Justesen Tobias Freyberg, Orhan Adile, Rosen Andreas Weinberger, Gögenur Mikail, Gögenur Ismail
From the Department of Surgery, Center for Surgical Science, Zealand University Hospital, Køge, Denmark.
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Ann Surg Open. 2024 Oct 16;5(4):e499. doi: 10.1097/AS9.0000000000000499. eCollection 2024 Dec.
This study examined the association between deficient mismatch repair (dMMR) versus proficient MMR (pMMR) status and overall survival and disease-free survival in patients with localized colorectal cancer.
Several distinctions exist between patients with dMMR and pMMR colorectal cancer. However, the impact on prognosis is yet to be investigated in large-scale cohort studies.
In this cohort study, we included patients who underwent curative-intent surgery for localized colorectal cancer between 2009 and 2020. Patients were identified in the Danish Colorectal Cancer Group database and patient-level data were extracted from 6 registry databases. After inclusion, patients with dMMR status were matched 1:1 to patients with pMMR status using an estimated propensity score.
After matching, 5994 patients were included. The patients had a median age of 74 years and a median follow-up of 4.1 years. There was no significant association between mismatch repair (MMR) status and overall survival (hazard ratio, 0.91; 95% confidence interval [CI], 0.81-1.03) or disease-free survival (hazard ratio, 0.89; 95% CI, 0.78-1.01). However, the restricted 5-year mean disease-free survival time, calculated due to violation of the proportional hazards assumption, showed a significant absolute difference of 0.13 years (95% CI, 0.03-0.23; = 0.01) in favor of the dMMR group.
No significant association with overall survival was found according to MMR status. dMMR status was, however, found to be associated with marginally improved disease-free survival compared to pMMR status in patients with localized colorectal cancer undergoing curative-intent surgery.
本研究探讨错配修复缺陷（dMMR）与错配修复功能正常（pMMR）状态与局限性结直肠癌患者总生存期和无病生存期之间的关联。
dMMR和pMMR结直肠癌患者之间存在一些差异。然而，其对预后的影响尚未在大规模队列研究中进行调查。
在这项队列研究中，我们纳入了2009年至2020年间接受局限性结直肠癌根治性手术的患者。患者在丹麦结直肠癌组数据库中被识别，并从6个登记数据库中提取患者层面的数据。纳入后，使用估计的倾向评分将dMMR状态的患者与pMMR状态的患者进行1:1匹配。
匹配后，纳入了5994例患者。患者的中位年龄为74岁，中位随访时间为4.1年。错配修复（MMR）状态与总生存期（风险比，0.91；95%置信区间[CI]，0.81 - 1.03）或无病生存期（风险比，0.89；95% CI，0.78 - 1.01）之间无显著关联。然而，由于违反了比例风险假设而计算的受限5年平均无病生存时间显示，dMMR组有显著的绝对差异0.13年（95% CI，0.03 - 0.23；P = 0.01）。
根据MMR状态未发现与总生存期有显著关联。然而，在接受根治性手术的局限性结直肠癌患者中，发现dMMR状态与pMMR状态相比，无病生存期略有改善。
