相对于微卫星稳定 (MSS) 结肠癌，微卫星不稳定 (MSI) 结肠癌中的淋巴结转移预测因子及其与复发的关联尚不明确。对2015年至2021年间行手术的非转移性结肠癌患者进行了淋巴结转移预测因子（LNMs）及其与无复发生存 (RFS) 的关联评估。共纳入了1466例患者进行分析，其中361例 (25 %) 为MSI。与MSS相比，MSI 与早期阶段、N1或N2病例中较少的LNMs以及更少的高风险特征有关。与T3-T4 MSS 患者相比，T3-T4 MSI 患者的LNM 的优势比 (OR) 为0.52 (95% 置信区间 [CI]，0.38-0.71)，T1-T2 MSS 患者为0.27 (95% CI ，0.38-0.71)，T1-T2 MSI 患者为0.15 (95% CI ，0.08-0.26)。在两个组中，LNMs 与 T 分类、患者年龄以及静脉、淋巴或神经浸润有关。在MSS患者中，LNMs 还与患者性别和组织学分级有关。与MSS患者相比，MSI 患者在N0和N1疾病中的3年RFS更好。然而，在N2疾病中，MSI患者的3年RFS率低于MSS患者 (风险比为 19.75 vs 4.49)。在MSI结肠癌中，LNMs 的发生率较MSS低50%，但与LNMs 相关的因素与MSS结肠癌相似。传统上与早期阶段MSI 结肠癌相关的良好预后在出现四个或更多 LNMs 后消失。这些发现应该考虑到临床医生在选择最适当的MSI结肠癌治疗方案时。© 2023. Society of Surgical Oncology.

In contrast to microsatellite stable (MSS) colon cancer, predictors of lymph node metastases and their association with recurrence are not well-defined in microsatellite instability (MSI) colon cancer.A cohort of nonmetastatic colon cancer patients undergoing surgery between 2015 and 2021 were evaluated for predictors of lymph node metastases (LNMs) and their association with recurrence-free survival (RFS).Of 1466 patients included in the analyses, 361 (25 %) had MSI. Compared with MSS, MSI was associated with earlier stage, fewer LNMs in the patients with N1 or N2 disease, and fewer high-risk features. Compared with the T3-T4 MSS patients, the odds ratios for LNM were 0.52 (95% confidence interval [CI], 0.38-0.71) for the T3-T4 MSI patients, 0.27 (95% CI, 0.38-0.71) for the T1-T2 MSS patients, and 0.15 (95 % CI, 0.08-0.26) for the T1-T2 MSI patients. In both groups, LNMs were associated with T category, patient age, and venous, lymphatic, or perineural invasion. In the MSS patients, LNMs were additionally associated with patient sex and histologic grade. Compared with the MSS patients, the MSI patients with N0 and N1 disease had a better 3-year RFS. However, the MSI patients with N2 disease had a lower rate of 3-year RFS than the MSS patients (hazard ratio, 19.75 vs 4.49).In MSI colon cancer, LNMs are 50 % less prevalent, but the factors associated with LNM are like those in MSS colon cancer. The improved prognosis traditionally associated with early-stage MSI colon cancers dissipates with four or more LNMs. These findings should be taken into consideration by clinicians selecting the most appropriate course of treatment for MSI colon cancer.© 2023. Society of Surgical Oncology.