胃间质瘤临床特征及免疫组化结果与危险度分级的相关性

Correlation of clinical features and immunohistochemical results with risk stratification in gastric stromal tumors

目的:探讨影响胃间质瘤危险度分级的相关因素,为临床诊断提供参考。方法:回顾性收集2016年01月至2019年12月于我院接受治疗的87例经手术后病理证实为胃间质瘤患者的相关临床资料,分析其临床特征、病理及免疫组化结果、治疗措施等,为临床实践提供重要依据。结果:胃间质瘤患者多为中年人,其平均年龄为(59.10±12.92)岁。首发症状最常见的为腹部不适。通过单因素分析提示患者年龄、肿瘤大小与首发症状有一定程度的相关性。肿瘤生长部位最常见的为胃底,直径以2~5 cm最常见。免疫组化分析可知CD117、DOG-1、CD34阳性率较高,分别为97.70%、97.70%、97.70%,Vim、SMA、Desmin阳性率较低,分别为50.57%、17.24%、5.75%。通过单因素分析提示年龄、SMA表达、Demsin表达、Ki-67标记指数(labeling index,LI)与危险度分级有一定相关性。87例患者中行开腹手术27例,腹腔镜手术25例,双镜联合8例,内镜下治疗27例,11例术后服用甲磺酸伊马替尼进行靶向治疗,外科手术及内镜手术均未出现围手术期治疗相关死亡。结论:胃间质瘤患者首发症状缺乏特异性,但可能与患者年龄、肿瘤大小有一定关系。临床上确诊还需依赖病理及免疫组化结果,必要时可结合患者年龄、SMA表达、Demsin表达、Ki-67 LI进一步判断危险度。

Objective:To retrospectively analyze the clinical features,immunohistochemical results of gastric stromal tumors(GSTs),and discussed the influencing factors of risk classification,in order to provide references for the diagnosis of GSTs.Methods:The clinical data of 87 patients admitted to our hospital from January 2016 to December 2019 who were pathologically confirmed to be gastric stromal tumor were collected,and their clinical features,clinicopathologic,immunohistochemical results and treatment methods were analyzed.Results:It proved that most of patients were middle-aged adults,and the mean age of was(59.10±12.9)years.It found that abdominal discomfort was the most common first symptom.Univariate analysis showed that age and tumor size were related to initial symptoms.Gastric fundus remains the most frequent site of gastric stromal tumor,and the diameter was mostly 2~5 cm.Immunohistochemical analysis showed that the positive rates of CD117,DOG-1 and D34 were high,97.70%,97.70% and 97.70%,respectively.The positive rates of Vim,SMA,and Desmin were low,50.57%,17.24%,5.75%,respectively.Univariate analysis showed that the age of the patients,SMA expression,Demsin expression and Ki-67 labeling index(LI)were correlated with risk grade.Among the 87 patients,27 patients underwent open surgery,25 patients underwent laparoscopic surgery,8 patients underwent laparoscopic combined endoscopic surgery,and 27 patients underwent endoscopic treatment,11 patients received targeted therapy with imatinib after surgery.No death occurred during the perioperative period.Conclusion:Gastric stromal tumor patients lack the characteristic first symptom,but it appeared to be related to the age or tumor size.It was diagnosed by postoperative pathological and immunohistochemical examination,and if necessary,age,SMA,Demsin and Ki-67 LI and can be used to further determine the risk grade.