微卫星不稳定在中晚期宫颈癌诊疗中的应用研究

Applied Research of Microsatellite Instability in the Diagnosis and Treatment of Advanced Cervical Cancer

摘要: 宫颈癌在女性恶性肿瘤中最常见，发病率和死亡率均较高。早期宫颈癌可通过手术根治，而中晚期宫颈癌通过手术方式常无法达到根治目的，主要采用放化同步治疗。对常见的妇科肿瘤有更好的防治，认识肿瘤发生发展的途径是目前要解决的关键问题。根据以往的研究得知基因的错配在肿瘤发生发展中占据重要地位，而错配修复(mismatch repair)系统，是通过对DNA复制过程中的碱基错配进行修复，以降低DNA自发性突变，加强DNA复制的保真性，达到维持基因高稳定性的目的。临床上，某些错配修复基因的检测已被用于相关肿瘤的诊断，并成为选择这些肿瘤治疗方案的向导。已有几项研究证实，靶向程序性死亡受体1 (PD-1)或程序性死亡配体1 (PD-L1)的免疫检查点抑制剂在微卫星高度不稳定(MSI-H)和错配修复缺陷(dMMR)的肿瘤患者中具有抗肿瘤活性。因此，通过研究错配修复进而研究MSI-H，根据表达来针对性地给予免疫抑制剂治疗来达到抑制恶性肿瘤的生长、增殖和转移成为宫颈癌治疗的新方向。

Abstract: Cervical cancer is the most common malignant tumor in women, with high morbidity and mortality. Early cervical cancer can be radically cured by surgery, and the middle and advanced cervical can-cer often can not be radically cured by surgery, the main use of radiochemical simultaneous treat-ment. To have better prevention and treatment of common gynecological tumors, understanding the way of tumor occurrence and development is the key problem to be solved at present. Accord-ing to previous studies, gene mismatch plays an important role in the occurrence and development of tumors, and the mismatch repair system is to repair the base mismatch in the process of DNA replication, so as to reduce the spontaneous mutation of DNA, strengthen the fidelity of DNA repli-cation, and achieve the purpose of maintaining high gene stability. Clinically, the detection of cer-tain mismatch repair genes has been used for the diagnosis of related tumors and has become a guide for the selection of treatment options for these tumors. Several studies have confirmed that immune checkpoint inhibitors targeting programmed death receptor 1 (PD-1) or programmed death ligand 1 (PD-L1) have antitumor activity in patients with microsatellite highly unstable (MSI-H) and mismatch repair deficiency (dMMR) tumors. Therefore, it has become a new direction for cervical cancer treatment to inhibit the growth, proliferation and metastasis of malignant tu-mors by studying mismatch repair and then studying MSI-H, and giving immunosuppressive ther-apy according to its expression.