胃间质瘤70例临床与预后分析

Clinical and prognostic analysis of 70 cases of gastric stromal tumors

目的 探讨胃间质瘤（GST）的临床特征、生物学表现及预后相关因素.方法 回顾性分析经手术治疗及病理证实的70例GST患者相关临床资料,并对其进行电话和信件随访.结果 （1）全组GST中男女性别比例相当,年龄范围在50 ～ 69岁之间,平均年龄59.1岁,主要临床表现为腹部不适（42.9％）,其次为腹部疼痛（37.1％）和上消化道出血（7.1％）,临床表现无特异性.（2） GST的预后与患者性别、年龄、首发症状、肿瘤原发部位等因素无相关性（P＞0.05）,肿瘤大小、核分裂像计数和恶性潜能分级与预后相关,其中肿瘤的大小（肿瘤最大径＞5 cmvs ＜2cm,HR =21.3,95％ CI：5.9 ～77.0;肿瘤最大径2～5 cmvs＜2 cm,HR =2.3,95％CI：1.2～7.8）和核分裂像计数（核分裂像计数＞10/50 HPF vs≤5/50 HPF,HR=22.5,95％ CI：8.6～58.6;核分裂像计数6～ 10/50 HPF vs≤5/50 HPF,HR=11.1,95％ CI：9.9～12.3）是影响GST预后的独立影响因素.结论 GST中肿瘤的大小、核分裂像计数和恶性潜能分级与预后相关,其中肿瘤的大小、核分裂像计数是影响GST预后的独立影响因素.肿瘤越大、核分裂数越多、恶性潜能分级越高,GST的预后越差.

Objective To discuss factors related to clinical characteristics,biological behavior,and prognosis in gastric stromal tumors （GST）.Methods We retrospectively analyzed clinical materials and records of 70 GST patients diagnosed after surgery and pathological examinations,all patients were contacted by telephone or mail for follow-up.Results （1） All GST patients had similar distribution of gender,and had age range of 50 to 69 years with mean age of 59.1 years.Clinical symptoms were non-specific,and main clinical manifestations included abdominal discomfort （42.9％）,followed by abdominal pain （37.1％）,and upper digestive tract hemorrhage （7.1％）.（2） Sex,age,presenting symptoms,and original location of tumors were not significantly related to prognosis （P ＞ 0.05）.However,size of the tumor,mitosis count,and the malignancy potential grading were significantly associated with patient prognosis.Among them,size of the tumor （maximum tumor diameter ＞ 5 cm vs ＜ 2 cm,HR =21.3,95％ CI：5.9-77.0;maximum tumor diameter 2-5 cm vs ＜ 2 cm,HR =2.3,95％ CI：1.2-7.8）,and mitosis count （mitosis count ＞ 10/50 HPF vs mitosis count ≤5/50 HPF,HR =22.5,95％ CI：8.6-58.6;6-10/50 HPF vs ≤5/50 HPF,HR =11.1,95％ CI：9.9-12.3） were independently associated with GST prognosis.Conclusions Tumor size,mitosis count,and malignancy potential grading were associated with prognosis of GST.Among them,tumor size and mitosis count were independent predictors of prognosis.When the tumor size is larger,and mitotic count and the malignant potential grade is higher,prognosis of GST patients were worse.