Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai 200011, PR China.
Oral Oncol. 2012 Feb;48(2):141-8. doi: 10.1016/j.oraloncology.2011.09.004. Epub 2011 Oct 19.
Owing to rarity and awareness deficiency towards inflammatory myofibroblastic tumor (IMT), we sought to review on its clinicopathological features; arising awareness to achieve early diagnosis; exploring prognostic factors and then establishing a treatment protocol. Retrospective study was performed on patients with histological proven IMT between January 2003 and December 2010. Their demographic data, clinical and histological presentations were recorded. Overall survival (OS) and progression-free-survival (PFS) were estimated via Kaplan-Meier method. Cox regression model was applied to determine the significant of prognostic factors. Logistic regression model was established to predict the probability of relapse. A total of 28 patients. Five-year PFS was 65%. Surgical margins primarily and independently determined the survival, followed by size, pseudocapsule of the lesion, intra-lesional necrosis and lastly Ki-67 and ALK overexpression. Logistic model in prediction of relapse was established, with the formula as probability of relapse = 1/(1 + e(-z)) where e = exponential function, z = constant value (3.9) + Bmargin + Bsize + Bimmunohistochemical expression + Bpseudocapsule + B*intra-lesional necrosis. Immunohistochemical overexpression was significant if Ki-67 was strongly expressed with a conditioned ALK overexpression simultaneously. Staining intensity must be at least moderate for those ALK nuclear staining was less than 25%. Weak ALK staining intensity is only significant if nuclear staining was more than 25%. Diagnosis of IMT is achieved via exclusion. Radical resection and obtaining negative margins remains the mainstay of treatment. Both high and moderate-risk groups required post-operative radiotherapy. In low-risk group, post-operative radiotherapy was recommended if the lesion is larger than 5 cm in diameter with a conditioned ALK & Ki-67 overexpression.
由于炎性肌纤维母细胞瘤 (IMT) 的罕见性和认知不足，我们旨在回顾其临床病理特征；提高认识以实现早期诊断；探讨预后因素，然后建立治疗方案。对 2003 年 1 月至 2010 年 12 月间经组织学证实的 IMT 患者进行回顾性研究。记录他们的人口统计学数据、临床和组织学表现。通过 Kaplan-Meier 方法估计总生存期 (OS) 和无进展生存期 (PFS)。应用 Cox 回归模型确定预后因素的显著性。建立逻辑回归模型预测复发的概率。共 28 例患者。5 年 PFS 为 65%。手术切缘主要且独立决定了生存，其次是肿瘤大小、病变的假包膜、瘤内坏死，最后是 Ki-67 和 ALK 过表达。建立了预测复发的逻辑模型，公式为复发概率 = 1/(1 + e(-z))，其中 e 是指数函数，z 是常数值（3.9）+ B切缘+B大小+B免疫组化表达+B假包膜+B*瘤内坏死。如果 Ki-67 强烈表达且同时伴有条件性 ALK 过表达，则认为免疫组化过表达有意义。对于 ALK 核染色少于 25%的情况，染色强度必须至少为中度。如果核染色大于 25%，则弱 ALK 染色强度才有意义。IMT 的诊断是通过排除法实现的。根治性切除并获得阴性切缘仍然是治疗的主要方法。高危和中危组均需要术后放疗。在低危组中，如果病变直径大于 5cm 且伴有条件性 ALK 和 Ki-67 过表达，则建议术后放疗。
