错配修复蛋白联合血清肿瘤标志物与Ki-67增殖指数对结直肠癌预后的临床价值

陈玺; 曾晓颖; 陈佳艳; 刘菲; 唐曦

doi:10.19401/j.cnki.1007-3639.2022.03.007

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错配修复蛋白联合血清肿瘤标志物与Ki-67增殖指数对结直肠癌预后的临床价值

论著 | 更新时间：2025-12-31

- 错配修复蛋白联合血清肿瘤标志物与Ki-67增殖指数对结直肠癌预后的临床价值
- The clinical value of mismatch repair protein combined with serum tumor markers and Ki-67 proliferation index in the prognostic evaluation of colorectal cancer
- 中国癌症杂志 2022年32卷第3期页码：243-250
- 作者机构：
  
  1. 复旦大学附属华东医院肿瘤科,上海 200040
  2. 上海市静安区统战部,上海 200041
- 作者简介：
  
  唐曦 E-mail： olivia9tang@126.com
- 基金信息：
- DOI：10.19401/j.cnki.1007-3639.2022.03.007
  中图分类号： R735.3
- 收稿：2022-01-03，
  
  纸质出版：2022-03-30
- 稿件说明：
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陈玺, 曾晓颖, 陈佳艳, 等. 错配修复蛋白联合血清肿瘤标志物与Ki-67增殖指数对结直肠癌预后的临床价值[J]. 中国癌症杂志, 2022,32(3):243-250.

Xi CHEN, Xiaoying ZENG, Jiayan CHEN, et al. The clinical value of mismatch repair protein combined with serum tumor markers and Ki-67 proliferation index in the prognostic evaluation of colorectal cancer[J]. China Oncology, 2022, 32(3): 243-250.
陈玺, 曾晓颖, 陈佳艳, 等. 错配修复蛋白联合血清肿瘤标志物与Ki-67增殖指数对结直肠癌预后的临床价值[J]. 中国癌症杂志, 2022,32(3):243-250. DOI： 10.19401/j.cnki.1007-3639.2022.03.007.

Xi CHEN, Xiaoying ZENG, Jiayan CHEN, et al. The clinical value of mismatch repair protein combined with serum tumor markers and Ki-67 proliferation index in the prognostic evaluation of colorectal cancer[J]. China Oncology, 2022, 32(3): 243-250. DOI： 10.19401/j.cnki.1007-3639.2022.03.007.

摘要

背景与目的：

结直肠癌是消化系统常见的恶性肿瘤之一

近年来中国结直肠癌发病率显著升高。各项临床与病理学指标对于结直肠癌的诊断、临床分期及预后的判断提供了帮助。探讨错配修复蛋白表达联合血清肿瘤标志物与Ki-67增殖指数在结直肠癌中的相关性及对预后判断的临床价值。

方法：

收集复旦大学附属华东医院2014年7月

#x02014;2018年6月收治的234例结直肠癌手术患者

分析其术前血清标本中肿瘤标志物癌胚抗原（carcinoembryonic antigen

CEA）、糖类抗原（carbohydrate antigen

CA）19-9、CA72-4、CA12-5水平及手术标本组织中的Ki-67增殖指数与错配修复蛋白的表达率

与结直肠癌临床病理学特征和预后的关系。

结果：

在234例结直肠癌患者术后标本中发生错配修复蛋白缺失表达（deficient mismatch repair

dMMR）的共29例（12.4%）

错配修复蛋白正常表达（proficient mismatch repair

pMMR）的有205例（87.6%）。在临床病理学指标的相关性分析中dMMR组与pMMR组在肿瘤原发部位、分化类型、分期、T分期、淋巴结转移方面的差异有统计学意义（

0.05）。在相关性分析中dMMR组与pMMR组在Ki-67增殖指数、术前CEA、CA72-4的水平差异有统计学意义（

0.05）。在单因素预后分析中

淋巴结转移组

分期较晚组生存率低

差异有统计学意义（

0.001）。在错配修复蛋白组中dMMR组的生存率为100%

pMMR组的生存率为83%

差异有统计学意义（

0.05）。术前肿瘤标志物组在预后分析中CEA、CA72-4对生存率的影响差异有统计学意义（

0.05）。通过对在单因素分析中影响结直肠癌患者预后的5组变量进行多因素COX回归分析发现

分期与术前CA72-4水平与预后显著相关（

0.05）。提示分期和术前CA72-4水平是影响患者预后的危险因素。

结论：

dMMR更多见于原发右半结肠的结肠癌

在低分化腺癌及黏液腺癌类型较差的肿瘤多见

对结直肠癌患者的预后评估具有一定的意义。

Abstract

Background and purpose:

Colorectal cancer is one of the most common malignant tumors of digestive system. The incidence of colorectal cancer has increased signi

ficantly in China in recent years. Various clinical and pathological indicators are helpful for the diagnosis

clinical staging and prognostic evaluation of colorectal cancer. This study aimed to observe the correlation between the expression of mismatch repair protein and serum tumor markers and Ki-67 proliferation index in colorectal cancer

and to analyze the prognostic value of mismatch repair protein

serum tumor markers and Ki-67 proliferation index.

Methods:

Data of 234 patients with colorectal cancer were collected after surgery in Huadong Hospital Affiliated to Fudan University from July 2014 to June 2018

and the preoperative serum levels of tumor markers (CEA

CA19-9

CA72-4

CA12-5)

Ki-67 proliferation index and mismatch repair protein expression rate in surgical specimens were analyzed

in order to find the relationship between these clinicopathological features and prognosis of colorectal cancer.

Results:

Among 234 postoperative specimens of colorectal cancer patients

a total of 29 cases (12.4%) had defective expression of mismatch repair protein (dMMR)

and 205 cases (87.6%) had normal expression of mismatch repair protein (pMMR). In the correlation analysis of clinicopathological features

there were statistically significant differences in tumor primary site

differentiation type

stage

T stage and lymph node metastasis between dMMR group and pMMR group (

0.05). In the correlation analysis of the observed indicators

the differences in Ki-67 proliferation index

preoperative CEA and CA72-4 levels between dMMR group and pMMR group were statistically significant (

0.05). Among the univariate prognostic analyses

the overall survival rate was significantly lower in the lymph node metastasis group and the advanced stage group (P

0.001). There was significant difference in overall survival rate between dMMR group (100%) and pMMR group (83%) (

0.05). In the prognostic analysis of the preoperative tumor marker

CEA and CA72-4 levels had prognostic value in survival analysis (

0.05). Multivariate COX regression analysis of 5 variables showed no significant correlation between expression of mismatch repair protein and lymph node metastasis in prognostic analysis

while significant correlation between staging and preoperative CA72-4 level was found in prognostic analysis (

0.05). It was suggested that staging and preoperative CA72-4 level were the most important risk factors affecting the prognosis of colorectal cancer patients.

Conclusion:

dMMR was more common in right-sided colon cancer and in poorly differentiated adenocarcinoma and mucinous adenocarcinoma with poor type. T stage was late

while general pathological stage was early. Lymph node metastasis was rare. In dMMR group

Ki-67 proliferation index was mostly below the mean level (

70% expression)

most patients had normal preoperative CEA level and elevated preoperative CA72-4 level. The dMMR group had a higher survival rate compared with the pMMR group

and later stage and increased preoperative CA72-4 level were risk factors affecting prognosis of patients. The expression deficiency of mismatch repair protein has certain prognostic value in patients with colorectal cancer.

关键词

Keywords

references

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