181例胃肠间质瘤的临床病理及预后分析

Analysis of clinicopathology and prognosis in 181 patients with gastrointestinal stromal tumors

目的探讨胃肠间质瘤（GIST）的临床诊治经验，分析其病理特征和影响GIST预后的因素，方法回顾性分析1999年1月至2007年12月间经手术治疗的181例GIST患者的临床病理及随访资料，根据FJetcher推荐的生物学行为分级法进行分组，比较不同因素对生存率的影响并进行预后分析。结果本组GIST病变部位：胃107例（59．1％），小肠51例（28．2％），结直肠等其他部位23例（12．7％）；伴有肝转移7例。172例（95．0％）术前通过影像学检查明确病灶部位，其中胃镜53．5％（92／172），CT 34，3％（59／172），超声内镜或胶囊内镜17．4％（30／172）。瘤体长径0．5～30．0cm不等，平均7．0cm。CD117阳性171例（94．5％），CD34阳性156例（86．2％）。外科手术完全切除176例，其中合并联合脏器切除26例；姑息性切除或活检术5例。全组患者1、3、5年生存率分别为95．2％、87．9％和78．5％。单因素分析显示，年龄、肿瘤大小、肿瘤原发部位、核分裂像数目、FIetcher分级和是否合并联合脏器切除对生存率有影响（P〈0．05）；多因素分析显示，Fletcher分级和肿瘤大小是影响预后的因素。术后有8例高危患者和3例复发转移患者服用伊马替尼后病情稳定。结论内镜和CT是GIST有效的诊断手段，用FIetcher分级法来判断GIST的生物学行为和预测预后是简单、有效的方法，外科手术仍是目前GIST的主要治疗方法，而结合靶向治疗将成为改善GIST预后的重要手段。

Objective To investigate the therapeutic experience of gastrointestinal stromal tumors （GIST） and to analyze the pathological features and prognostic factors of GIST. Methods The clinicopathological and follow-up data of 181 patients with GIST admitted in Renji Hospital between January 1999 and December 2007 were analyzed retrospectively. All the cases were grouped according to Fletcher＇s risk scheme. Life table and COX regression model were used to evaluate the prognostic factors. Results Out of 181 tumors, 107（59.1%） were located in stomach, 51 （28.2%） in intestine and 23（12.7%） in colorectum or other sites. Distant metastases,including liver metastases were found in 7 patients intraoperatively. Tumor size ranged from 0.5 to 30 cm with the mean of 7.02 cm. The positive rate of CDll7 was 94.5% （171/181） and that of CD34 was 86.2% （156/181）. One hundred and seventy-six patients underwent complete resections, including multi-organ resections in 26 patients. The other patients underwent palliative operations. The 1-, 3- and 5-year overall survival rates of 181 patients were 95.2%, 87.9% and 78.5% respectively. Univariate analysis revealed age, tumor size, primary organ of tumor, mitotic count, Fleteher＇s classification and multi-organ resection were associated with survival rate. No significant difference of sex was existed among groups. COX hazard proportional model revealed that advanced stage and large tumor size indicated worse prognosis. Eight patients with high risk of recurrence and 3 patients with recurrence and metastasis were stable after receiving imatinib therapy. Conclusions The diagnosis of GIST depends on endoscope and CT. Fleteher＇s classification is simple and effective to evaluate GIST behavior and prognosis. Surgical resection is still the main therapy for GIST and targeted therapy will play a more important role for prognosis in the future.