Gupta Princy, Zhan Peter L, Leeds Ira, Mongiu Anne, Reddy Vikram, Pantel Haddon J
Division of Colon and Rectal Surgery, Yale School of Medicine, New Haven, Connecticut.
Division of General Surgery, Yale School of Medicine, New Haven, Connecticut.
J Surg Res. 2024 Dec;304:371-382. doi: 10.1016/j.jss.2024.10.041. Epub 2024 Nov 29.
Defects in the DNA mismatch repair (MMR) pathway can predispose individuals to colorectal cancer (CRC), with germline mutations in this pathway leading to Lynch syndrome. Consequently, universal MMR testing is recommended for all newly diagnosed CRC patients to detect mismatch repair deficient (MMR-D) tumors, enabling informed treatment decisions. Given the increased potential for metachronous disease in patients with Lynch syndrome, the current guidelines for surgical management of Lynch-associated colon cancer recommend extended resection in patients under age 60.
A retrospective analysis of nonmetastatic CRC was performed from the National Cancer Database to evaluate the current trends and practice patterns in the surgical management of MMR-D colon cancer, as well as assess the factors influencing choice of surgical procedure.
From 2018 to 2020, 98,112 nonmetastatic CRC patients were identified, with 19.93% being MMR-D. MMR-D colon cancer patients were more likely to undergo extended resection than those with mismatch repair proficient tumors (9.4% versus 4.2%, P < 0.001). When accounting for approximately one-fourth of MMR-D colon cancers being attributable to Lynch syndrome, the frequency of extended resection was less than expected (9.4% versus 25%, P < 0.001). MMR-D patients under age 60 were more likely to undergo extended resection than those over age 60 (9% versus 3%) (odds ratio [OR] 3.57, 95% confidence interval [CI] 3.06-4.15). Several factors were associated with decreased rate of extended resection: uninsured (OR 0.42, 95% CI 0.21-0.84), Black race (OR 0.54, 95% CI 0.35-0.82), treatment at nonacademic centers (OR 0.74, 95% CI 0.56-0.97), and crowfly distance >25 miles (OR 1.98, 95% CI 1.14-3.45).
These findings provide valuable insight into the current surgical practice patterns in the management of MMR-D colon cancers and possibly colon cancers associated with Lynch syndrome.
DNA错配修复（MMR）途径的缺陷会使个体易患结直肠癌（CRC），该途径中的种系突变会导致林奇综合征。因此，建议对所有新诊断的CRC患者进行普遍的MMR检测，以检测错配修复缺陷（MMR-D）肿瘤，从而做出明智的治疗决策。鉴于林奇综合征患者发生异时性疾病的可能性增加，目前林奇相关结肠癌的外科治疗指南建议对60岁以下的患者进行扩大切除术。
对国家癌症数据库中的非转移性CRC进行回顾性分析，以评估MMR-D结肠癌外科治疗的当前趋势和实践模式，并评估影响手术方式选择的因素。
2018年至2020年，共识别出98112例非转移性CRC患者，其中19.93%为MMR-D。与错配修复功能正常的肿瘤患者相比，MMR-D结肠癌患者更有可能接受扩大切除术（9.4%对4.2%，P<0.001）。当考虑到约四分之一的MMR-D结肠癌归因于林奇综合征时，扩大切除术的频率低于预期（9.4%对25%，P<0.001）。60岁以下的MMR-D患者比60岁以上的患者更有可能接受扩大切除术（9%对3%）（比值比[OR]3.57，95%置信区间[CI]3.06-4.15）。几个因素与扩大切除术的发生率降低相关：未参保（OR 0.42，95%CI 0.21-0.84）、黑人种族（OR 0.54，95%CI 0.35-0.82）、在非学术中心接受治疗（OR 0.74，95%CI 0.56-0.97）以及直线距离>25英里（OR 1.98，95%CI 1.14-3.45）。
这些发现为MMR-D结肠癌以及可能与林奇综合征相关的结肠癌的当前外科治疗实践模式提供了有价值的见解。
