal cancers diagnosed before age 60 years was tested for MSI. Pathology features, site, and age at diagnosis were obtained. Multiple logistic regression was performed to determine the predictive value of each feature, as measured by an odds ratio (OR), from which a scoring system (MsPath) was developed to estimate the probability a colorectal cancer is MSI-H. Results: Fifteen percent of tumors (162) were MSI-H. Independent predictors were tumor-infiltrating lymphocytes (OR, 9.1; 95 % confidence interval [CI], 5.9-14.1), proximal subsite (OR, 4.7; 95% CI, 3.1-7.3), mucinous histology (OR, 2.8; 95% CI, 1.7-4.8), poor differentiation (OR, 1.9; 95% CI, 1.2-3.1), Crohn's-like reaction (OR, 1.9; 95% CI, 1.2-2.9), and diagnosis before age 50 years (OR, 1.9; 95% CI, 1.3-2.9). MsPath score >= 1.0 had a sensitivity of 93% and a specificity of 55% for MSI-H. Conclusions: The probability an individual colorectal. cancer is MSI-H is predicted well by the MsPath score. There is little value in testing for DNA mismatch repair loss in tumors, or for germline mismatch repair mutations, for colorectal cancers diagnosed in patients before age 60 years with an MSPath score < 1 (approximately 50%). Pathology can identify almost all MSI-H colorectal cancers diagnosed before age 60 years.