Gómez-Álvarez Miguel A, Lino-Silva Leonardo S, Salcedo-Hernández Rosa A, Padilla-Rosciano Alejandro, Ruiz-García Erika B, López-Basave Horacio N, Calderillo-Ruiz German, Aguilar-Romero José M, Domínguez-Rodríguez Jorge A, Herrera-Gómez Ángel, Meneses-García Abelardo
Surgical Oncology, Instituto Nacional de Cancerología, México City, Mexico.
Department of Anatomic Pathology, Instituto Nacional de Cancerología, México City, Mexico.
Prz Gastroenterol. 2017;12(3):208-214. doi: 10.5114/pg.2016.64740. Epub 2016 Dec 20.
Colorectal medullary carcinoma (MC) is a rare subtype of poorly differentiated adenocarcinoma (PDA) with unclear prognostic significance. Microsatellite instable (MSI) colorectal carcinomas have demonstrated better prognosis in clinical stage II.
To analyze the survival and clinicopathological characteristics of MCs versus PDAs with MSI in clinical stage III.
We studied 22 cases of PDAs with MSI versus 10 MCs.
Of the 10 MCs, 7 patients were men; the mean age was 57.8 ±5.6 years. The mean tumor size was 9.6 ±4.1 cm, and the primary site was the right colon in 9; 7 patients showed lymph node metastases (LNM) and lymphovascular invasion (LVI). Of the 22 PDA cases, 12 (54.5%) were women with a mean age of 75 ±16.1 years. The mean tumor size was 6.4 ±3.2 cm. Twelve (54.5%) presented in the right colon, 21 (95.5%) showed LNM and 7 (31.8%) LVI. Follow-up was 32 ±8 months, with a 5-year overall survival of 42.9% for MCs and 76.6% for PDAs ( = 0.048). Univariate analysis found local recurrence ( = 0.001) and medullary subtype ( = 0.043) associated with lower survival.
Medullary carcinomas were of greater tumor size and associated with more LVI and worse survival versus PDAs with MSI in stage III.
结直肠髓样癌（MC）是低分化腺癌（PDA）的一种罕见亚型，其预后意义尚不清楚。微卫星不稳定（MSI）的结直肠癌在临床II期显示出较好的预后。
分析临床III期MC与MSI-PDA的生存情况及临床病理特征。
我们研究了22例MSI-PDA和10例MC。
10例MC中，男性7例；平均年龄为57.8±5.6岁。平均肿瘤大小为9.6±4.1 cm，9例原发部位在右半结肠；7例患者出现淋巴结转移（LNM）和淋巴管侵犯（LVI）。22例PDA病例中，12例（54.5%）为女性，平均年龄为75±16.1岁。平均肿瘤大小为6.4±3.2 cm。12例（54.5%）位于右半结肠，21例（95.5%）出现LNM，7例（31.8%）出现LVI。随访时间为32±8个月，MC的5年总生存率为42.9%，PDA为76.6%（P = 0.048）。单因素分析发现局部复发（P = 0.001）和髓样亚型（P = 0.043）与较低的生存率相关。
与III期MSI-PDA相比，髓样癌肿瘤更大，LVI更多，生存率更差。
