【作者】 杜春燕； 师英强； 傅红； 赵广法； 周烨； 蔡国响；

【Author】 Du Chun-Yan Shi Ying-Qiang Fu Hong Zhao Guang-Fa Zhou Ye Cai Guo-Xiang Abdominal surgery department of Changhai Cancer hospital affiliated to Fudan university, Oncology of Shanghai medical college of Fudan university, Shanghai, 200030, China

【机构】 复旦大学附属肿瘤医院腹外科复旦大学上海医学院肿瘤学系；

【摘要】 目的:探讨影响胃肠道间质瘤预后的因素。方法: 回顾性分析我院1998年至2004年5月103例胃肠道间质瘤临床病理及随访资料,包括患者的年龄、性别、肿瘤原发部位、免疫组化、手术方式、术后辅助治疗、肿瘤大小以及核分裂相等资料。用寿命表法绘制总生存曲线。本研究中将手术方式分为根治性手术(R0手术),非根治性手术(包括剖腹探查+ 活检、减瘤手术及切缘阳性的R1-R2手术),免疫组化主要包括CD117,CD34,SMA,S-100,并且参照Flecther等提出的GIST恶性潜能分级标准。将本组胃肠道间质瘤分为极低危险性组(肿瘤直径≤2cm,核分裂相<5／50hpf),低危险性组(肿瘤直径2—5cm,核分裂相<5／50hpf),中危险性组 (肿瘤直径<5cm,核分裂相5～10／50hpf或肿瘤直径5～ 10cm,核分裂相<5／50hpf),高危险性组(肿瘤直径>10cm、任何核分裂相或核分裂相>10／50hpf、任何肿瘤大小)。采用 Kaplan—meier法比较不同因素对生存的影响,并用cox多因素回归分析对该组病例行预后分析。结果:本组103例胃肠道间质瘤病人的1年,3年,5年的总生存率为86．3％, 51．7％,42．8％,其中胃间质瘤病人的1年,3年,5年的总生存率为93．2％,76．1％,66．5％,小肠间质瘤病人的1年,3 年,5年总生存率为78．1％,30．7％,24．5％。单因素生存分析显示不同部位间质瘤的生存率差异有显著性意义(P=0．023 <0．05)。对不同危险度的间质瘤进行生存率分析显示:极低危险性组、低危险性组、中危险性组及高危险性组的5年总生存率分别为100％、76．2％、47．9％和20．4％,差异具有显著性意义(P=0．0001,<0．05),而性别、年龄、免疫组化表达情况、是否联合脏器切除以及是否辅助放化疗差异无显著性。 Cox回归分析显示恶性潜能分级(P=0．012)和手术是否为根治性(P=0．009)是影响生存预后的独立预后因素。结论: 用Flecther恶性潜能分级方法来判断间质瘤的生物学行为和预测间质瘤的预后是合理科学简单可行的标准,根治性手术仍是目前原发胃肠道间质瘤的首选治疗,靶向治疗将成为治疗间质瘤的重要手段。更多还原

【Abstract】 Objective: to investigate the prognostic factor of gastrointestinal stromal tumor. Methods: The clini-copathological data of 103 patients with gastrointestinal stromal tumors, which included age、sex、primary organ of tumor、 Immunehistochemistry expression、 surgical information、 tumor size and Mitotic rate, were analyzed retrospectively. Life table、kaplan-meier survival rate and Cox regression model were used to evaluate the prognostic factors. Results: The 1 year. 3 years and 5 years total survival rate of these 103 gastrointestinal stromal tumors was 86.3%, 51.7%, 42.8%. Among them, the 1-year, 3-year and 5-year total survival rates for gastric stromal tumors was 93.2%, 76.1%, 66.5%, while for intestinal stromal tumors was 78.1%, 30.7%, 24.5%. Single factor survival analysis indicated that the survival rate of stromal tumors of different parts was of significance (P =0.023 <0.05). Analysis of stromal tumors of different risk levels indicated that the 5-year survival rate for extremely low, low, medium and high risk was 100%、 76.2%、 47.9% and 20.4% respectively, and the difference was of significance(P =0.0001<0.05). Tumor size. Mitotic rate 、 primary organ of tumor and radical surgical excision or not were analyzed respectively,the difference was statistical significance(P <0.5);No significiant difference between the group of sex、 age、 immunohistochemistry expression and multi-organ resection or not Cox regression analysis showed Flechers’ classification of malignance potential grade (P=0.012) and whether it was radical treatment (P =0.009) were independent prognostic factors. Conclusion: Flechers1 classification was ratinal、 scientific、 simple and feasible.Radical surgical excision was the best therapy to the primary gastrointestinal stomal tumor.更多还原