错配修复状态和淋巴结比率在II/III期直肠癌患者生存预测中的作用：一项多中心回顾性研究的综合分析

Mismatch Repair Status and Lymph Node Ratio in Survival Prediction of Stage II/III Rectal Cancer Patients: A Comprehensive Analysis of a Multi-Center Retrospective Study.

作者信息

Zhao Kailong, Pang Wenwen, Liu Xinyu, Ni Kemin, Gao Weifeng, Tan Zhiquan, Xue Jun, Liang Weizheng, Wu Xueliang, Zhang Xipeng, Su Xiaomin, Zhang Chunze

机构信息

School of Medicine, Nankai University, Tianjin, China.

Department of Colorectal Surgery, Tianjin Union Medical Center, The First Affiliated Hospital of Nankai University, Tianjin, China.

出版信息

Cancer Med. 2025 Apr;14(7):e70756. doi: 10.1002/cam4.70756.

DOI:10.1002/cam4.70756

PMID:40176366

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11965272/

Abstract

BACKGROUND

The microsatellite status (dMMR vs. pMMR) in colorectal cancer can serve as a guiding factor for patient prognosis and treatment, where dMMR status indicates a better prognosis and often obviates the need for adjuvant chemotherapy (ACT). Conversely, a higher lymph node ratio (LNR) is associated with a poorer prognosis. This study aims to elucidate the prognostic significance of LNR and MMR status in relation to ACT in stages II and III colorectal cancer.

METHODS

A total of 1946 patients who underwent radical resection for colorectal cancer and were pathologically staged as II and III from three medical centers between 2012 and 2019 were selected. Among them, 1104 patients were included after MMR status was tested and postoperative chemotherapy was administered, along with other clinical information. MMR (mismatch repair) status was determined via pathological immunohistochemistry (IHC), and LNR was calculated. Patients were divided into three groups based on the LNR value and subjected to Kaplan-Meier and Cox regression analysis to assess the impact of MMR, LNR, and ACT on overall survival (OS) and disease-free survival (DFS).

RESULTS

A total of 6.47% of stage II and III colorectal cancers were detected as dMMR. Significant differences in OS and DFS between dMMR and pMMR patients were observed when the LNR ranged from 0.03 to 0.31, with pMMR patients showing a better prognosis. Stratified analysis with ACT revealed that postoperative chemotherapy did not affect the prognosis within the dMMR patient group. However, compared to the pMMR group, dMMR patients experienced significantly adverse effects on prognosis after receiving postoperative chemotherapy (p < 0.05). This result was more pronounced in the stratified analysis based on LNR (0.03-0.31) (p < 0.01).

CONCLUSIONS

Integrating LNR based on the microsatellite status of colorectal tumors provides comprehensive prognostic predictions, enhancing postoperative prognostic considerations for tumor patients. Additionally, our study suggests that patients with stage II and III colorectal cancer with dMMR status do not require any adjuvant chemotherapy postoperatively.

摘要

背景

结直肠癌中的微卫星状态（错配修复缺陷[dMMR]与错配修复功能正常[pMMR]）可作为患者预后和治疗的指导因素，其中dMMR状态提示预后较好，且通常无需辅助化疗（ACT）。相反，较高的淋巴结比率（LNR）与较差的预后相关。本研究旨在阐明LNR和错配修复状态在II期和III期结直肠癌中与ACT相关的预后意义。

方法

选取2012年至2019年间来自三个医疗中心的1946例行结直肠癌根治性切除术且病理分期为II期和III期的患者。其中，1104例患者在检测错配修复状态并给予术后化疗后纳入研究，并收集其他临床信息。通过病理免疫组织化学（IHC）确定错配修复（MMR）状态，并计算LNR。根据LNR值将患者分为三组，进行Kaplan-Meier分析和Cox回归分析，以评估MMR、LNR和ACT对总生存期（OS）和无病生存期（DFS）的影响。

结果

II期和III期结直肠癌中共有6.47%检测为dMMR。当LNR在0.03至0.31之间时，观察到dMMR和pMMR患者在OS和DFS方面存在显著差异，pMMR患者预后较好。ACT分层分析显示，术后化疗对dMMR患者组的预后无影响。然而，与pMMR组相比，dMMR患者接受术后化疗后预后受到显著不良影响（p<0.05）。基于LNR（0.03 - 0.31）的分层分析中这一结果更为明显（p<0.01）。