摘要：
目的 分析不同部位大肠癌患者的K-ras基因突变状态与临床病理特征、预后情况的关系.方法 回顾性分析69例于2007年5月至2017年8月在南京医科大学附属无锡市人民医院经病理诊断为大肠癌并行K-ras基因检测患者的临床病理资料,分析其临床病理特征与K-ras基因突变状态的关系,随访预后情况,进行Kaplan-Meier生存分析.结果 69例大肠癌患者K-ras基因突变率为50.7％(35/69),其中,左、右半结肠癌和直肠癌患者分别为40.0％(12/30)、73.3％(11/15)、50.0％(12/24).年龄≥60岁、血清糖类抗原19-9(CA19-9)升高患者K-ras基因突变率分别较＜60岁、血清CA19-9正常患者升高[61.5％(24/39)比36.7％(11/30),χ2=4.197,P=0.041;65.6％(19/29)比37.5％(15/40),χ2=5.486,P=0.019],而与患者性别、肿瘤原发部位、病理类型、TNM分期、血清癌胚抗原水平、临床症状等无关(均P＞0.05).大肠癌患者K-ras基因突变与预后无关(χ2=0.001,P=0.997).K-ras基因状态与不同部位大肠癌患者总生存无关(χ2=0.583,P=0.445).左半结肠癌、直肠癌、右半结肠癌患者5年总生存率分别为76.9％、69.7％、31.3％,大肠癌原发部位与总生存有关(χ2=11.004,P=0.004).结论 大肠癌患者K-ras基因突变与年龄及血清CA19-9水平有关.左半结肠癌预后最佳,直肠癌次之,右半结肠癌最差.K-ras基因状态是否为大肠癌预后因素尚不明确.对大肠癌患者行K-ras基因、血清肿瘤标志物检测并明确发病部位、年龄层次,可为临床靶向治疗选择及患者生存状况判断提供依据.%Objective To analyze the correlation between K-ras gene mutation and clinicopathological characteristics and prognosis of colorectal cancer patients with different primary sites.Methods The clinical and pathological records of 69 patients who were pathologically confirmed as colorectal cancer and tested K-ras gene status at Wuxi People's Hospital Affiliated to Nanjing Medical University between May 2007 and August 2017 were adopted.The correlation between clinicopathological characteristics and prognosis of colorectal cancer patients with different primary sites and K-ras gene mutation status were retrospectively analyzed.And the patients were visited to adopt the prognosis data and perform the Kaplan-Meier survival analysis.Results The K-ras mutation rate was 50.7％(35/69),including 40.0％(12/30)in left-side colon cancer,73.3％(11/15)in right-side colon cancer and 50.0％(12/24)in rectal cancer.The mutation rate of K-ras gene in patients ≥ 60 years old [61.5％(24/39)vs.36.7％(11/30),χ2= 4.197,P = 0.041] or serum CA19-9 raising up abnormally was conspicuously high [65.6％(19/29)vs.37.5％(15/40),χ 2= 5.486,P =0.019].Other clinicopathological characteristics,such as gender,lesion location,histological classification,TNM stage,serum CEA expression,clinical features had no correlation with K-ras gene mutation status(all P＞ 0.05).And no relationship was found between prognosis and overall survival of colorectal cancer patients with different primary sites and K-ras gene mutation status(χ 2= 0.001,P = 0.997; χ 2= 0.583,P =0.445).In general,the 5-year survival rate of left-side colon cancer patients was highest(76.9％),followed by rectal cancer(69.7％),and right-side colon cancer was lowest(31.3％).The primary site of colorectal cancer was related to the overall survival of patients(χ2=11.004,P =0.004).Conclusions K-ras gene mutation in colorectal cancer is closely related to age and serum CA19-9 levels of the patients.The prognosis of left-side colon cancer is best,rectal cancer second,and right-side colon cancer poorest.Whether K-ras gene mutation is the prognostic factor of colorectal cancer is not clear.Testing the K-ras gene status and serum tumor index expression,distinguish the primary site and age group will provide the theory basis and promote the clinical targeted therapy and improve the survival of colorectal cancer patients.
