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Objective To investigate the clinicopathological characteristics of colon cancer patients with different mismatch repair gene (MMR) status and evaluate the value of MMR status combined with preoperative blood neutrophil-lymphocyte ratio (NLR) in predicting postoperative recurrence of colon cancer. Methods We retrospectively analyzed the pathological MMR immunohistochemistry results of 125 colon cancer patients after radical resection. Patients were divided into deficient mismatch repair (dMMR) group (n=55) and proficient mismatch repair (pMMR) group (n=70), and further divided into four groups according to MMR status and NLR level. Results Compared with the pMMR group, the patients in the dMMR group had younger onset age, larger tumor size, lower differentiation and more nerve invasion, and were more likely to occur in the right hemicolon (P < 0.05). According to the ROC curve, the NLR threshold was determined as 3. The proportion of low NLR in dMMR group was significantly higher than that in pMMR group (P < 0.05). The 3-year recurrence-free survival rate of the dMMR with low NLR group was 85.0%, significantly higher than those of the other three groups (P < 0.05); Survival analysis showed a significant advantage of the dMMR with low NLR group comparing with the pMMR with high NLR group. Conclusion dMMR colon cancer has unique clinicopathological characteristics. MMR status combined with NLR value can be used to evaluate the postoperative recurrence risk of colon cancer patients.
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EGISTs originating outside the gastrointestinal tract share some similarities with the GISTs regarding their immunohistochemical features including the positive expression of CD117 and CD34. The majority of EGISTs carry activating mutations of the C-KIT or PDGFRA genes. However, there is no precedent in the literature where the two mutations occur in one case of EGISTs to date. We describe herein, a 52-year-old female who presented as mesenteric and pelvic regions masses showing positive immunoreactivity for CD117, DOG-1, CD34. Mutation analysis identified two mutations that located in the exon 13 of C-KIT and in the exon 18 of PDGFRA. The patient was treated sequentially with imatinib, sunitinib, sorafenib, and regorafenib. However, the prognosis was undesirable. Previous research has shown that expression of members of Bcl-2 family may be helpful in predicting prognosis, the survival time, and the resistance to chemotherapeutic agents. IHC was performed to detect the expression of BCL-2 family. The results show that high BCL-2 expression and low BAX expression in both specimens. In conclusion, our case may suggest that the presence of both C-KIT and PDGFRA mutations in EGISTs patients may indicate a very poor prognosis; and the expression level of BCL-2 and BAX could predict clinical outcome.
Assuntos
Neoplasias Gastrointestinais/patologia , Tumores do Estroma Gastrointestinal/secundário , Mesentério/patologia , Recidiva Local de Neoplasia/patologia , Proteínas Proto-Oncogênicas c-kit/genética , Receptor alfa de Fator de Crescimento Derivado de Plaquetas/genética , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Feminino , Neoplasias Gastrointestinais/tratamento farmacológico , Neoplasias Gastrointestinais/genética , Tumores do Estroma Gastrointestinal/tratamento farmacológico , Tumores do Estroma Gastrointestinal/genética , Humanos , Mesentério/efeitos dos fármacos , Mesentério/metabolismo , Pessoa de Meia-Idade , Mutação , Recidiva Local de Neoplasia/tratamento farmacológico , Recidiva Local de Neoplasia/genética , PrognósticoRESUMO
Objective:To evaluate the clinical efficacy,toxicity,and prognostic factors of nab-paclitaxel as first-line treatment for elderly patients with advanced lung squamous carcinoma.Methods:This was a prospective study.Forty patients enrolled in the Second Affili-ated Hospital of Fujian Medical University were treated with nab-paclitaxel(260 mg/m2,ivggt d1),and a period of three weeks was considered as one session.The effects were evaluated after two cycles.Results:All 40 patients were followed up and appraised.Two patients achieved complete remission,13 achieved partial remission,13 achieved stable disease,and 12 achieved progressive disease. The objective response rate was 37.5% and the disease control rate was 70.0%.The progression-free survival(PFS),median overall sur-vival,and 1-year survival rate was 6.3 months,12.6 months,and 62.5%,respectively.The main hematologic toxicities were neutrope-nia and anemia,and the main non-hematologic adverse events were fatigue,constipation,nausea,vomiting,muscle aches,and hear-ing loss.Most patients could tolerate these toxic reactions.Moreover,Cox multivariate regression analysis showed that the neoplasm stage,Eastern Cooperative Oncology Group performance status,response rate,and PFS were independent factors for the survival rate (P<0.05),while age was not related to patient prognosis(P>0.05).Conclusions:Nab-paclitaxel as single drug and first-line therapy for elderly patients with advanced lung squamous carcinoma is effective and safe.
