The significance of microsatellite instability in colorectal cancer after controlling for clinicopathological factors.
The significance of microsatellite instability in colorectal cancer after controlling for clinicopathological factors.
复制标题
DOI：
10.1097/md.0000000000010019
复制
发表时间：
2018-03
期刊：
影响因子：
1.6
通讯作者：
Min BW
中科院分区：
文献类型：
--
作者：
Kang S;Na Y;Joung SY;Lee SI;Oh SC;Min BW
具有微卫星不稳定性（MSI）的结直肠癌（CRC）患者具有独特的临床病理特征，包括预测阳性和阴性结果的因素，例如高淋巴结采集和低分化。在本研究中，我们在控制这些差异因素后测量了 MSI 作为预后因素的价值。共有 603 名接受 I 期至 III 期结直肠癌根治性手术的患者入组。将患者分为微卫星不稳定性高（MSI-H）组和微卫星稳定/微卫星不稳定性低（MSS/MSI-L）组。使用倾向评分匹配来匹配两组之间的临床病理因素。 MSI-H 患者淋巴结采集量高（中位数：31.0 vs 23.0，P < .001）、早期肿瘤（P < .001）、晚期 T 分期（89.3% vs 74.0%，P = .018）和低分化（19.6% vs 2.0%， P < .001)。生存分析显示MSI-H组的生存率较高，但差异无统计学意义（P = .126）。对 Cox 风险回归确定的显着预后因素进行倾向评分匹配。匹配后，MSI状态的生存差异估计比之前更大，并达到统计学显着性（P = .045）。总之，在控制病理特征后，MSI-H 可能是患者生存的一个有效的预后因素。
The colorectal cancer (CRC) patients with microsatellite instability (MSI) have distinct clinicopathological characteristics consisting of factors predicting positive and negative outcomes, such as a high lymph node harvest and poor differentiation. In this study, we measured the value of MSI as a prognostic factor after controlling for these discrepant factors. A total of 603 patients who underwent curative surgery for stages I to III colorectal cancer were enrolled. The patients were divided into microsatellite instability high (MSI-H) and microsatellite stable/microsatellite instability low (MSS/MSI-L) groups. Propensity score matching was used to match clinicopathological factors between the 2 groups. MSI-H patients had a high lymph node harvest (median: 31.0 vs 23.0, P < .001), earlier-stage tumors (P < .001), advanced T stage (89.3% vs 74.0%, P = .018), and poor differentiation (19.6% vs 2.0%, P < .001). Survival analysis showed better survival in the MSI-H group, but the difference was not statistically significant (P = .126). Propensity score matching was performed for significant prognostic factors identified by Cox hazard regression. After the matching, the survival difference by MSI status was estimated to be larger than before, and reached statistical significance (P = .045). In conclusion, after controlling for pathological characteristics, MSI-H could be a potent prognostic factor regarding patient survival.