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산발성 대장암에서 MSI상태를 반영하는 지표로서 hMLH1/hMSH2 면역조직화학적 염색의 유용성

Efficacy of hMLH1/hMSH2 Immunohistochemical Staining as Representative Index for Microsatellite Instability Status in Sporadic Colorectal Cancer

대한대장항문학회지 2006년 22권 3호 p.184 ~ 191
정상훈 ( Jung Sang-Hun ) - 울산대학교 의과대학 외과학교실

김희철 ( Kim Hee-Cheol ) - 울산대학교 의과대학 외과학교실
김정선 ( Kim Jung-Sun ) - 울산대학교 의과대학 병리학교실
최진 ( Choi Jin ) - 울산대학교 의과대학 병리학교실
유창식 ( Yu Chang-Sik ) - 울산대학교 의과대학 외과학교실
김진천 ( Kim Jin-Cheon ) - 울산대학교 의과대학 외과학교실


Purpose: Sporadic colorectal cancer with micosatellite instability (MSI) is supposed to have a distinct molecular profile, distinct clinocopathologic feature, and a distinct prognosis. However, the test for MSI is still expensive, and a big machine is needed for routine screening. This study was performed to examine the clinicopathologic of characteristics of MSI sporadic colorectal cancer and the efficacy of immunohistochemical staining for hMLH1 and hMSH2.

Methods: Five hundred sixty nine colorectal adenocarinomas resected from September 2003 to August 2004 at Asan Medical Center were prospectively collected. FAP (familial adenomatous polyposis), HNPCC (hereditary non- polyposis colo-rectal cancer), and incomplete tests of immunohistochemical staining or MSI were excluded. The MSI status was determined by using PCR (polymerase chain reaction). A first round of immunohistochemical staining for hMLH1/hMSH2 was performed, and a second round was performed for cases showing a disparity between the two exams. The clinicopathologic variables regarding the MSI status were analyzed, and the sensitivity and the specificity of immunohistochemical staining were evaluated.

Results: Sporadic colorectal cancers with MSI-H were 8.4% (n=48) and were associated with age (≤60 years), colorectal cancer familial history, synchronous colorectal cancer, right side tumor location, and poorly differentiated or mucinous cell type. However, age, synchronous colorectal cancer, and right side tumor location were associated an the multivariate analysis. In the first round of immunohistochemical staining, no expression of hMLH1 and/or hMSH2 was obserred in 71 cases (12.5%), and the sensitivity and the specificity were 50.0% and 91.9%, respectively. After repetitive immunohistochemical staining for the 71 cases showing disagreement with the to MSI status, the sensitivity and the specificity of the second round of immunohistochemical staining were 53.3% and 97.6%, respectively.

Conclusions: Sporadic colorectal cancer with MSI appears to have distinct characteristics. However, immunohistochemical staining for hMLH1 and hMSH2 is not accurate enough to be used instead of MSI. J Korean Soc Coloproctol 2006;22:184-191


산발성 대장암;현미부수체 불안정성;면역조직화학 염색
hMLH1;hMSH2;Sporadic colorectal cancer;Microsatellite instability;Immunohistochemical staining
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