| BackgroundIn China,the incidence of colorectal cancer(CRC)is increasing year by year,and the number of deaths from CRC is also increasing every year.CRC has become a major public health problem that endangers the life and health of Chinese people.With the advancement of surgical techniques and the development of neoadjuvant therapy,postoperative adjuvant chemotherapy,targeted and immunotherapy,the prognosis of CRC patients has been improved to some extent,and the 5-year survival rate has increased,but it is still only about 60%.Therefore,it has become increasingly important to fully understand the factors affecting the prognosis of CRC patients and to use them to develop individualized treatment plans.stage Ⅱ CRC patients usually have a good prognosis,with 5-year survival rates ranging from 75%to 87.5%.However,approximately 20%of stage Ⅱ CRC patients still develop distant metastases and eventually die from metastatic disease.Microsatellite instability(MSI)is present in approximately 15-20%of CRC.Recent studies have concluded that MSI is a valid indicator of prognosis in CRC patients.PART Ⅰ Analysis of prognostic factors in colon cancer patientsObjectiveTo analyze the clinical characteristics of 196 colon cancer patients who underwent surgery at Qilu Hospital of Shandong University between 2014 and 2017 and to explore the relevant factors affecting the prognosis of colon cancer patients in our center,so as to provide help for precise and individualized medical treatment for colon cancer patients and to provide evidence to support the formation of a colon cancer treatment plan with the characteristics of our center.Materials and MethodsClinical data of colon cancer patients who underwent surgery at Qilu Hospital of Shandong University between 2014 and 2017 were collected and retrospectively analyzed.The clinical data collected included:gender,age,family history of colorectal cancer,presence or absence of ascites,presence or absence of enlarged lymph nodes at the root of the inferior mesenteric artery,whether radical surgery was performed,whether laparoscopic surgery was performed,tumor location,tumor size,degree of tumor differentiation,tumor pathological type,presence or absence of vascular invasion,presence or absence of nerve invasion,depth of muscular infiltration(T stage),number of lymph node metastases(N stage),distant metastasis(M stage),TNM stage,expression levels of carcinoembryonic antigen(CEA),glycoprotein(CA)19-9,CA125 and CA72-4 and whether the combined test of tumor makers was positive or not.Survival data were analyzed using univariate analysis combined with COX proportional risk regression models to reveal factors affecting the prognosis of colon cancer.Data were recorded by standard excel sheet.Data analysis was performed using SPSS 26.0.A computer search of PubMed,Cochran Library,Web of Science,and EMBASE databases for studies on the effect of MSI on OS and DFS in stage Ⅱ CRC patients was conducted to conduct a meta-analysis to assess whether MSI was a relevant factor affecting the prognosis of stage Ⅱ CRC patientsResultsThe 3-year survival rate of 196 colon cancer patients who underwent surgery at Qilu Hospital of Shandong University between 2014 and 2017 was 79.3%and the 5-year survival rate was 68.2%,and radical surgery and TNM stage were independent risk factors affecting the prognosis of colon cancer patients in our center.ConclusionThe 3-year survival rate of 196 colon cancer patients who received surgical treatment at Qilu Hospital of Shandong University between 2014 and 2017 was 79.3%and the 5-year survival rate was 68.2%.Radical surgery and TNM stage were independent risk factors affecting the prognosis of patients with colon cancer.PART Ⅱ Systematic review and meta-analysis of the prognostic impact of MSI on stage Ⅱ CRC patientsObjectiveMeta-analysis was conducted to investigate the effect of MSI status on the prognosis of stage Ⅱ CRC patients and to provide theoretical support for the evaluation of the effect of MSI on the prognosis of stage Ⅱ CRC.Materials and MethodsA computer search of PubMed,Cochran Library,Web of Science and EMBASE databases for studies on the correlation between MSI status and overall survival(OS)and disease-free survival(DFS)in stage Ⅱ CRC patients.The effect of MSI status on patients’ OS and DFS was investigated by conducting a Meta-analysis to assess whether MSI status is a relevant factor affecting the prognosis of patients with stage Ⅱ CRC.ResultsA total of 26 studies including 12519 patients were analyzed in this study.In the included studies,23%of CRC cases were diagnosed with MSI status(range 13.00-52.90%).The HR for OS was 0.97(95%CI=0.73-1.31,P=0.86)for patients in the MSI-H group versus those in the MSS or MSI-L groups,and the results were not statistically different;the HR for DFS was 0.64(95%CI=0.49-0.84,P=0.001),and the results were statistically different.ConclusionMSI status significantly improved the risk of recurrence in stage Ⅱ CRC patients,but was not associated with the risk of death. |
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