标题：直肠癌复发转移与错配修复蛋白表达的相关性研究

      作者：许梅海 1，覃永平 1*，尹家瑜 1，韦洁勤 1，潘洋洋 1，申炜 1，蒋洪棉 2，刘刚 3    广西医科大学第五附属医院(南宁市第一人民医院)放射科 1、病理科 2、胃肠外科 3，广西 南宁 530022

      卷次： 2022年33卷12期

      【摘要】 目的 探讨直肠癌复发转移与错配修复蛋白表达的相关性。方法 收集广西医科大学第五附属医院2014年1月至2020年9月收治的120例原发性直肠癌患者的临床、影像及病理学资料。所有手术切除的肿瘤标本均采用免疫组化法检测错配修复(MMR)蛋白表达，主要包括MLH1、PMS2、MSH2、MSH6，以这4种MMR蛋白中出现1~3种表达缺失现象为错配修复基因缺失(dMMR)，将其作为dMMR组；以4种MMR蛋白均为阳性为错配修复基因健全(pMMR)，将其作为pMMR组。术后对患者定期随访12个月，综合影像学、病理学资料将随访过程中出现复发和或转移的患者作为复发转移组，随访截止时无复发与转移者作为无复发转移组。比较各组间的临床基线资料、病理特征的差异。结果 120例原发性直肠癌患者中因失访18例，术后影像资料不全6例，以及因直肠癌术后其他并发症死亡2例，最终纳入94例患者进行研究，其中pMMR组55例(58.5%)，dMMR组39例(41.5%)；定期随访12个月，dMMR组患者的腹腔及远处转移的比例明显高于pMMR组，差异均有统计学意义(P<0.05)；MMR分型与直肠癌复发与转移存在一定相关性，但关联性较低(列联系数为0.198)。结论 MMR蛋白表达情况对预测直肠癌复发与转移有提示作用并对临床治疗选择有一定的帮助。
      【关键词】 直肠癌；复发和或转移；错配修复蛋白；错配修复基因缺失；错配修复基因健全
      【中图分类号】 R735.3+7 【文献标识码】 A 【文章编号】 1003—6350（2022）12—1501—04

Correlation between recurrence and metastasis of rectal cancer and expression of mismatch repair protein.
XUMei-hai 1, QIN Yong-ping 1*, YIN Jia-yu 1, WEI Jie-qin 1, PAN Yang-yang 1, SHEN Wei 1, JIANG Hong-mian 2, LIU Gang 3.Department of Radiology 1, Department of Pathology 2, Department of Gastrointestinal Surgery 3, the Fifth Affiliated Hospitalof Guangxi Medical University (the First People's Hospital of Nanning), Nanning 530022, Guangxi, CHINA
【Abstract】 Objective To investigate the correlation between the expression of mismatch repair protein and therecurrence and metastasis of rectal cancer. Methods The clinical, imaging and pathological data of 120 patients withprimary rectal cancer in the Fifth Affiliated Hospital of Guangxi Medical University from January 2014 to September2020 were collected. The expression of mismatch repair (MMR) proteins, including MLH1, PMS2, MSH2, and MSH6,was detected by immunohistochemistry in all the tumor specimens. It is regarded as mismatch repair deficiency (dMMR)when 1 to 3 of the four MMR proteins were not expressed (dMMR group). It is regarded as mismatch repair proficiency(pMMR) when all the four MMR proteins were positively expressed (pMMR group). The patients were followed up reg-ularly for 12 months. According to the imaging and pathological data, the patients with recurrence or metastasis duringthe follow-up were regarded as the recurrence and metastasis group, and the patients without recurrence or metastasis atthe end of follow-up were regarded as the non-recurrence and non-metastasis group. The differences of clinical baselinedata and pathological characteristics between the two groups were compared and analyzed. Results Among the 120 pa-tients with primary rectal cancer, 18 patients were lost to follow-up, 6 patients had incomplete postoperative imaging da-ta, 2 patients died of other postoperative complications of rectal cancer, and finally 94 patients were included in thestudy, including 55 patients (58.5%) in pMMR group and 39 patients (41.5%) in dMMR group. The proportion of abdom-inal cavity and distant metastasis in dMMR group was significantly higher than that in pMMR group (P<0.05). MMRclassification was correlated with recurrence and metastasis of rectal cancer, and the contingency coefficient was 0.198.Conclusion The expression of MMR protein can be used to predict the recurrence and metastasis of rectal cancer, andit is helpful for clinical treatment.
      【Key words】 Rectal cancer; Recurrence and/or metastasis; Mismatch repair deficiency; Mismatch repair gene de-letion; Mismatch repair proficiency