胃肠内外间质瘤临床病理特征及预后比较分析

Analysis and comparison of the clinicopathological features and prognosis of gastrointestinal stromal tumor and extra-gastrointestinal stromal tumor

目的分析比较胃肠外间质瘤(EGIST)与胃肠间质瘤(GIST)的临床病理特征和预后差异。方法回顾性分析2011年1月至2018年8月经西南医科大学附属医院病理科确诊的33例EGIST和315例GIST病人的临床病理及预后资料。结果33例EGIST中男性11例(33.3%),女性22例(66.7%),发病年龄(53.2±13.1)岁;315例GIST中男性141例(44.8%),女性174例(55.2%),发病年龄(56.3±11.8)岁。与GIST病人相比,EGIST病人肿瘤直径更大(χ^(2)=24.644,P<0.001)、肿瘤易破裂(χ^(2)=5.534,P=0.019)、肿瘤易发生囊性变(χ^(2)=15.375,P=0.002)、核分裂象计数>5个/50HPF者更多(χ^(2)=24.867,P<0.001),NIH危险度分级更高(χ^(2)=39.583,P<0.001)。接受肿瘤切除术后,EGIST与GIST病人5年总生存率分别为55.3%、81.2%,5年无进展生存率分别为43.1%、74.6%,差异有统计学意义(P值均<0.001),EGIST病人的预后更差,并且更易复发转移(χ^(2)=11.418,P=0.005)。多因素分析显示肿瘤直径是影响EGIST组病人5年总生存率的独立因素(P=0.028)。结论与GIST病人相比,EGIST病人的肿瘤体积更大,更易发生破裂,核分裂象计数更高,高危险度者更多,预后更差,更易发生复发转移,而肿瘤直径是影响EGIST病人预后的独立因素。

Objective To analyze and compare the clinicopathological features and prognosis of extra-gastrointestinal stromal tumor(EGIST)and gastrointestinal stromal tumor(GIST).Methods The clinicopathological and prognostic data of 33 patients with EGIST and 315 patients with GIST admitted in Department of Pathology,the Affiliated Hospital of Southwest Medical University from January 2011 to August 2018 were analyzed retrospectively.Results There were 33 cases of EGIST,with 11 males(33.3%)and 22 females(66.7%),and the average onset age was 53.2±13.1 years.There were 315 cases of GIST with 141 males(44.8%)and 174 females(55.2%),and the average onset age was 56.3±11.8 years.Compared with the GIST patients,the EGIST patients accompanied with a larger tumor volume(χ^(2)=24.644,P<0.001),an easier rupture to tumor(χ^(2)=5.534,P=0.019),an easier cystic-change(χ^(2)=15.375,P=0.002),a higher mitotic figure(χ^(2)=24.867,P<0.001),and a higher NIH risk(χ^(2)=39.583,P<0.001).After tumor resection,the 5-year overall survival rates of EGIST and GIST patients were 55.3%and 81.2%respectively,and the 5-year progression-free survival rates were 43.1%and 74.6%respectively.Both difference had statistics significance(P<0.001).The EGIST patients were prone to recurrence and metastasis after operation(χ^(2)=11.418,P=0.005)with a poor prognosis.By multivariate analysis,the independent indicator for the 5-year overall survival was tumor diameter in the EGIST patients(P=0.028).Conclusion EGIST is prone to a large tumor volume,easy to rupture,a high mitotic figure,and a high NIH risk.After tumor resection,the 5-year survival rate and progression-free survival rate of EIGST patients are low;meanwhile the prognosis of EGIST patients is poor and those patients are more likely to recurrence and metastasis.Moreover,tumor diameter is an independent factor for the prognosis of EGIST patients.