胃肠间质瘤合并消化道出血的预后分析

Prognostic analysis of gastrointestinal stromal tumors complicated with gastrointestinal bleeding

目的探讨原发性胃肠间质瘤（GIST）消化道出血与临床病理特征及预后的关系。方法回顾性分析2008年4月至2014年12月间收治的200例GIST患者的临床病理和术后随访资料，比较消化道出血与GIST患者临床病理特征和预后的关系。结果200例GIST患者根据消化道出血情况分为消化道出血组（57例）和未出血组（143组）。在消化道出血组中，肿瘤直径为1．8～22．0cm，平均为6．5cm；肿瘤位于胃31例，小肠25例，结直肠1例；核分裂象≤5个／50HPF者50例，6～10个／50HPF者6例，〉10个／50HPF者1例；其中有6例患者合并肿瘤破裂。在消化道未出血组中，肿瘤直径0．4～18cm，平均为2．5cm；肿瘤位于胃125例，小肠8例，结直肠1例，其他（食管及未知来源）9例：核分裂象≤5个／50HPF者141例，6～10个／50HPF者1例，〉10个／50HPF者1例；有1例患者合并肿瘤破裂。GIST消化道出血与肿瘤大小、核分裂象、肿瘤部位、肿瘤危险分级、肿瘤破裂和肿瘤复发情况有关（均P〈O．05）。200例GIST患者的3、5年生存率分别为96．5％和8618％，有16例患者出现复发和（或）转移，死亡11例。消化道出血组和未出血组患者的5年生存率分别为76．2％和91．6％．差异有统计学意义（P〈0．05）。结论合并消化道出血的GIST患者预后较差，应引起临床重视，

Objective To study the relationship between cliificopathological characteristics, prognosis and gastrointestinal bleeding in primary gastrointestinal stromal tumors （GIST）. Methods The clinicopathological and follow-up data of 200 patients with gastrointestinal stromal tumors treated in our hospital from April 2008 to December 2014 were retrospectively reviewed. The correlation of gastrointestinal bleeding with gastrointestinal stromal tumor clinicopathologieal characteristics and prognosis were analyzed. Results The 200 GIST patients were divided into two groups according to the bleeding in the digestive tract, including 57 gastrointestinal bleeding patients anti 143 non-bleeding patients. The mean tumor diameter was 6.5 cm （range 1.8-22 era） in the bleeding group and 2.5 cm （range 0.4-18 era） in the non- bleeding group （P〈0.05）. Of the 57 bleeding patients, 31 located in the stomach, 25 in the small intestine, and one had colorectal bleeding. Fifty patients had mitotic index （MJ） ~〈 5/50 HPF, other 6 patients ranged between 5 and 10/50 HPF and one patient had MI 〉 10/50 HPF. Six GIST patients were complicated with tumor rapture. But in the non-bleeding group, 125 patients had gastric GIST, 8 in the small intestine, one colorectum, and 9 had esophageal or other GIST. 141 patients bad MI ~〈 5/50 HPF, 1 patients ranged between 5 and 10/50 HPF and one patient had MI 〉 10/50 HPF. Only 1 GIST patients was complicated with tumor rapture. The gastrointestinal bleeding was closely associated with tumor size, mitotic index, tumor location, risk classifications, tumor rapture and tumor recurrence （P〈O.05 for all）. The 3-year and 5-year survival rates of the 200 patients were 96.5% and 86.8%, respectively. 16 patients developed recurrence or metastasis, and 11 died of GIST. The 5-year survival rate of patients with gastrointestinal bleeding was 76.2%, significantly lower than that of patients without gastrointestinal bleeding （91.6%, P 〈 0.05）. Conclusions GIST patients complicated with gastrointestinal bleeding have poor prognosis, and attention should be paid to stratifying patients for therapy.