Clinical Analysis Of Multiple Primary Colorectal Carcinomas And The Clinical Significance Of PCNA, KAI1, MMP-7 Expression

PART I CLINICAL ANALYSIS OF 63 CASES OF MULTIPLE PRIMARY COLORECTAL CARCINOMASObjective To investigate the clinicopathological features,diagnosis, treatment and prognosis of multiple primary colorectal carcinoma(MPCC). Methods A retrospective analysis was made on 63 patients with MPCC admitted from January 1993 to January 2007 in our hospital.Results 63 patients with MPCC accounts for 2.1%(63/3 021) of the cases of colorectal carcinoma during the same period of time,with 31 cases being synchronous carcinoma(SC) and 32 cases diagnosed as metachronous carcinoma(MC).Male to female ratio was 2.5:1.Most tumors were located in rectum and sigmoid colon. Pathological types of 77.8%(105/135)were adenocarcinoma and 13.3%(18/135)were mucinous adenocarcinoma.The pathological stage of most tumors was stageâ…¡(64/135).A total of 34 cases(54.0%) were diagnosed by fiberoptic colonoscopy before operation. The diagnosis rate of SC by fiberoptic colonoscopy before operation and during operative exploration were all 38.7%(12 cases). The diagnosis rate of MC by fiberoptic colonoscopy before operation and during operative exploration were 68.7%(22 cases) and 6.25%(2 cases) respectively.The overall 5-year survival of the patients in SC was 45%(9/20),the overall 5-year survival of the patients in MC after the first operation was 72.4%(21/29).Conclusion Clinician should improve the recognition of MPCC.Patients with colorectal carcinoma should undergo routine fibercolonscopy and standard radical excision. Periodic follow-up for the high-risk group should be highlighted. PARTâ…¡THE EXPRESSION AND CLINICAL SIGNIFICANCE OF PCNA,KAI1,MMP-7 IN MULTIPLE PRIMARY COLORECTAL CARCINOMAObjective To investigate the expression and clinical significance of PCNA,KAI1 and MMP-7 in multiple primary colorectal carcinoma(MPCC).Methods The expression of PCNA,KAI1,MMP-7 were detected by immunohistochemical(IHC) method in 36 cases of MPCC and 36 cases of sporadic colorectal carcinoma(SCC).The expression of KAI1 mRNA was detected by reverse transcriptase-polymerase chain reaction (RT-PCR) in 14 cases of MPCC and 20 cases of SCC.Results The label index(LI) of PCNA and the positive expression of KAI1 in MPCC were significantly higher than that in SCC(P<0.05).The positive expression of MMP-7 in MPCC were significantly lower than that in SCC(P<0.05).The PCNA LI of two groups in stageâ… +â…¡was lower than that in stageâ…¢+â…£;the poorer the differrentiation and the deeper the infiltration were,the higher the PCNA LI was;that without lymph node metastasis was lower than that with lymph node metastasis(P<0.05).Two groups showed that the positive expression of KAI1 protein and mRNA in stageâ… +â…¡was higher than that in stageâ…¢+â…£,that without lymph node metastasis was higher than that with lymph node metastasis(P<0.05). Two groups showed that the positive expression of MMP-7 in stageâ… +â…¡was lower than that in stageâ…¢+â…£, the poorer the differrentiation and the deeper the infiltration were,the higher the positive expression of MMP-7 was,and that without lymph node metastasis was lower than that with lymph node metastasis(P<0.05).There was a negative correlation between KAI1 and MMP-7 expressions(r=-0.295,P<0.05).Conclusion The expression of PCNA and MMP-7 was related to TNM stage,differentiation,the depth of invasion and lymph node metastasis of colorectal carcinoma. The expression of KAI1 was related to TNM stage, lymph node metastasis of colorectal carcinoma.The Proliferative activity of MPCC was higher than SCC,the invasion/metastasis of MPCC was weaker than SCC. KAI1 and MMP-7 may cooperate with each other to inhibit the invasion/metastasis of MPCC. The high expression of PCNA and KAI1 were valuable in predicting the occurrence of MPCC.