错配修复（MMR）状态已经被确定作为
研究方法：
纳入17项试验的7803例II/III期结肠癌患者，针对MLH1/MSH2/MLH6蛋白质利用微卫星不稳定性（MSI，14项研究）或者免疫组织化学分析（1项研究）开展分析；其中有2项研究对两种分析都进行检测。在汇总分析中，571例患者接受单纯手术治疗；3878例患者接受5-FU单药治疗（mrx）；2292例5-FU+
MSI-高或者没有蛋白质的肿瘤被列为dMMR；剩余的被归为MMR-proficient (pMMR)。中位随访期是7年。预后包括总生存期（OS）和复发时间（TTR）。相关性分析包括纳入分析的所有患者；预后分析仅限于接受单纯手术治疗或者5-FU mrx，排除接受oxri/iri治疗患者。
研究结果：
2270例II期患者有524名（23.1%），和5533例III期患者有823名（14.9%）表现出dMMR。MMR状态与女性性别（dMMR，19% F vs 16% M，P=0.004），较高的T期（dMMR，11% T1/2 v 18% T3 v 21% T4，P＜0.001），和右侧面肿瘤位置（dMMR，左9% v 右27%，P＜0.001）具有相关性。在接受单纯手术治疗的II期患者中（表），与pMMR比较，dMMR与改善的OS（HR=0.27，P=0.01）和TTR（HR=0.27，P=0.01）具有很强的关联。MMR与预后的关系在5-FU治疗的II期和III期患者中影响衰减，其显著性联系仅限于经5-FU-mrx治疗的III期患者（TTR：HR=0.80，P=0.02；OS：HR=0.79，P=0.02）。
研究结论：
研究人员经该研究证实，II期结肠癌患者中MMR状态具有预后价值。MMR也会影响III期患者预后，但是目前不会改变患者管理。
医脉通整理报道，转载请注明出处。
会议专题》》》2014年ASCO年会专题报道
阅读原文摘要
Prognosticimpact of deficient mismatch repair (dMMR) in 7,803 stage II/III colon cancer(CC) patients (pts): A pooled individual pt data analysis of 17 adjuvant trialsin the ACCENT database.（Abstract3507）
Authors: Daniel J.Sargent, Qian Shi, Greg Yothers, et al.
Session Type: General Poster Session
Background: MMR status has been established as an important prognostic factor in CC pts. We determined the association of dMMR status with clinical/pathological features and prognosis using the ACCENT database.
Methods: Microsatellite instability (MSI, 14 studies) or immunohistochemical analysis (1 study) for MLH1/MSH2/MLH6 proteins was performed on 7,803 stage II/III pts enrolled in 17 trials; 2 studies tested both. 571 pts received surgery alone; 3,878 5FU monotherapy (mrx); 2,299 5FU+oxaliplatin (oxal); and 1,055 5-FU+irinotecan (iri). Tumors with MSI-high or an absent protein were classified as dMMR; remainder were MMR-proficient (pMMR). Median follow-up was 7 years. Outcomes included overall survival (OS) and time to recurrence (TTR). Correlation analyses included all pts; prognostic analyses were limited to pts receiving surgery alone or 5FU mrx excluding pts receiving oxal/iri.
Results: 524 (23.1%) of 2,270 stage II and 823 (14.9%) of 5,533 stage III pts exhibited dMMR. MMR status was associated with female sex (dMMR, 19% F v 16% M, p=0.004), higher T stage (dMMR, 11% T1/2 v 18% T3 v 21% T4, p < 0.001), and right-sided tumor location (dMMR, left 9% v right 27%, p < 0.001). Compared to pMMR, dMMR was strongly associated with improved OS (HR=0.27, p=0.01) and TTR (HR=0.27, p=0.01) in stage II pts treated with surgery alone (Table). Association of MMR was prognostic although of attenuated impact in 5FU treated stage II and in stage III pts , with significance confined to 5FU-mrx treated stage III pts (HR=0.80, p =0.02 for TTR; HR=0.79, p=0.02 for OS).
Conclusions: Our study confirms prognostic utility of MMR status in stage II CCs. MMR also impacts outcome in stage III patients, but does not currently alter pt management.
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