胃肠道间质瘤91例临床分析

An Analysis of 91 Cases of Gastrointestinal Stromal Tumors

目的研究胃肠道间质瘤（GISTs）的临床特点、治疗方法和预后。方法对1986年-2006年1月在北京协和医院经病理确诊的所有胃肠道间质瘤患者的临床表现、诊断、治疗、预后进行回顾性分析。结果共有91例确诊的胃肠道间质瘤。主要起源于胃（35例，38．5％）和小肠（30例，33．0％）。68例（75％）有临床症状，最常见临床表现为腹痛、消化道出血、消瘦。内镜和CT对胃肠道间质瘤的诊断比较重要，阳性率超过90％。免疫组化CD117阳性率83．7％，CD34阳性率88．5％。治疗以手术为主，很少发生淋巴转移（3．3％）。7例晚期GISTs行一线化疗，均无效。11例晚期GISTs行伊马替尼治疗，10例可评估，有效率40％，临床获益率80％；中位生存时间已达10个月。91例中84例长期随诊，中位随诊时间13月，中位生存时间16．5月，1年生存率52．9％，2年生存率19．5％。结论胃肠道间质瘤的临床特点不同于其他常见的消化道肿瘤，CD117对其诊断较为重要，分子靶向治疗延长了晚期GISTs患者的生存。

Objective To study the clinical character, treatment and prognosis of gastrointestinal stromal tumors. Methods All cases of gastrointestinal stromal tumors （GISTs） in PUMCH who were diagnosed between 1986 and January 2006 were analyzed retrospectively to evaluate their clinical findings. Results There were totally ninety-one cases. Most of them occured in the stomach （38. 5%） and less commonly in the small intestine （33. 0%）. 68 cases （75%） were symptomatic, including abdominal pain, gastrointestinal bleeding and weight loss. Endoscopy and computed tomograph were two more sensitive way for detection of GISTs. The positive immunohistochemical rate of CD117 and CD34 were 83. 7% and 88. 5 % respectively in GISTs. The main treatment of GISTs was surgery. They rarely spread to regional lymph nodes （3. 3%）. Seven cases of advanced GISTs were treated with chemotherapy in first line and no case got response. Eleven cases got imatinib. Ten cases could be evaluated. The response rate was 40%, the disease control rate was 80% and the median survival time was more than 10 months. Eighty-four cases were long-term followed up and median follow time was 13 months. The median survival time was 16. 5 months, 1-year survival rate 52. 9% ,2-year survival rate 19. 5%. Conclusion The Clinical characteristics of GISTs are different from that of other common gastrointestinal eancers. CD117 is important for the diagnosis of GISTs. Molecular target therapy can improve the survival of the patients with advanced GISTs.