胃肠道间质瘤c-kit基因突变的研究

Analysis of c-kit gene mutations in gastrointestinal stromal tumors

目的 探讨c kit基因在胃肠道间质瘤 (GIST)中的突变状况。方法 用PCR扩增和基因测序的方法 ,检测 5 2例GIST及 2 8例对照肿瘤c kit基因第 11号外显子序列 ,其中 30例GIST另检测了c kit基因第 9和第 13号外显子序列。结果 2 5例恶性GIST中 ,14例有c kit基因 11号外显子突变 (5 6 .0 % ) ;2 7例良性及交界性GIST中 ,仅 2例有突变 (7.4 % )。良恶性GIST中 ,c kit基因突变的差异有显著性 (χ2 =14 .39,P <0 .0 1)。 5 2例GIST中 ,14例为杂合性突变 ,2例为纯合性突变。突变方式有点突变和片段的缺失或重复等 ,缺失和重复的片段为 3～ 4 8bp不等 ,碱基数是 3的倍数。原发及复发组织突变方式相同 ,突变病例瘤旁正常组织及伴发的腺癌无突变。对照肿瘤无c kit基因突变。GIST中c kit基因 11号外显子的突变位点多不固定 ,但有集中趋势 ,点突变和片段的缺失集中在5 5 0～ 5 70密码子 ,片段的重复集中在 5 70～ 5 85密码子。结论 11号外显子的突变是恶性GIST的分子生物学机制之一 ,可作为辅助判断GIST良恶性的参考指标。c kit基因突变提示GIST是不同于消化道平滑肌瘤及神经鞘瘤的独立疾病。

Objective To define the frequency and spectrum of c-kit gene mutations in gastrointestinal stromal tumors (GIST). Methods Fifty two cases of GIST and 28 cases of other tumors were examined for mutations in exon 11, 9 and 13 of c-kit gene using PCR amplification and DNA sequencing. Results Fourteen out of 25 malignant GIST (56%),while 2 of 27 benign and borderline GIST (7.4%) revealed mutations in exon 11 of c-kit gene (P<0.01). Most of the mutations consisted of in-frame deletion or replication from 3 to 48 bp in heterozygous and homozygous fashions, but none of the mutations disrupted the downstream reading frame of the gene. Point mutation and deletion concentrated at 550-570 codons but replication clustered within 570-585 codons. The mutation pattern in recurrence tissues was the same as the primary ones. Normal tissues adjacent to GIST with or without c-kit gene mutations showed wild type c-kit gene sequence. No mutation was found in exon 9 and 13. Neither c-kit gene expression nor gene mutations was found in 3 leiomyomas, 8 leiomyosarcomas, 2 schwannomas, 2 intra-abdomenal fibromitoses and 8 adenocarcinomas. Conclusion The mutations in exon 11 of c-kit gene might partially represent one of the molecular mechanisms of GIST. It can be used as a marker for distinguishing benignancy and malignancy of GIST. The mutations did not involve the reading frame. Except for long frame deletion, most mutations also did not affect protein expression. Mutation of c-kit gene in GIST provides a new genotypic marker to distinguish GIST from authentic leiomyomas, leiomyosarcomas, schwannomas and etc.