不同解剖段原发灶的胃肠道间质瘤患者转移预后发生情况的比较

Comparison of metastatic prognosis in patients with gastrointestinal stromal tumors from different primary anatomical segments

目的讨论不同解剖段原发灶的胃肠道间质瘤患者转移预后发生情况。方法回顾性分析该院2012-2014年确诊的胃肠道间质瘤患者104例临床资料,统计患者原发病灶的解剖学信息,并比较和讨论不同解剖段肿瘤患者随访2.5年发生转移的情况及特征。结果 104例患者中男61例,女43例;男性和女性间质瘤原发灶位于胃部的比例分别为55.74%和53.49%、位于十二指肠的比例分别为9.84%和9.30%;位于直结肠的比例分别为6.56%和6.98%;原发灶解剖部位分布的比例在性别间差异无统计学意义(P>0.05)。男性原发灶肿瘤平均直径为(6.34±3.51)mm,女性为(6.72±3.02)mm,差异无统计学意义(P>0.05)。原发空回肠部的间质瘤随访检出9例转移,转移率为30.00%;原发直结肠转移1例,转移率为14.29%;十二指肠转移1例,转移率为10.00%;胃部转移4例,转移率为7.02%。不同部位转移率比较,差异有统计学意义(χ2=8.589,P=0.035)。肝转移患者中原发部位为胃的患者占36.36%,原发部位为十二指肠及直结肠的比例各占9.09%,原发于空回肠的占45.45%,但不同解剖段胃肠道间质瘤随访转移比例比较,差异无统计学意义(P>0.05)。胃转移患者全部来自于原发部位为空回肠的间质瘤患者;直结肠转移患者全部来自于空回肠原发间质瘤;此外检出1例胃原发间质瘤患者出现其他器官的转移。几种不同转移部位在4个解剖段胃肠道间质瘤随访转移比例差异无统计学意义(P>0.05)。结论胃原发间质瘤在原发部位中所占比例最高,但转移率在空回肠原发灶患者中最高,值得引起临床关注;未见不同解剖段的间质瘤转移部位差别。

Objective To investigate the metastatic prognosis of patients with gastrointestinal stromal tumors from different primary anatomical segments. Methods Totally 104 patients with gastrointestinal stro real tumors diagnosed in the hospital from 2012 to 2014 were selected. The anatomical distribution of the pri mary lesion was counted and the situation and characteristics of patients with different anatomical segments of tumors who were followed up for 2.5 years were analyzed and discussed. Results In this study,104 patients included 61 males,43 females. The proportion of male and female stromal tumors in the stomach was 55.74% and 53.49%,in the duodenum was 9.84% and 9.30%,in the straight colon was 6.56% and 6.98%,respec-tively. The differences of the proportion of primary lesion anatomical between gender was no statistically sig nificant （P〉0.05）. In addition, the mean diameter of the primary tumor in male was （6.34±3.51）ram and in female was （6.72±3.02）ram,the difference was not statistically significant （P〉0.05）. Nine cases of primary ileum stromal tumor metastasis, metastasis rate was 30.00%. One case of primary colorectal tumor metasta-sis ,metastatic rate was 14.29%. One case of duodenal tumor metastasis,metastatic rate was 10.00%. Four ca-ses of gastric metastasis, the metastatic rate was 7.02%. The difference in metastatic rate between different parts were statistically significant X^2 =8. 589,P=0. 035）. Further analysis of the results suggested that pa-tients with liver metastases in the primary site of the stomach accounted of 36.36%,the primary site for the duodenum and straight colon of the proportion were 9. 09%, primary in the empty ileum accounted for 45.45% ,but there was no statistically significant differences in the proportion of follow up metastases of gas-trointestinal stromal tumors in different anatomical segments （P〉0. 05）. Patients with gastric metastases were all from stromal tumor patients with ileum in the primary site. Patients with colonic metastases were all from the primary interstitial tumor. In addition, one case of gastric primary mesothelioma patients was other organ metastatic. There were no statistically significant differences in the proportion of follow up metastases of gastrointestinal stromal tumors in four different metastatic segments （P〉O. 05）.Conclusion The propor-tion of primary gastric stromal tumors in the primary site is the highest, but the metastasis rate is the highest in the patients with primary ileum. It is worthy of clinical attention. However,there is no difference in stromal metastasis between different anatomical segments.