Wu Ting-Jung, Lee Li-Yu, Yeh Chun-Nan, Wu Pei-Yu, Chao Tzu-Chieh, Hwang Tsann-Long, Jan Yi-Yin, Chen Miin-Fu
Division of General Surgery, Department of Surgery, Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
BMC Gastroenterol. 2006 Oct 24;6:29. doi: 10.1186/1471-230X-6-29.
Gastrointestinal stromal tumors (GISTs), the most common type of mesenchymal tumors of the gastrointestinal (GI) tract, demonstrate positive kit staining. We report our surgical experience with 100 small intestine GIST patients and identify predictors for long-term disease-free survival (DFS) and overall survival (OS) to clarify the difference between high- and low-risk patients.
The clinicopathologic and follow-up records of 100 small intestine GIST patients who were treated at Chung Gung Memorial Hospital between 1983 and 2002 were retrospectively reviewed. Clinical and pathological factors were assessed for long-term DFS and OS by using a univariate log-rank test and a multivariate Cox proportional hazard model.
The patients included 52 men and 48 women. Their ages ranged from 27 to 82 years. Among the 85 patients who underwent curative resection, 44 (51.8%) developed disease recurrence (liver metastasis was the most common form of recurrence). The follow-up period ranged from 5 to 202 months (median: 33.2 months). The 1-, 3-, and 5-year DFS and OS rates were 85.2%, 53.8%, and 43.7%, and 91.5%, 66.6%, and 50.5%, respectively. Using multivariate analysis, it was found that high tumor cellularity, mitotic count >5/50 high-power field, and a Ki-67 index > or =10% were three independent factors that were inversely associated with DFS. However, absence of tumor perforation, mitotic count < 5/50 high power field, and tumor with low cellularity were predictors of long-term favorable OS.
Tumors with low cellularity, low mitotic count, and low Ki-67 index, which indicate low risk, predict a more favorable DFS for small intestine GIST patients undergoing curative resection. Absence of tumor perforation with low mitotic count and low cellularity, which indicates low risk, can predict long-term OS for small intestine GIST patients who have undergone curative resection.
胃肠道间质瘤（GISTs）是胃肠道最常见的间叶性肿瘤类型，其kit染色呈阳性。我们报告了100例小肠GIST患者的手术经验，并确定长期无病生存（DFS）和总生存（OS）的预测因素，以阐明高风险和低风险患者之间的差异。
回顾性分析1983年至2002年在中坜荣民总医院接受治疗的100例小肠GIST患者的临床病理和随访记录。通过单因素对数秩检验和多因素Cox比例风险模型评估临床和病理因素对长期DFS和OS的影响。
患者包括52名男性和48名女性。年龄范围为27至82岁。在85例行根治性切除的患者中，44例（51.8%）出现疾病复发（肝转移是最常见的复发形式）。随访期为5至202个月（中位数：33.2个月）。1年、3年和5年的DFS率分别为85.2%、53.8%和43.7%，OS率分别为91.5%、66.6%和50.5%。多因素分析发现，高肿瘤细胞密度、有丝分裂计数>5/50高倍视野以及Ki-67指数>或=10%是与DFS呈负相关的三个独立因素。然而，无肿瘤穿孔、有丝分裂计数<5/50高倍视野以及低细胞密度的肿瘤是长期良好OS的预测因素。
细胞密度低、有丝分裂计数低和Ki-67指数低的肿瘤提示低风险，对于接受根治性切除的小肠GIST患者，其DFS更有利。无肿瘤穿孔且有丝分裂计数低、细胞密度低提示低风险，可预测接受根治性切除的小肠GIST患者的长期OS。
