胃肠道间质瘤恶性指标的研究

Study on clinicopathologic parameters of malignant behavior in gastrointestinal stromal tumors

目的探讨一组临床病理指标在预测恶性胃肠道间质瘤（GIST）中的价值。方法回顾性研究840例GIST，假设肉眼播散[包括肝转移和（或）腹腔播散]、显微镜下播散（包括淋巴结转移、血管浸润、脂肪浸润、神经浸润和黏膜浸润）以及肿瘤复发为恶性组，剩余为生物学行为不明组，根据此初步分组后进行多因素分析。结果多因素分析发现以下形态学指标与恶性组密切相关：核分裂象≥10个／50HPF、肌层浸润、肿瘤性坏死、围绕血管呈簇状排列以及细胞明显异型（均P〈0．01）。由此获得了2项肉眼播散、5项镜下播散和5项组织形态学指标。485例具有其中任意一项指标者归入恶性组，其余355例为非恶性组。随访资料提示非恶性组患者5年无瘤生存率（DFS）及5年总生存率（OS）分别为99．3％和100％，而恶性组患者5年DFS及5年OS分别为43．9％和59．7％，恶性组与非恶性组5年DFS与5年OS差异有统计学意义（均为P〈0．01）。结论此组12项临床及形态学指标能有效地将恶性GIST从非恶性GIST中区分开来，可用于区分GIST的性质。

Objective To determinate the clinicopathologic parameters in predicting the malignant behavior of gastrointestinal stromal tumor （GIST）. Methods Eight hundred and forty cases of GIST were retrospectively reviewed. The tumors were classified as malignant if they met any of the following criteria： evidence of gross dissemination （including fiver metastasis and/or peritoneal spread）, evidence of microscopic dissemination （including lymph node metastasis, infiltration to vessels, fat tissue, nerves and/ or mucosal tissue ）, or disease relapse. The remaining cases were provisionally classified as tumors of uncertain biologic behavior. A number of morphologic parameters were then evaluated under light microscopy and univariate and multivariate analyses were adopted for this study. Results Histologic findings correlated with evidences of the following morphologic parameters were considered in accord with the criteria of the malignant behavior： mitotic count 〉 or = 10 per 50 high-power fields （ P 〈 0. 01 ）, muscle infiltration （ P 〈 0. 01 ）, coagulative necrosis （ P 〈 0. 01 ）, perivascular growth pattern （ P = 0. 005 ） and remarkable nuclear atypia （P =0. 014）. Basing on the above criterion, 485 cases were re-classified as ＂malignant＂ and 355 cases as ＂non-malignant＂. Follow-up data showed that the five-year disease-free survival and overall survival in the ＂non-malignant＂ group were 99. 3% and 100% respectively, in contrast to 43.9% and 59. 7% respectively in the ＂malignant＂ group （P 〈 0. 01 ）. Conclusions The set of clinicopathologic parameters is useful in predicting the malignant behavior of GIST and prognosis.