胃肠道间质瘤临床病理特征和预后因素分析

Clinicopathologic Characteristics and Prognostic Factors for Gastrointestinal Stromal Tumors

背景:胃肠道间质瘤(GISTs)是胃肠道间叶细胞肿瘤,过去常被诊断为胃肠道平滑肌瘤或神经鞘瘤。目的:探讨GIST的临床病理特征和预后因素。方法:回顾性分析143例GIST患者的临床病理资料,以及其中131例患者的随访资料,分析临床病理因素与预后的关系。结果:143例GIST中,恶性占71.3%,交界性和良性分别占23.8%和4.9%。免疫组化检测结果显示,CD117和CD34的阳性表达率分别为91.6%和85.3%。患者总体1、3、5年生存率分别为90.8%、74.0%和54.6%;恶性患者的5年生存率显著低于交界性和良性患者(44.0%对88.9%和100%,P<0.01);接受根治性切除术者的术后5年生存率显著优于局部肿瘤切除者(67.9%对38.5%,P<0.01)。多因素生存分析表明,肿瘤大小、细胞核分裂像、肿瘤性质和手术方式是GIST的独立预后因素(P<0.05)。结论:加强对GIST的认识,正确诊断,合理采用手术治疗,对改善GIST患者的预后有着深远的意义。

Background： Gastrointestinal stromal tumors （GISTs） are defined as mesenchymal tumors arising from the gastrointestinal wall, previously termed as leiomyomas or neurolemmomas. Aims： To investigate the clinicopatbologic characteristics and prognostic factors of GISTs. Methods： The clinicopathologic data of 143 patients with GIST were retrospectively reviewed, and 131 out of them were followed-up to study the correlation between clinieopathologic characteristics and the prognosis. Results： Among these patients, malignant GISTs accounted for 71.3%, borderline 23.8% and benign 4.9%. 91.6% and 85.3% of patients expressed CD117 and CD34, respectively. The overall 1-, 3- and 5-year survival rates were 90.8%, 74.0% and 54.6%, respectively. The 5-year survival rate of the malignant GISTs was lower than that of the borderline and the benign ones （44.0% vs. 88.9% and 100%, P〈0.01）, but for the patients with their tumors resected radically, the 5-year survival rate was higher （67.9% vs. 38.5%, P〈0.01）. Muhivariable survival analysis revealed that tumor size, karyokinesis, pathologic type and surgical modality were independent prognostic factors of GIST （P〈0.05）. Conclusions： In order to improve the prognosis, it is of great importance to diagnose and treat GIST early and properly.