Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Hum Pathol. 2010 Oct;41(10):1422-30. doi: 10.1016/j.humpath.2010.02.013. Epub 2010 Jun 22.
Gastrointestinal stromal tumors have a wide spectrum of biologic behavior, and occasional cases show liver metastases. The modified risk grade based on tumor size and mitotic counts has been proposed to predict the biologic behavior in gastric gastrointestinal stromal tumors. Blood vessel invasion (BVI) is important in the development of metastasis of various kinds of cancer. The aim of this study was to elucidate the potential role of blood vessel invasion in gastric gastrointestinal stromal tumors. Blood vessel invasion was found in 17 of 122 cases (13.9%) of gastrointestinal stromal tumors, and was significantly correlated with larger tumor size, higher mitotic count and higher modified risk grade. Among 83 cases of primary, localized gastric gastrointestinal stromal tumors available for follow-up information, liver metastasis was observed in 14 cases (16.9%). When blood vessel invasion was positive in the primary tumor, liver metastasis occurred in 80% of cases after the initial surgery, indicating that blood vessel invasion was a significant risk factor of liver metastasis (P < .0001). In univariate and multivariate analyses, tumor size (>5 cm), mitotic count (>5/50 high-power fields) and blood vessel invasion (positive) were significantly associated with a shorter period of disease-free survival. Our results suggest that the evaluation of blood vessel invasion may be useful for predicting the risk of liver metastasis and aggressive biologic behavior of gastrointestinal stromal tumors, and may serve as important information for determining the therapeutic strategies including adjuvant molecular target therapy.
胃肠道间质瘤具有广泛的生物学行为谱，偶尔会出现肝转移。基于肿瘤大小和有丝分裂计数的改良风险分级已被提出用于预测胃胃肠道间质瘤的生物学行为。血管侵犯（BVI）在各种癌症转移的发展中很重要。本研究旨在阐明血管侵犯在胃胃肠道间质瘤中的潜在作用。在 122 例胃肠道间质瘤中发现 17 例（13.9%）存在血管侵犯，与肿瘤较大、有丝分裂计数较高和改良风险分级较高显著相关。在可获得随访信息的 83 例原发性、局限性胃胃肠道间质瘤中，观察到 14 例（16.9%）发生肝转移。当原发性肿瘤存在血管侵犯时，初次手术后 80%的病例发生肝转移，表明血管侵犯是肝转移的显著危险因素（P<.0001）。在单因素和多因素分析中，肿瘤大小（>5cm）、有丝分裂计数（>5/50 高倍视野）和血管侵犯（阳性）与无疾病生存时间缩短显著相关。我们的结果表明，血管侵犯的评估可能有助于预测肝转移和胃肠道间质瘤侵袭性生物学行为的风险，并可能作为确定包括辅助分子靶向治疗在内的治疗策略的重要信息。
