de Manzoni G, Tomezzoli A, Di Leo A, Moore P S, Talamini G, Scarpa A
Istituto di Semeiotica Chirurgica, Dipartimento di Patologia, Università di Verona, Verona, Italy.
Br J Surg. 2001 Mar;88(3):419-25. doi: 10.1046/j.1365-2168.2001.01667.x.
Tumour stage is the only reliable prognostic factor for gastric cancer. The molecular anomalies involved in this process have the potential to serve as additional prognostic markers.
Forty-four gastric cancers, treated by surgery alone, have been analysed for chromosome 17p and 18q allelic loss and for the presence of microsatellite instability (MSI), using microsatellite markers and DNA from paraffin-embedded tumours.
Eight cancers showed a MSI-positive (MSI+) phenotype. Among the 36 MSI-negative cancers, chromosome 17p and 18q allelic losses were found in 22 of 34 and 19 of 33 informative cases respectively. Multivariate survival analysis indicated MSI status to be an independent prognostic factor along with the tumour stage. MSI+ cancers were associated with longer patient survival, whereas MSI-negative cancers had a significantly poorer prognosis (P = 0.007), with a median actuarial survival of 24 months.
MSI status is an independent prognostic factor among gastric cancers at the same stage. Chromosome 17p and 18q status added no additional prognostic information to that of tumour stage. The combined use of tumour stage and MSI status may help in deciding whether patients with advanced gastric cancer require additional therapy other than surgery alone.
肿瘤分期是胃癌唯一可靠的预后因素。该过程中涉及的分子异常有可能作为额外的预后标志物。
对44例仅接受手术治疗的胃癌患者进行分析，使用微卫星标记和石蜡包埋肿瘤的DNA检测17号染色体短臂和18号染色体长臂的等位基因缺失以及微卫星不稳定性（MSI）情况。
8例癌症表现为MSI阳性（MSI+）表型。在36例MSI阴性癌症中，34例信息充分的病例中有22例发现17号染色体短臂等位基因缺失，33例信息充分的病例中有19例发现18号染色体长臂等位基因缺失。多因素生存分析表明，MSI状态与肿瘤分期一样是独立的预后因素。MSI+癌症患者的生存期较长，而MSI阴性癌症患者的预后明显较差（P = 0.007），精算中位生存期为24个月。
MSI状态是同阶段胃癌的独立预后因素。17号染色体短臂和18号染色体长臂状态并未为肿瘤分期提供额外的预后信息。联合使用肿瘤分期和MSI状态可能有助于确定晚期胃癌患者除单纯手术外是否需要额外治疗。
