胃肠道间质瘤患者的预后分析：单一单位原发性疾病手术治疗经验。

Prognostic analysis of patients with gastrointestinal stromal tumors: a single unit experience with surgical treatment of primary disease.

机构信息

Department of General Surgery, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China.

出版信息

Chin Med J (Engl). 2010 Jan 20;123(2):131-6.

PMID:20137358

Abstract

BACKGROUND

Gastrointestinal stromal tumor (GIST), the most common type of mesenchymal tumors of the gastrointestinal tract, is a recently recognized tumor. The biological behavior of GIST is highly variable. Surgical resection remains the major treatment for GIST. In this study we retrospectively analyzed our surgical experience with 181 GIST patients to determine the effects of the treatment and the pathological features and prognosis factors of these GIST patients.

METHODS

The clinicopathological features and follow-up data of the 181 patients with GIST who had received surgical resection between January 1999 and December 2007 at Ren Ji Hospital were retrospectively reviewed. Immunohistochemical stains including CD117 (KIT), CD34, and other markers were used. Tumor size, mitotic index and other pathological parameters were recorded. According to the consensus of NIH risk-group stratification system based on maximum tumor size and mitotic index (per 50 high power field), tumors were classified into very-low-risk group (15 tumors, 8.3%), low-risk group (48, 26.5%), intermediate-risk group (52, 28.7%) and high-risk group (66, 36.5%). Prognostic factors were analyzed by Cox analysis including age, sex, tumor size, tumor site, mitotic index, NIH categories and surgical procedures.

RESULTS

One hundred and seven (59.1%) of the 181 tumors were located in the stomach, 51 (28.2%) in the small intestine, 9 (5.0%) in the colon and rectum, and 14 (7.7%) in other sites including the omentum and mesentery. The median age of the patients was 58 (range, 24-84) years, and 102 patients (56.4%) were male. Tumor size ranged from 0.5 to 30 cm, while the mean size was 7.02 cm. Metastasis was found in 7 patients. One hundred and seventy-six (97.2%) of the 181 patients underwent radical resection, and among them 26 patients received extensive resection with the adjacent organ adherent to the tumors. The positive rate for the KIT protein (CD117) in immunostaining was 94.5% (171/181), while that for CD34 was 86.2% (156/181). The 1-, 3-, and 5-year survival rates of the 181 patients were estimated to be 95.2%, 87.9% and 78.5%, respectively. There was a significant difference in age, tumor size, tumor site, mitotic index, NIH categories, and presence or absence of multivisceral resection (P<0.05). But there was no significant difference in sex between the groups. Cox hazard proportional model revealed that advanced clinical stage and large tumor size contributed to worse prognosis. The patients who were treated with imatinib because of recurrence and metastasis or high recurrence risk showed stable disease.

CONCLUSIONS

Surgical resection is the gold standard of treatment for primary GIST. NIH categorization is simple and effective to evaluate GIST behavior and prognosis. Targeted therapy such as imatinib, a KIT tyrosine kinase inhibitor, may play an important role in the treatment of GIST.

摘要

背景

胃肠道间质瘤（GIST）是胃肠道最常见的间叶性肿瘤，是一种最近才被认识的肿瘤。GIST 的生物学行为差异很大。手术切除仍然是 GIST 的主要治疗方法。本研究回顾性分析了我们 181 例接受手术切除的 GIST 患者的手术经验，以确定治疗效果以及这些 GIST 患者的病理特征和预后因素。

方法

回顾性分析 1999 年 1 月至 2007 年 12 月在仁济医院接受手术切除的 181 例 GIST 患者的临床病理特征和随访资料。采用 CD117（KIT）、CD34 等标志物进行免疫组织化学染色。记录肿瘤大小、有丝分裂指数等病理参数。根据 NIH 风险分组系统基于最大肿瘤大小和有丝分裂指数（每 50 个高倍视野）的共识，将肿瘤分为极低危组（15 例，8.3%）、低危组（48 例，26.5%）、中危组（52 例，28.7%）和高危组（66 例，36.5%）。采用 Cox 分析包括年龄、性别、肿瘤大小、肿瘤部位、有丝分裂指数、NIH 分类和手术方式等预后因素。

结果

181 例肿瘤中 107 例（59.1%）位于胃，51 例（28.2%）位于小肠，9 例（5.0%）位于结肠和直肠，14 例（7.7%）位于网膜和肠系膜等其他部位。患者中位年龄为 58 岁（范围 24-84 岁），其中 102 例（56.4%）为男性。肿瘤大小从 0.5 厘米至 30 厘米不等，平均大小为 7.02 厘米。7 例患者发生转移。181 例患者均行根治性切除术，其中 26 例因与肿瘤相邻的器官粘连而行广泛切除术。免疫组化 KIT 蛋白（CD117）阳性率为 94.5%（171/181），CD34 阳性率为 86.2%（156/181）。181 例患者的 1、3、5 年生存率估计分别为 95.2%、87.9%和 78.5%。年龄、肿瘤大小、肿瘤部位、有丝分裂指数、NIH 分类和是否多脏器切除均有显著差异（P<0.05）。但组间性别无显著差异。Cox 风险比例模型显示，晚期临床分期和较大的肿瘤大小与预后不良有关。因复发和转移或高复发风险而接受伊马替尼治疗的患者疾病稳定。