胃肠间质瘤46例临床分析

Clinical analysis on 46 cases with gastrointestinal stromal tumor

目的探讨胃的胃肠间质瘤(GIST)临床特点和影响预后的因素。方法回顾性分析手术治疗的46例胃GIST患者的临床、病理资料。结果病变部位:胃底贲门17例(37.0%),胃体22例(47.8%),胃窦部5例(10.9%),占据胃壁两个部位2例(4.3%)。肿瘤直径1.0-15.0cm。全组患者均行肿瘤完整切除;淋巴结清扫11例,未发现转移淋巴结。免疫组织化学染色,CD117阳性率91.3%(42/46),CD34阳性率80.4%(37/46)。40例患者获随访,1、3和5年生存率分别为94.7%、80.2%和56.6%。单因素分析显示,Fletcher分级、肿瘤大小、肿瘤侵犯其他脏器、转移和口服甲磺酸伊马替尼对生存率有影响(P<0.05或P<0.01)。结论手术是治疗胃GIST的主要方法。转移是影响胃GIST预后的独立危险因素。Fletcher分级是判断胃GIST生物学行为及预后简单有效的方法。

Objective To investigate the clinicopathologecal characteristics and the factors to influence the prognosis of gastric gastrointestinal stromal tumors（GIST） in the stomach.MethodsThe clinicopathological data of 46 patients with gastric GIST were analyzed retrospectively.ResultsTumor located at the cardia or fundus in 17 cases（37.0%）,the stomach body in 22 cases（47.8%）,the antrum in 5 cases（10.9%）,and at two regions in 2 cases（4.3%）.Tumor sized 1.0 to 15.0 cm.All patients underwent complete tumor resection,of whom 11 cases underwent lymph node dissection without lymph node metastasis.The positive rate was 91.3%（42/46） for CD 117 and 80.4%（37/46） for CD34.The 1-,3-and 5-year survival rates of the 40 cases with follow up were 94.7%,80.2%,and 56.6%,respectively.Univariate analysis revealed that the differences in Fletcher classification,tumor size,infiltration to surrounding tissues,preoperative metastasis,and adjuvant postoperative therapy with imatinib were related to the survival rates（P〈0.05 or P〈0.01）.Conclusion Surgery is the main therapy for gastric GIST.Metastasis is an independent factor for predicting the prognosis of gastric GIST.Fletcher classification can be used to evaluate the biological behavior and prognosis.