52例原发胃肠间质瘤临床病理特点及预后分析

Clinicopathologic features and prognosis for 52 cases with primary gastrointestinal stromal tumor

目的：探讨原发性胃肠间质瘤（gastrointestinal stromal tumors,GISTs）的临床病理特点及影响预后的因素。方法：回顾性分析2009年7月至2014年3月辽宁省肿瘤医院大肠外科经手术治疗的52例原发胃肠间质瘤病人的临床病理资料,并比较不同因素对预后的影响。结果：52例患者有6例见淋巴结转移（11.5%）。核分裂像平均值6.3±3.4（3~34个/50 HPFs）,Ki-67指数（%）平均值10.8±10.4（1~40）,对二者进行相关性分析,结果有统计学意义（r=0.419,P=0.002）。CDl17、CD34、DOG-1阳性率分别为86.5%（45/52）、78.8%（41/52）、84.6%（44/52）,三者同时阳性率为61.5%（32/52）。外显子11突变36例（69.2%）,外显子9突变7例（17.3%）,外显子12及18突变各2例,野生型5例。所有病人均获随访,1、3年生存率分别为97.7%、85.3%。单因素分析显示,肿瘤是否完整切除、核分裂像数目、K i-6 7指数对生存率有影响（P〈0.0 5）;多因素分析显示,肿瘤是否完整切除是预后的独立影响因素（P〈0.05）。对外显子11突变患者进行分层分析,口服伊马替尼生存率高于未口服伊马替尼患者（P=0.026）。结论：原发GISTs的核分裂像、Ki-67指数以及是否完整切除是判断预后的重要因素,核分裂像与Ki-67指数具有相关性。完整切除肿瘤是原发GISTs最有效的治疗方法。中高危患者术后需靶向治疗,外显子11突变患者对伊马替尼的治疗最为受益。

Objective： To investigate clinicopathologic features and prognostic factors of gastrointestinal stromal tumors（GISTs）. Methods： The clinicopathological data of 52 patients of GISTs admitted between July 2009 and March 2014 in Colorectal Department of Liaoning Cancer Hospital Institute were analyzed retrospectively and the prognostic factors were evaluated. Results： 6 patients with lymph nodes metastasis were found in 52 cases（11.5%）. The mean of Mitotic index was 6.3±3.4（3-34/50 HPFs）, and the mean of Ki-67 index（%） was 10.8±10.4（1-40）. The results of the correlation analysis between them were statistically significant（r=0.419, P=0.002）. The positive rates of CDl17, CD34 and DOG-1 was 86.5%（45/52）, 78.8%（41/52） and 84.6%（44/52） respectively, while the simultaneous positive rate of three was 61.5%（32/52）. Kit exon 11 mutation was detected in 36 cases（69.2%）, and exon 9 mutation in 7 cases（17.3%）, exon 12 and 18 mutations in each 2 cases, the wild type in 5 cases. All patients were followed, The 1-, 3-year survival rates were 97.7% and 85.3%. Univariate analysis revealed that complete tumor resection, mitotic index and Ki-67 index（%） were related to the survival rates. Multivariate analysis demonstrated that complete tumor resection was the independent prognostic factor for survival. Stratified analysis of patients with exon 11 mutation showed that survival rate of patients with postoperative therapy of imatinib mesylate was higher than those without therapy of imatinib mesylate（P=0.026）. Conclusion： Mitotic index, Ki-67 index and complete tumor resection are important prognostic factors of primary GISTs. Mitotic index has great correlate with Ki-67. Complete resection of tumors plays the key role in treatment for primary GISTs. Moderate and high risk patients are required to accept targeted therapy postoperatively, in which patients with kit exon 11 mutation may get more benefit with imatinib therapy.