Department of Gastroenterology and Hepatology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands.
Virchows Arch. 2021 Sep;479(3):451-457. doi: 10.1007/s00428-021-03074-w. Epub 2021 Mar 14.
Mismatch repair (MMR) testing is recommended in the Netherlands for all patients under 70 years of age with newly diagnosed colorectal cancer (CRC) in order to identify Lynch syndrome. T1 CRC can be removed by local excision or oncological surgical resection. We evaluated the frequency of MMR testing in pT1 lesions within the Dutch CRC screening cohort. pT1 CRC diagnosed within the Dutch population-based screening program from 2016-2018 were identified by the Dutch pathology registry (PALGA). Pathology reports were evaluated, including registration of MMR testing (by immunohistochemistry and/or microsatellite instability PCR). Frequency of MMR testing was compared between pT1 tumors that were treated by local (endoscopic or transanal) excision and oncological surgical resections. A total of 3.692 pT1 CRCs were diagnosed (median age 63 years, 61.4% males). MMR testing was performed in 83% and uptake increased over time (71% in 2016 to 92% in 2018, p<0.01). MMR testing was significantly more often performed in younger patients and in academic hospitals. When pT1 CRC was treated by oncological surgical resection (n=1.132), MMR testing was performed in 89% of cases and was known prior to oncological resection in 51% of cases. MMR testing occurred significantly less often in case of local excision (80% of n=2.560) compared to oncological surgical resection (p<0.01). MMR testing was performed in 83% of T1 CRCs and uptake increased over time. MMR testing was more frequently performed in pT1 CRC resected by oncological surgical resection compared with local excision.
在荷兰，所有 70 岁以下新诊断为结直肠癌（CRC）的患者都建议进行错配修复（MMR）检测，以确定林奇综合征。T1CRC 可通过局部切除或肿瘤外科切除术切除。我们评估了荷兰 CRC 筛查队列中 pT1 病变中 MMR 检测的频率。通过荷兰病理学登记处（PALGA）确定了 2016-2018 年荷兰人群筛查计划中诊断的 pT1CRC。评估了病理学报告，包括 MMR 检测（通过免疫组织化学和/或微卫星不稳定性 PCR）的登记情况。比较了接受局部（内镜或经肛门）切除和肿瘤外科切除术治疗的 pT1 肿瘤中 MMR 检测的频率。共诊断出 3692 例 pT1CRC（中位年龄 63 岁，男性占 61.4%）。83%的患者进行了 MMR 检测，并且随着时间的推移，接受率有所增加（2016 年为 71%，2018 年为 92%，p<0.01）。MMR 检测在年轻患者和学术医院中更为常见。当 pT1CRC 接受肿瘤外科切除术（n=1132）时，89%的病例进行了 MMR 检测，51%的病例在肿瘤外科切除前已知 MMR 检测结果。与肿瘤外科切除术相比，局部切除（n=2560）的病例中 MMR 检测明显较少（80%，p<0.01）。83%的 T1CRC 进行了 MMR 检测，并且随着时间的推移，接受率有所增加。与局部切除相比，肿瘤外科切除的 pT1CRC 中更频繁地进行了 MMR 检测。
