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目的探讨微卫星不稳定性(MSI)发生与胃癌临床病理生物学行为的关系及其临床意义。方法采用酚-氯仿-异戊醇法从胃癌组织切片中提取DNA。组织切片中肿瘤成分不足50%时采用显微微切割方法。以PCR为基础的单链构像多态性方法分析胃癌组织分别在BAT26、BAT40、D2S123、D5S346和D17S2505个位点的微卫星不稳定性。结果按照微卫星不稳定性的发生频率将胃癌患者分为3组:出现2个或2个以上微卫星位点不稳定性为高MSI组(MSI-H);出现1个位点不稳定性为低MSI组(MSI-L);无MSI发生为微卫星稳定组(MSS)。61例胃癌患者中,12例(19.7%)为MSI-H,11例(18.0%)为MSI-L,38例(62.3%)表现为MSS。MSI-L组与MSS组患者在胃癌各临床病理生物学参数间差异无显著性意义(P>0.05),但这两组与MSI-H组比较,在肿瘤的发生位置、Laurén分型、淋巴结是否转移和肿瘤分期方面差异有显著性意义(P<0.05)。MSI-H型胃癌多发生于胃窦部,多见于淋巴结转移阴性、肠型和较早期胃癌,其发生与患者年龄、性别和肿瘤大小无明显的相关性。结论MSI-H型胃癌与MSI-L或MSS型胃癌具有不同的临床病理学行为,MSI-H型胃癌与肿瘤位置、淋巴结是否转移、Laurén分型及肿瘤分期密切相关。微卫星不稳定性可能是胃癌发生的另一分子机制。
Objective To investigate the relationship between the occurrence of microsatellite instability (MSI) and the clinicopathological biological behavior of gastric cancer and its clinical significance. Methods DNA was extracted from gastric cancer tissue by phenol-chloroform-isoamyl alcohol method. Microscopic microdissection was used when the tumor component was less than 50% in the tissue section. The microsatellite instability of gastric cancer tissues at BAT26, BAT40, D2S123, D5S346 and D17S250 sites was analyzed by PCR-based single-strand conformation polymorphism method. Results The gastric cancer patients were divided into 3 groups according to the frequency of microsatellite instability: 2 or more microsatellite instability occurred in the MSI group (MSI-H); 1 site instability occurred. The low MSI group (MSI-L); no MSI occurred for the microsatellite stability group (MSS). Of 61 patients with gastric cancer, 12 (19.7%) were MSI-H, 11 (18.0%) were MSI-L, and 38 (62.3%) showed MSS. There was no significant difference in clinical pathological biological parameters of gastric cancer between MSI-L group and MSS group (P>0.05), but compared with MSI-H group, the location of tumor, Laurén type, lymph node There was significant difference in metastasis and tumor stage (P<0.05). MSI-H gastric cancer mostly occurred in the antrum of gastric antrum. It was more common in lymph node metastasis-negative, intestinal-type and earlier-stage gastric cancer. There was no significant correlation between the occurrence of MSI-H gastric cancer and age, gender and tumor size. Conclusion MSI-H gastric cancer and MSI-L or MSS gastric cancer have different clinical pathological behaviors. MSI-H gastric cancer is closely related to tumor location, lymph node metastasis, Lauren classification and tumor stage. Microsatellite instability may be another molecular mechanism of gastric cancer.