胃肠间质瘤复发危险度的临床分析

Assessment of recurrence risk in gastrointestinal stromal tumors

目的:探讨不同临床病理因素对胃肠间质瘤(gastrointestinal stromal tumor,GIST)预后的影响,以期为GIST诊断和治疗以及预后判断提供依据。方法:回顾性分析2001年1月—2006年12月接受手术治疗的128例GIST患者的临床病理资料并进行随访,分析肿瘤原发部位、肿瘤大小、组织学类型、核分裂相、远处转移、甲磺酸伊马替尼等因素和GIST危险度与生存率之间的关系。结果:本组患者CD117表达阳性率为94.5%(121/128),CD34表达阳性率为72.7%(93/128)。按照Miettinen危险度分级标准,相同危险度的胃间质瘤与非胃间质瘤的生存率差异无统计学意义;而组织学类型与危险度分级相关(P=0.0282)。远处转移与GIST患者的生存率密切相关(P<0.0001)。甲磺酸伊马替尼治疗GIST可以明显提高中-高危险度GIST患者的生存率。结论:Miettinen危险度分级标准作为GIST的预后判定标准更为合理。组织学类型和远处转移可以作为评估GIST的重要因素,应在分级标准中予以体现。对中-高度危险的GIST患者,应建议口服甲磺酸伊马替尼治疗。

Objective：To investigate the relationship between the clinicopathological factors and the prognosis of patients with gastrointestinal stromal tumor（GIST）,and to provide clinical evidence supporting appropriate diagnosis,treatment and prognosis determination.Methods：The medical records of 128 patients with GIST undergoing surgical resection between Jan 2001 and Dec 2006 were analyzed retrospectively.All patients received follow-up care.The associations of primary tumor location,tumor size,histology,mitotic count,distant metastasis,adjuvant imatinib mesylate and risk-grading with the survival of GIST were evaluated.Results：The positive rates of CD117 and CD34 expression were 94.5%（121/128） and 72.7%（93/128）,respectively.There was no significant difference in survival between gastric stromal tumor and non-gastric stromal tumor at the same risk by Miettinen grading criteria.The histology was related to the risk-grading（P=0.028 2）.The distant metastasis was related to the survival（P〈0.000 1）.Adjuvant imatinib mesylate therapy increased the survival rate of patients at high-and intermediate-risk.Conclusion：Miettinen grading criteria seems to be more reasonable for prognosis determination of GIST patients.The histology and distant metastasis factors should be considered to be included in the risk grading criteria for GIST.It is suggested that GIST patients at high-and intermediate-risk should receive adjuvant imatinib mesylate therapy.