近期的文献指出，盲肠腺癌在分子水平变化上与非盲肠部近端结肠腺癌有所不同，且盲肠肿瘤的位置可能是一个预后相关的变量。我们比较了2年期间诊断的、根据肿瘤位置（盲肠、右半结肠、左半结肠）进行分层的328例结肠腺癌病例的分子水平变化、组织病理特征及疾病特异性生存期。总体来看，盲肠腺癌的分子学异常频率最高，其中74%为KRAS第2或3外显子突变、BRAF突变或DNA错配修复蛋白缺陷。KRAS突变在盲肠部位的发生率高于其他部位（P=0.03),可在46%的盲肠腺癌中出现，而右半结肠腺癌中只有25%(P=0.004)。盲肠腺癌也更易出现不良的组织病理学特征，特别是出现较多肿瘤出芽（31%），而该病变在右半结肠肿瘤中的发生率为18%（P=0.04)、左半结肠肿瘤中的发生率为17%（P=0.02)。在多变量分析中，总体分期是疾病特异性生存率最重要的独立预测因子；然而，盲肠肿瘤部位和较多肿瘤出芽也是生存期短的预测指标，特别对于Ⅲ或Ⅳ期肿瘤患者而言。总之，与非盲肠部右半结肠腺癌相比，盲肠腺癌的特征是具有更高频率的KRAS突变，且表现为常见较多肿瘤出芽，这些特征可能成为预后相关的变量，尤其对于Ⅲ和Ⅳ期的患者而言。

Am J Surg Pathol 2018;42:351-358

美国外科病理学杂志中文版2018年第三期摘要No.1

（沈光月 翻译 纪元 审校）

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