115例胃肠间质瘤的临床病理及其预后影响因素分析

Analysis of clinical pathology characteristics and prognostic factors of gastrointestinal stromal tumor patients,a report of 115 cases

目的探讨胃肠间质瘤(GIST)患者的临床、病理特点,并分析预后影响因素。方法对115例接受外科手术治疗的GIST患者的临床、病理资料进行回顾性分析。采用免疫组织化学法检测CD117、DOG-1及CD34蛋白的表达、基因测序法进行基因突变检测,并分析影响GIST预后的因素。结果 115例GIST患者中,病理类型以梭型细胞为主型95例(82.6%),上皮细胞为主型17例(14.8%),混合细胞型3例(2.6%)。CD117、DOG-1、CD34蛋白阳性表达率分别为89.6%、92.2%、84.2%。CD117、DOG-1、CD34蛋白在不同性别、肿瘤大小、危险度分级、核分裂数及是否转移分组中阳性表达率比较,差异无统计学意义。103例CD117阳性表达患者的DOG-1、CD34阳性表达率明显高于12例CD117阴性患者(P<0.001)。109例患者获得随访,1年、3年、5年总体生存率分别为90.1%、63.4%、48.6%,其中行根治切除患者1年、3年、5年总体生存率分别为100%、84.2%、70.3%。单因素分析结果显示:肿瘤大小、NIH危险度分级、是否转移、手术方式与患者生存有关(P<0.05)。多因素分析结果显示是否转移是影响患者术后生存时间的独立危险因素(P<0.001)。结论影响GIST预后的因素有肿瘤大小、NIH危险度分级、手术方式、转移情况,其中否转移是影响患者术后生存时间的独立危险因素。

Objective To investigate the clinical and pathological characteristics and prognostic factors of gastrointestinal stromal tumors（GIST） patients. Methods The clinical and pathological data of 115 postoperative GIST patients were analyzed retrospectively. Expression level of CD117, DOG-1 and CD34 were examined by immunohistochemistry, and gene mutation were determined by gene sequencing. Results Pathological examination showed that, of all 115 GIST patients, 95 cases （ 82.6% ） were spindle cell type, 17 cases （14.8%） were epithelial ceils type, and 3 cases （2.6%） were mixed cell type. Positive expression rate of CD117, DOG-1, CD34 were 89.6% ,92.2% ,and 84.2% ,respectively, but there was no significant difference in positive expression rate of CD117, DOG-1, or CD34 among groups of different gender, tumor size, risk classification, mitotic counts, or with metastasis or without. Positive expression rate of DOG-1 or CD34 was higher in CD117 positive GIST patients than in CD117 negative patients （P 〈 0.05 ）. Altogether 109 GIST patients were followed-up,and 1-, 3-, 5-year overall survival rate were 90. 1% , 63.4%, and 48.6%, respectively, by contrast, specifically for patients underwent radical resection rates were 100% ,84.2% and 70.3%, respectively. Univariate analysis showed tumor size, NIH risk classification,operation method, and metastasis were factors of survival, while multivariate analysis indicated only metastasis was its independent risk factor（P 〈 0.001 ）. Conclusion Tumor size, NIH risk classification, operation method, and metastasis might be factors influencing prognosis, but only metastasis is the independent risk factor affecting postoperative survival for GIST patients.