结肠直肠癌的临床病理学和分子特征在80岁以上的患者中
Renjie Luo1,2,3, Xiangchao Shi1,2,3, Zimin Zhao1,2,3
1Department of General Surgery, Peking University Third Hospital, Beijing, People's Republic of China.
Clinical interventions in aging
|December 10, 2025
概括
非常老的结肠直肠癌 (CRC) 患者 (≥80岁) 呈现出明显的临床和分子特征,包括较高的不匹配修复缺陷 (dMMR) 和较差的生存率. 这些发现支持为这个不断增长的人口提供个性化治疗.
科学领域:
- 在瘤学瘤学.
- 老年医学 老年医学
- 分子生物学分子生物学
背景情况:
- 全球人口老龄化正在增加老年人结直肠癌 (CRC) 的发病率.
- 非常老年CRC患者 (≥80岁) 的临床和分子特征尚不清楚.
- 这种差距阻碍了为这一群体制定有效的个性化治疗策略.
研究的目的:
- 系统地比较60-80岁的CRC患者的临床和分子形状,与80岁以上的CRC患者进行比较.
- 为了确定可能为非常老年CRC人口提供个性化治疗方法的独特特征.
- 提供基于证据的见解,了解晚年CRC的独特生物学.
主要方法:
- 对1172名接受了彻底手术的CRC患者进行了回顾性分析.
- 分类为老年人群 (≥80岁) 和年轻人群 (≥60岁和<80岁).
- 从初级CRC组织中对临床病理特征,无病生存率 (DFS) 和转录组测序数据的比较分析.
主要成果:
- 80岁以上的组显示化疗使用减少,CEA升高,更多的右侧和粘膜瘤,更大的尺寸和更高的不匹配修复缺陷 (dMMR) 患病率.
- 无病生存期 (DFS) 在≥80岁组显著较短,年龄≥80岁是一个独立的风险因素.
- 转录组分析显示,神经调节和细胞外基质重塑的调高,通过M2巨细胞透降低免疫力,并在老年人群中丰富CMS1/CMS4亚型.
结论:
- 80岁以上的CRC患者出现了较高的dMMR率和较短的DFS.
- 独特的分子特征包括免疫抑制,ECM重塑和增强的神经与瘤相互作用.
- 这些发现挑战了缓慢进展的假设,并支持对非常老的CRC患者进行个性化治疗.
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