DNA复制错误阳性大肠癌的临床病理特点

目的探讨ＤＮＡ复制错误（ＲＥＲ）与大肠癌发生发展的关系。方法采用银染ＰＣＲ单链构象多态性（ｓｉｎｇｌｅｓｔｒａｎｄｃｏｎｆｏｒｍａｔｉｏｎｐｏｌｙｍｏｒｐｈｉｓｍ，ＳＳＣＰ）和ＰＣＲ－变性聚丙烯酰胺凝胶（ＰＡＧ）技术检测６０例大肠癌及其相应正常组织的第２、５、１７号染色体的４个位点的微小卫星ＤＮＡ不稳定性（ｍｉｃｒｏｓａｔｅｌｉｔｅｉｎｓｔａｂｉｔｙ，ＭＳＩ），有至少２个位点的ＭＳＩ则诊断为ＲＥＲ阳性。结果６０例大肠癌中，１９例为ＲＥＲ阳性（３１７％）。结合家族史，根据Ａｍｓｔｅｒｄａｎ标准，６０例病例中有４例被诊断为遗传性非息肉病性大肠癌（ｈｅｒｅｄｉｔａｒｙｎｏｎｐｏｌｙｓｉｓｃｏｌｏｒｅｃｔａｌｃａｎｃｅｒ，ＨＮＰＣＣ）。ＲＥＲ阳性率在ＨＮＰＣＣ中为３／４例与散发性大肠癌的２８５％比差异有显著性（Ｐ＜００５）。ＲＥＲ阳性大肠癌与ＲＥＲ阴性大肠癌比较大多为分化不良型腺癌（Ｐ＜００１），多位于右半结肠（Ｐ＜００５），有家族史（Ｐ＜００５），ＤｕｃｋｅｓＡ、Ｂ期较ＤｕｃｋｅｓＣ、Ｄ期患者所占比例高（Ｐ＜０．０５）。结论ＲＥＲ阳性大肠癌与ＲＥＲ阴性大肠癌有不同的生物学特性。

The relation between DNA replication error and clinicopathological features of colorectal carcinoma

Objective To study the relationship between DNA replication error and develpment of colorectal carcinoma (CRC). Methods Silver staining PCR SSCP and denatured polyacrlamide gel electrophoresis methods were used to detect microsatellits instability (MSI) at 4 loci on chromosome 2, 5, 17 in paraffin embedded speciments of 60 CRC and their paired normal tissue. If replication errors (RER) were found at 2 or more loci, then a diagnosis of RER was made. Results RER was observed in 19/60 CRC, among which 7 cases had CRC family history. According to Amsterdam criteria, 4 were diagnosed as HNPCC(hereditary nonpolyposis colorectal cancer), of which 3 cases were RER . The ratio of RER in HNPCC (75%) was significantly higher than that among sporadic CRC (28.5%). Most RER CRC have features of poorly differentiated adenocarcinoma ( P <0.01), tendency for right side involvement of the colon ( P <0.05) and a higher proportion with family history ( P <0 05). Rate of Dukes A and B stage higher than C and D stage ( P <0.05). Conclusion RER is a relatively common molecular event in CRC. RER CRC and RER- CRC have different clinicopathological features and behavior.