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3기 결장암 조직에서 hMLH1과 hMSH2 단백발현의 의의

Clinicopathological Correlation of hMLH1 and hMSH2 Protein Expressions in Stage III Colon Cancer

대한대장항문학회지 2004년 20권 4호 p.218 ~ 224
조영규 ( Cho Young-Kyu ) - 한일병원 외과

유창식 ( Yu Chang-Sik ) - 울산대학교 의과대학 외과학교실
남궁환 ( Namgung Hwan ) - 울산대학교 의과대학 외과학교실
김희철 ( Kim Hee-Cheol ) - 울산대학교 의과대학 외과학교실
김정선 ( Kim Jung-Sun ) - 울산대학교 의과대학 병리학교실
이제환 ( Lee Je-Hwan ) - 울산대학교 의과대학 서울아산병원 내과학교실
김태원 ( Kim Tae-Won ) - 울산대학교 의과대학 서울아산병원 내과학교실
김진천 ( Kim Jin-Cheon ) - 울산대학교 의과대학 서울아산병원 외과학교실


Purpose: Functional loss of mismatch repair has been reported to be the reason for resistance to several chemotherapeutic drugs. The expressions of hMLH1 and hMSH2 were examined to assess whether they correlated with the biological behavior and the chemotherapeutic responsiveness in paflents with sporadic colon cancers.

Methods: Ninety-one patients with stage III primary colon cancer were included from the tumor registry of the Asan Medical Center, Seoul, Korea. All patients underwent a curative operation and postoperative chemotherapy with 5- fluorouracil and leucovorin for 6 cycles between 1993 and 1997. Immunohistochemical staining for hMLH1 and hMSH2 was performed using archival paraffin blocks. A positive expression was determined when unequivocal nuclear staining was identified in more than 10% of the cancer cells. The survival and the clinicopathologic variables regarding hMLH1 and hMSH2 expressions were assessed using the log-rank test and the Cox proportional regression method.

Results: Either hMLH1 or hMSH2 expression was lost in nine cases (9.9%). hMLH1 and hMSH2 expressions were significantly correlated with tumor invasion (P=0.012) and tumor differentiation (P=0.017). The disease-free survival did not differ with respect to hMLH1 and hMSH2 expressions. The number of metastatic lymph nodes and the preoperative serum CEA level were independent predictors of disease-free survival on a multivariate analysis.

Conclusions: The loss of hMLH1 or hMSH2 expresscon appears to be involved in the differentiation of and the invasion by colon cancer. However, nether hMLH1 nor hMSH2 expression was correlated withthe 5-fluorouracil responsiveness. J Korean Soc Coloproctol 2004;20: 218-224


Colonic neoplasms;Microsatellite instability;Prognostic factor;Chemotherapy
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