Basil J B, Goodfellow P J, Rader J S, Mutch D G, Herzog T J
Washington University School of Medicine, Department of Obstetrics and Gynecology, Barnes-Jewish Hospital Plaza, St. Louis, Missouri, USA.
Cancer. 2000 Oct 15;89(8):1758-64. doi: 10.1002/1097-0142(20001015)89:8<1758::aid-cncr16>3.0.co;2-a.
The purpose of this study was to compare the clinical characteristics of endometrial carcinomas with and without microsatellite instability (MSI).
The authors prospectively acquired DNA from patients with endometrial carcinomas at Washington University Medical Center. Tumors were assigned MSI (+) status when two or more of five microsatellite repeat markers revealed novel bands in tumor DNA not present in the corresponding normal DNA. Clinical characteristics and survival data of patients with and without MSI were abstracted from patient charts. Statistical significance was calculated with the chi-square test, and survival was assessed with Kaplan-Meier methods.
The authors found 65 of 70 (93%) patients with MSI (+) tumors to be of white race, whereas only 124 of 159 (78%) patients with MSI (-) tumors were white (P = 0.012). Advanced disease (International Federation of Gynecology and Obstetrics Stage III-IV) was observed in 9 of 70 (13%) MSI (+) patients and 44 of 159 (28%) MSI (-) patients (P = 0.017). In addition, aggressive histologic subtypes were observed less frequently in MSI (+) tumors (6/70 [8%]) than in MSI (-) tumors (30 of 159 [19%]) (P = 0.034). Race and stage were shown by multivariate analysis to be different in MSI (+) and MSI (-) patients. Recurrence and overall survival were similar in the two groups.
Patients with MSI (+) tumors were more likely to be of white race and to present with early stage disease. Further investigation is needed to explain why patients with MSI (+) tumors have similar survival to patients with MSI (-) tumors, despite presenting at earlier stages, being of white race, and being less likely to be associated with virulent histologic subtypes.
本研究的目的是比较伴有和不伴有微卫星不稳定性（MSI）的子宫内膜癌的临床特征。
作者前瞻性地获取了华盛顿大学医学中心子宫内膜癌患者的DNA。当五个微卫星重复标记中的两个或更多个在肿瘤DNA中显示出相应正常DNA中不存在的新条带时，肿瘤被判定为MSI（+）状态。有或无MSI患者的临床特征和生存数据从患者病历中提取。采用卡方检验计算统计学显著性，并用Kaplan-Meier方法评估生存情况。
作者发现70例MSI（+）肿瘤患者中有65例（93%）为白种人，而159例MSI（-）肿瘤患者中只有124例（78%）为白种人（P = 0.012）。70例MSI（+）患者中有9例（13%）出现晚期疾病（国际妇产科联盟III-IV期），159例MSI（-）患者中有44例（28%）出现晚期疾病（P = 0.017）。此外，MSI（+）肿瘤中侵袭性组织学亚型的发生率（6/70 [8%]）低于MSI（-）肿瘤（159例中的30例 [19%]）（P = 0.034）。多变量分析显示，MSI（+）和MSI（-）患者在种族和分期方面存在差异。两组的复发率和总生存率相似。
MSI（+）肿瘤患者更可能为白种人且表现为早期疾病。尽管MSI（+）肿瘤患者处于较早期阶段、为白种人且与侵袭性组织学亚型相关的可能性较小，但为何其生存率与MSI（-）肿瘤患者相似仍需进一步研究来解释。
