【摘要】 目的总结胃肠道间质瘤肝转移的临床病理特征,行生存分析,对诊断和治疗原则进行探讨。方法收集本院收治的资料完整的胃肠道间质瘤患者99例,对其中26例肝转移患者的临床病理特征进行回顾性分析,探讨肝转移发生后生存时间的影响因素。结果原发肿瘤和发生肝转移的平均年龄为50.8和51.8岁。病理证实者5例,手术中探查诊断为肝转移者12例,14例为单纯影像学诊断。发现原发肿瘤的同时和非同时伴肝转移者分别为8例和18例,非同时发现者肝转移距原发肿瘤手术时间的中位时间为12个月。肿瘤原发于胃12例,结直肠5例,小肠6例,胃肠道外3例。肝转移灶切除者4例,无水乙醇注射2例,介入治疗3例,全身静脉化疗7例,伊马替尼(格列卫)治疗8例,未治疗2例。肝转移后中位生存时间为21个月。伊马替尼治疗为影响肝转移后生存时间的重要因素。结论原发部位为胃的胃肠道间质瘤肝转移最常见;小肠间质瘤易发生肝转移;服用伊马替尼3个月以上可延长生存。更多还原

【Abstract】 Objective To summarize the clinical and pathological characteristics of gastrointestinal stromal tumors with hepatic metastasis, and to analyze its survival and explore its principles of diagnosis and treatment. Methods Among 99 patients diagnosed as gastrointestinal stromal tumors who had a completely case history in our hospital, we retrospectively analyzed the clinical data of 26 patients with hepatic metastatic and the factors influencing survival. Results The average age at diagnosis of primary and hepatic metastatic gastrointestinal stromal tumors was 50.8 and 51.8 years old respectively. Five cases were confirmed by pathological examination, 12 cases were diagnosed by the exploration during the operation and 14 patients had an imaging diagnosis only. Synchronous and metachronous hepatic metastasis happened in 8 and 18 patients respectively. The median interval between the primary tumor and the metachronous hepatic metastasis was 12 months. The primary sites of 12 cases were in stomach, 5 in colorectum, 6 in small intestine and 3 in extra-gastrointestinal tract.Four cases of the hepatic metastatic tumors were treated with surgical resections, 2 with injections of anhydrous alcohol, 3 with interven-tional therapies, 7 with systemic chemotherapies, 8 with imatinib and 2 without treatment. The median survival was 21 months after hepatic metastasis. The administration of imatinib was an important factor prolonging the survival after hepatic metastasis. Conclusions The most frequent primary site of hepatic metastatic stromal tumor is the stomach while small intestinal stromal tumors are most inclined to metastasize to the liver. Treatment with imatinib for more than 3 months can prolong the survival.更多还原