胃间质瘤26例临床诊治分析

Clinical analysis for 26 patients with gastric stromal tumors

背景与目的:胃间质瘤(gastric stromal tumor,GST)是起源于间叶组织的肿瘤,胃是消化道间质瘤的最常见的发生部位,以往外科手术是唯一的治疗手段,随着酪氨酸激酶受体CD117在肿瘤中的表达的发现,胃间质瘤的诊治出现了重大的进展。本研究回顾性分析26例胃间质瘤的患者的临床资料,探讨胃间质瘤的病理特点、治疗方式以及影响预后的因素。方法:回顾性分析2000年1月至2008年12月期间本院普外科收治的26例胃间质瘤患者的临床资料,所有患者均经手术治疗,其中3例术后口服甲磺酸伊马替尼,剂量为400mg/d。分析全部病例的临床病理结果及随访资料。结果:全部患者肿瘤切除率100%,发现肝转移3例,一并手术切除转移灶。复发转移6例,其中低度危险组1例,中度危险组1例,高度危险组4例。肿瘤大小从2～15cm(中位数5.5cm)。术后病理以及免疫组织化学结果显示CD117阳性24例(92.3%)、CD34阳性21例(80.8%),Vimentin阳性25例(96.2%)。术后3例口服甲磺酸伊马替尼6个月以上,1例目前无瘤生存,1例肝脏带瘤生存,1例6个月后死亡。本组随访时间4～36个月,术后失访4例(15.3%),平均随访时间28个月;全组病例1、3生存率分别为96.2%和84.6%。结论:肿瘤大小、核分裂相、免疫组织化学指标是判断胃间质瘤预后的重要指标,发生转移者预后差。手术仍是胃间质瘤的首选方式,靶向治疗可改善其预后。

Background and purpose： Gastric stromal tumor（GST）tumor of the gastrointestinal tract and most often arises in the stomach. In the past, surgery was the only effective treatment. The diagnosis and treatment of GST has been revolutionized over the past, since expression of the receptor tyrosine kinase KIT （CD117） was shown to occur on these tumors, the outcome of GST treatment has dramatically been improved. This study focused on the therapeutic experience of GST and analyzed the pathological features and prognostic factors of GST in our center. Methods： All the 26 cases underwent surgical resection and three of them were treated over 6 months with imatinib 400 mg/d. The clinical pathological and follow-up data of 26 patients with GST admitted in our hospital between Jan. 2000 and Dec. 2008 were analyzed retrospectively. Results： All the cases underwent curative resections, including palliative liver resection in 3 patients with liver metastasis. Recurrence occured on 6 patients, including 1 case with low risk group, 1 case with intermediate risk group, 4 cases with high risk group. Tumor size ranged from 2 to 15 cm with the mean of 5.5 cm. The immunohistochemistry results revealed that the positive rates of CD117, CD34 and Vimentin were 92.3%, 80.8% and 96.2% respectively. After operation, three patients accepted imatinib mesylate therapy over 6 months. Two of them were alive, but one had liver metastasis. The follow-up period ranged from 4 to 36 months （median： 28 months）. Four cases were lost. The 1-, 3-year overall survival rates of 26 cases were 96.2% and 84.6%. Conclusion： Tumor size, location, mitosis and immunohistoehemical data are important variables to evaluate GST behavior and prognosis. Surgical resection is the main therapy for GST and targeted therapy will improve the prognosis.