胃肠道间质瘤的临床研究

Clinical study of gastrointestinal stromal tumors

目的探讨胃肠道间质瘤（GIST）临床病理特点、手术治疗及预后。方法对1997年4月至2008年6月间84例手术切除的GIST患者的临床病理资料进行回顾性分析，并评价预后。结果84例GIST位于胃42例，小肠24例，食管5例，直肠6例，胃肠道外7例；肿瘤直径（5．6±4．8）cm，肿瘤组织免疫组织化学检测CD117阳性表达率为96．4％。79例行肿瘤完全切除，5例行姑息切除或肿瘤活检。78例获随访患者1、3、5年生存率分别为92．0％、79．2％和72．0％，根据肿瘤直径和核分裂像计数分级的Fletcher恶性程度风险分级与生存率有密切关系（P〈0．01），极低度风险组、低度风险组生存率与高度风险组生存率间差异有统计学意义（P值分别为0．003及0．000）。结论GIST的Fletcher分级与患者术后生存率有关。对高度风险者，需积极施行切除范围较大的手术。

Objective To investigate the clinicopathological characteristics, surgical treatment and prognosis of gastrointestinal stromal tumors （GIST）. Methods The clinicopathological data of 84 patients with GIST undergone resection between April 1997 and June 2008 were analyzed retrospectively, and the prognosis was evaluated. Results Out of 84 cases, 42 tumors located in stomach, 24 in small intestine, 18 in other sites. Tumor sizes ranged from 0.5 to 25 cm （average 5.6 cm）. Positive rate of CDll7 expression determined by immunohistochemical methods was 96.4%. Seventy-nine cases underwent complete tumor resection, while 5 cases received palliative resection or biopsy. Seventyeight patients were followed up and their 1-, 3-, 5-year survival rates were 92.0%, 79.2%, 72.0% respectively. The Fletcher＇s classification of malignancy risk groups for GIST was related to the survival rates （P=0.001）. The differences of survival rate among very low risk group, low risk group and highrisk group were significant （P=0.003, P=0.000）. Conclusions Complete tumor resection in the initial operation of GIST should be emphasized, The Fletcher＇s classification of malignancy risk groups for GIST is related to the survival rate. Extended surgical resection is required for GIST of higher malignancy risk.