胃肠道间质瘤CT表现与Ki-67指数及危险分层相关性

ASSOCIATION OF CT FINDINGS OF GASTROINTESTINAL STROMAL TUMOR WITH KI-67 INDEX AND RISK STRATIFICATION

目的探讨胃肠道间质瘤(GIST)病人CT表现与Ki-67指数、危险分层的相关性。方法回顾性分析行CT检查并经手术病理及免疫证实的464例GIST病人的临床病理及影像学资料,探讨GIST的CT征象与Ki-67指数、危险分层的相关性。结果单因素分析显示,CT显示的肿瘤大小、边界、轮廓、坏死或囊变与Ki-67指数呈正相关(r=0.326~0.446,P<0.05),生长方式、密度、溃疡与Ki-67指数相关性较弱(r=0.173~0.259,P<0.05);钙化与Ki-67指数无相关性(P>0.05)。多因素Logistic回归分析显示,肿瘤直径>4.65 cm(OR=1.163,95%CI=1.055~1.282,P<0.05)和边界不清(OR=3.701,95%CI=2.185~6.269,P<0.001)是区分Ki-67指数≤5%和>5%的有效指标。Ki-67指数与病理检查的肿瘤直径、核分裂象、肿瘤部位、危险度分层呈正相关(r=0.143~0.508,P<0.05)。CT显示的包块大小、部位、边界、轮廓、生长方式、密度、坏死或囊变与危险分层呈中高度正相关(r=0.336~0.809,P<0.05),溃疡与危险分层呈弱相关(r=0.216,P<0.05);钙化、性别与危险分层无相关性(P>0.05)。结论GIST的CT征象具有一定特征性,与Ki-67指数、危险分级密切相关,对GIST的临床治疗方案选择、预后判断具有一定的指导意义。

Objective To investigate the association of CT findings of gastrointestinal stromal tumor(GIST)with Ki-67 index and risk stratification.Methods A retrospective analysis was performed for the clinicopathological and imaging data of 464 patients who underwent CT examination and were diagnosed with GIST confirmed by surgical pathology and immunology,and the association of CT findings with Ki-67 index and risk stratification was analyzed.Results The univariate analysis showed that tumor size,boundary,contour,necrosis,and cystic change on CT were positively correlated with Ki-67 index(r=0.326-0.446,P<0.05);tumor growth pattern,density,and ulcer had weak correlation with Ki-67 index(r=0.173-0.259,P<0.05);there was no correlation between calcification and Ki-67 index(P>0.05).The multivariate logistic regression analysis showed that a tumor size of>4.65 cm(odds ratio(OR)=1.163,95%confidence interval(CI):1.055-1.282,P<0.05)and unclear boundary(OR=3.701,95%CI:2.185-6.269,P<0.001)were effective indices for distinguishing Ki-67≤5%from Ki-67>5%.Ki-67 index was positively correlated with pathological tumor diameter,mitotic count,tumor location,and risk stratification(r=0.143-0.508,P<0.05).Mass size,location,boundary,contour,growth pattern,density,necrosis,and cystic change on CT were mo-derately or highly positively correlated with risk stratification(r=0.336-0.809,P<0.05);ulcer was weakly correlated with risk stratification(r=0.216,P<0.05);calcification and sex were not correlated with risk stratification(P>0.05).Conclusion GIST has characteristic CT signs which are closely correlated with Ki-67 index and risk stratification,with certain guiding significance for selecting clinical treatment regimen and predicting prognosis.