结肠腺癌的位置特异性差异——KRAS基因突变和较多肿瘤出芽在盲肠腺癌中更为常见

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  近期的文献指出,盲肠腺癌在分子水平变化上与非盲肠部近端结肠腺癌有所不同,且盲肠肿瘤的位置可能是一个预后相关的变量。我们比较了2年期间诊断的、根据肿瘤位置(盲肠、右半结肠、左半结肠)进行分层的328例结肠腺癌病例的分子水平变化、组织病理特征及疾病特异性生存期。总体来看,盲肠腺癌的分子学异常频率最高,其中74%为KRAS第2或3外显子突变、BRAF突变或DNA错配修复蛋白缺陷。KRAS突变在盲肠部位的发生率高于其他部位(P=0.03),可在46%的盲肠腺癌中出现,而右半结肠腺癌中只有25%(P=0.004)。盲肠腺癌也更易出现不良的组织病理学特征,特别是出现较多肿瘤出芽(31%),而该病变在右半结肠肿瘤中的发生率为18%(P=0.04)、左半结肠肿瘤中的发生率为17%(P=0.02)。在多变量分析中,总体分期是疾病特异性生存率最重要的独立预测因子;然而,盲肠肿瘤部位和较多肿瘤出芽也是生存期短的预测指标,特别对于Ⅲ或Ⅳ期肿瘤患者而言。总之,与非盲肠部右半结肠腺癌相比,盲肠腺癌的特征是具有更高频率的KRAS突变,且表现为常见较多肿瘤出芽,这些特征可能成为预后相关的变量,尤其对于Ⅲ和Ⅳ期的患者而言。
Am J Surg Pathol 2018;42:351-358
美国外科病理学杂志中文版2018年第三期摘要No.1
(沈光月 翻译 纪元 审校)
  The American Journal of Surgical Pathology中文版声明:
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