Jun Sun-Young, Hong Seung-Mo, Jang Kee-Taek
Department of Pathology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
J Korean Med Sci. 2024 Dec 30;39(50):e335. doi: 10.3346/jkms.2024.39.e335.
The retinoblastoma (RB) protein which is encoded by gene selectively provides a cell type-specific function in malignancies. In colorectal carcinoma, RB has been highly expressed and related cyclin/cyclin-dependent kinase 4/6 inhibitors have shown improved therapeutic effects in some patients. However, little is known about RB in small intestinal adenocarcinoma (SIAC).
Here, we conducted a multi-institutional study of RB expression in 229 surgically resected SIACs to explore the clinicopathologic and prognostic implications and the relationship with microsatellite instability (MSI) status and mutations.
High RB expression (RB) was more commonly observed in SIACs (76/229, 33%) than in normal small intestinal mucosa (27/188, 14%; < 0.001). RB was associated with nodular growth patterns ( = 0.028), the absence of lymphovascular ( = 0.001) and perineural invasion ( = 0.048), and a lower T category ( = 0.042) and indicated better overall survival ( = 0.003). In multivariate analysis, RB ( = 0.049) was an independent prognostic predictor of better prognosis, along with younger patient age ( = 0.049), the absence of retroperitoneal seeding ( = 0.004), lower tumor stage ( < 0.001), and MSI ( = 0.005). The prognostic impact of RB expression was consistently observed regardless of MSI status and specifically persistent in SIACs with lower stages (stages I and II).
RB was related to favorable clinicopathologic SIAC characteristics and indicated better patient prognosis. The prognostic predictability of RB was found in SIACs with lower stages, independent of MSI status. RB expression is a reliable and potent prognostic indicator for SIAC and may aid in selecting chemotherapy for patients.
由 基因编码的视网膜母细胞瘤（RB）蛋白在恶性肿瘤中选择性地提供细胞类型特异性功能。在结直肠癌中，RB 高表达，相关的细胞周期蛋白/细胞周期蛋白依赖性激酶 4/6 抑制剂在一些患者中显示出改善的治疗效果。然而，关于小肠腺癌（SIAC）中的 RB 知之甚少。
在此，我们对 229 例手术切除的 SIAC 进行了一项多机构研究，以探讨 RB 表达的临床病理和预后意义以及与微卫星不稳定性（MSI）状态和 突变的关系。
在 SIAC 中比在正常小肠黏膜中更常观察到高 RB 表达（RB）（76/229，33% 比 27/188，14%；<0.001）。RB 与结节状生长模式（=0.028）、无淋巴管（=0.001）和神经周围浸润（=0.048）以及较低的 T 类别（=0.042）相关，并表明总体生存率更好（=0.003）。在多变量分析中，RB（=0.049）是预后较好的独立预后预测指标，同时还有患者年龄较小（=0.049）、无腹膜后种植（=0.004）、肿瘤分期较低（<0.001）和 MSI（=0.005）。无论 MSI 状态如何，均一致观察到 RB 表达的预后影响，并且在较低分期（I 期和 II 期）的 SIAC 中尤为持续。
RB 与 SIAC 的良好临床病理特征相关，并表明患者预后较好。在较低分期的 SIAC 中发现了 RB 的预后可预测性，与 MSI 状态无关。RB 表达是 SIAC 的可靠且有效的预后指标，可能有助于为患者选择化疗方案。
