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Valutazione dei fattori prognostici nel cancro colorettale: grading, staging e caratteristiche genetiche in 334 casi

Articolo, 35 - 38
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Abstract
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Obiettivo: Scopo del presente studio è l’analisi dei fattori prognostici nel cancro colorettale radicalmete operato.
Metodi: Sono stati analizzati i risultati relativi a 334 pazienti operati radicalmente (R0) per cancro colorettale in un periodo di due anni e mezzo: 195 uomini e 139 donne, di età media di 68.5 anni. I pezzi operatori sono stati esaminati per il grading, lo staging e, tramite analisi del DNA con tecnica PCR per lo studio genetico dei markers microsatellitari: i risultati sono stati espressi in tumore stabile (MSS: nessun markers instabile), MSI-LOW (< al 40%, bassa instabilità) e MSI-HIGH (≥al 40%, alta instabilità). La terapia adiuvante è stata eseguita secondo i protocolli internazionali; il follow-up, disponibile per 318 pazienti, è stato in media di 49 mesi.
Risultati: La sopravvivenza libera da malattia è stata del 60% ed è risultata per i vari fattori esaminati: grading G1 75%, G2 62% e G3 34%; stadio I 90%, II 68%, III 45%, IV 7%; MSS 56%, MSI-LOW 54%, MSI-HIGH 60%; la correlazione fra i dati istologici e quelli genetici mostra che la sopravvivenza è risultata significativamente migliore (p<0.05) per i tumori instabili nei G2 (MSS 59%, MSI-HIGH 81%), negli stadi I e II (MSS 75%, MSI-HIGH 96%), ma nettamente peggiore (p<0.05) negli stadi III-IV (MSS 34%, MSI-HIGH 0%).
Conclusioni: I principali fattori prognostici nel cancro colorettale operato sono senza dubbio quelli legati alle caratteristiche istopatologiche, grading e staging, ma dai nostri dati emerge chiaramente che anche i fattori genetici ed in particolare lo stato microsatellitare sono cruciali nel determinare la prognosi.

English version
Aim: The aim of this study is the assessment of prognotic factors in resected colorectal cancer. Methods. The outcome of 334 patients, 195 men and 139 women of median age of 68.5 years, radically resected (R0) for colorectal cancer from december 2003 to june 2006 was examinated for patholgic and genetic characteristics; all resected specimens were evaluated for grading, staging and, tested for markers of microsatellite instability with the examinination of extracted DNA by polymerase chain reaction (PCR): results are expressed in MSS no instable markers, MSI-LOW < 40% of instable markers and MSI-HIGH ≥ of instable markers. Adjuvant therapy was performed in selected patients; median follow-up, available for 318 patients, was of 49 months
Results: Overall disease free survival was of 60%; based on the pathologic and genetic correlations, survival was for grading: G1 75%, G2 62%, G3 34%; for staging: I 90%, II 68%, III 45%, IV 7%; forMS status: MSS 59%, MSI-LOW 54%, MSI-HIGH 60%. If pathologic and genetic correlations are considered, the data showed that disease-free survival is significantly better for MSI-HGH tumors in G2 (MSS 59%, MSI-HIGH 81%) and in stage I-II (MSS 75%, MSI-HIGH 96%), but significantly worse for stage III-IV (MSS 34%, MSI-HIGH 0%).
Conclusion: Our data showed that grading and staging are the most important prognostic factors in radically resected colorectal cancer, but correlation between pathologic and genetic features, showed that microsatellite status of tumors is a determining factor that must be carefully evaluated in prognosis in order to improve treatment results.

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