Expresión tisular de proteínas reparadoras e infiltración linfocítica tumoral: significado pronóstico en el carcinoma colorrectal resecado / Tissular expression of mismatch repair proteins and tumour lymphocytic infiltration: prognostic significance in resected colorectal carcinoma

RESUMEN

Fundamento. En el cáncer colorrectal se discute la posible relación entre la expresión patológica de proteínas reparadoras (EPPR) y la infiltración linfocítica tumoral (ILT), así como el posible efecto pronóstico de ambos factores. Material y métodos. Se han revisado 243 cánceres colorrectales, resecados consecutivamente. Estudiamos inmunohistoquímicamente la EPPR de MLH1, MSH2 y MSH6. La ITL se valoró mediante la tinción de CD3 en el epitelio tumoral. Comparamos la mortalidad y progresión tumoral post-operatoria entre los casos con y sin EPPR y con y sin ITL. Adicionalmente estudiamos la mortalidad y progresión tumoral entre los casos EPPR (+), según presentaran o no ITL. Resultados. El 13,6% tumores expresaron EPPR (+) y el25,5% ITL (+). El seguimiento fue 73,8±34,6 meses. La frecuencia de ITL (+) resultó similar entre tumores EPPR (+)27,3% y EPPR (-) 25,2% (p = 0,80). Los casos EPPR (+) mostraron menor mortalidad 12,1% versus 23,3% (p = 0,15) y menor progresión tumoral 21,2% versus 29% (p = 0,35). Las neoplasias ITL (+) tuvieron menor mortalidad 9,7% versus26% [p = 0,007; OR = 3,27(1,25-9,05)] y progresión tumoral 12,9% versus 33,1% [p = 0,002; OR = 3,35 (1,42-8,15)]. Los 9 tumores EPPR (+) e ILT (+) no presentaron mortalidad ni progresión tumoral, frente a una mortalidad 16,7% y progresión 29,2% de los 24 casos EPPR (+) e ITL (-) p = 0,19 y p= 0,07 respectivamente. Conclusiones. No se ha encontrado relación entre EPPR e ITL, con tasas muy similares de ILT (+) entre casos con y sin EPPR. La ILT (+) mostró un efecto pronóstico favorable superior a la EPPR (+). La combinación de ILT (+) e EPPR (+) parece tener un efecto protector acumulativo, aunque su escasa frecuencia resta significación al hallazgo(AU)

ABSTRACT

Background. In colorectal cancer there is discussion about the possible relation between the mismatch repair protein expression (MMRPE) and tumour lymphocytic infiltration(TLI), as well as the possible prognostic effect of both factors. Methods. A review was made of 243 colorectal cancers, consecutively resected. We made an immunohystochemical study of the MMRPE of MLH1, MSH2 and MSH6. The TLI was evaluated through CD3 staining in the tumoural epithelium. We compared mortality and post-operative tumoural progression amongst the cases with and without MMRPE and with and without TLI. Additionally, we studied mortality and tumoural progression amongst MMRPE (+) cases, according to whether or not they presented TLI. Results. Thirteen point six percent of the tumours expressed MMRPE (+) and 25.5% TLI (+). The follow-up was 73.8±34.6 months. The frequency of TLI (+) turned out to be similar between MMRPE (+) tumours 27.3% and MMRPE (-) 25.2% (p = 0.80). The MMRPE (+) cases showed less mortality 12.1%versus 23.3% (p = 0.15) and less tumoural progression 21.2%versus 29% (p = 0.35). The ITL neoplasias (+) had a lower mortality 9.7% versus 26% [p = 0.007; OR = 3.27(1.25-9.05)]and tumoural progression 12.9% versus 33.1% [p = 0.002; OR = 3.35 (1.42-8.15)]. The 9 MMRPE (+) and ILT (+) tumours did not present mortality or tumoural progression, against a mortality 16.7% and progression 29.2% of the 24 MMRPE (+) and TLI (-) cases p = 0.19 and p = 0.07 respectively. Conclusions. No relation was found between MMRPE and TLI, with very similar rates of TLI (+) between cases with and without MMRPE. The TLI (+) showed a favourable prognostic effect higher than that of the MMRPE (+). The combination of TLI (+) and MMRPE (+) seems to have an accumulative protective effect, although its limited frequency reduces the significance of the finding(AU)