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KMID : 0356720080240030175
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Journal of the Korean Society of Coloproctology
2008 Volume.24 No. 3 p.175 ~ p.183
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Clinicopathologic Features of Sporadic Colorectal Cancer with MLH1/MSH2 Loss of Expression - Reduced Likelihood of Metastases
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Park Ji-Won
Chang Hee-Jin
Jung Kyung-Hae
Kim Dae-Yong
Sohn Dae-Kyung
Han Kyung-Soo
Hong Chang-Won
Lim Seok-Byung
Choi Hyo-Seong
Jeong Seung-Yong
Lee Sang-Jeon
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Abstract
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Purpose: This study was designed to determine the frequency of MMR defective sporadic colorectal cancer (CRC) by using immunohistochemistry and to investigate the correlation between the MMR status and the metastatic potential.
Methods: The study included 249 patients with sporadic colorectal cancer who underwent surgical resection. The MMR status was determined by using an immunohistochemical analysis of MLH1 and MSH2 expression.
Results: Twenty seven (10.8%) carcinomas showed abnormal MMR protein expression (18 MLH1 negative and 9 MSH2 negative) and were classified as MMR defective tumors whereas 222 tumors demonstrated normal MLH1/MSH2 immunoreactivity (MMR intact tumor). MMR defective tumors developed at significantly higher frequencies in a proximal site (59.3% vs. 27.5%, P=0.001) and tended to be larger in size (6.3±2.4 cm vs. 5.1±2.1 cm, P=0.026). They showed significantly lower overall stage, N stage, and M stage at the time of diagnosis (P=0.002, P=0.014, P=0.010, respectively). In patients who had MMR defective tumors, lymphocytic infiltration (40.7% vs. 8.7%, P＜0.001) and poor differentiation (22.2% vs. 11.7%, P=0.012) were more frequently observed. Less frequently MMR defective tumors displayed lymphatic invasion (40.7% vs. 67.1%, P=0.007) and infiltrative borders (22.2% vs. 51.8%, P=0.004). The MMR defect was strongly associated with a decreased likelihood of lymph node (odds ratio: 0.34, 95% CI: 0.13∼0.95) and distant organ metastases at diagnosis (odds ratio: 0.09, 95% CI: 0.01∼0.94), independent of the clinicopathologic features.
Conclusions: Immunohistochemical analysis revealed that 10.8% of sporadic CRC cases showed no staining for MLH1 or MSH2. Lymphatic invasion and distant metastases were found at lower rates in these MMR defective tumors. J Korean Soc Coloproctol 2008;24:175-183
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KEYWORD
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Sporadic colorectal cancer, Mismatch repair protein, Microsatellite instability, Immunohistochemistry
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