Morgan B K, Compton C, Talbert M, Gallagher W J, Wood W C
Department of Surgery, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston 02114.
Ann Surg. 1990 Jan;211(1):63-6. doi: 10.1097/00000658-199001000-00011.
Between 1963 and 1987, 131 patients with benign gastrointestinal stromal tumors, primarily leiomyomas, were treated at the Massachusetts General Hospital. Eighty per cent of tumors were located in stomach or small intestine. Two thirds of the tumors were discovered in symptomatic patients before operation by a variety of diagnostic studies. A mitotic index (MI) was determined for each tumor, defined as the number of mitoses per 50 high-power microscopic fields. Only gastric and small intestine tumors had MIs more than 2. Tumors were treated by conservative excision in 67% and radical excision in 33%. At a median follow-up of 6 years there were no local recurrences. No patient with a tumor discovered incidentally has recurred. Three symptomatic patients have died of metastatic liver disease. Each patient with recurrence had a tumor with MI of 2 or more, which represents a recurrence rate of 16% in this group. We conclude that symptomatic gastric and small intestine tumors having two or more mitoses per 50 high-power fields carry a significant risk for recurrence, and that routine pathologic assessment of MI may identify a subset of patients who would potentially benefit from close follow-up and consideration for further therapy.
1963年至1987年间，131例主要为平滑肌瘤的胃肠道良性间质瘤患者在麻省总医院接受了治疗。80%的肿瘤位于胃或小肠。三分之二的肿瘤在有症状的患者术前通过各种诊断研究被发现。为每个肿瘤确定了有丝分裂指数（MI），定义为每50个高倍显微镜视野中的有丝分裂数。只有胃和小肠肿瘤的MI超过2。67%的肿瘤采用保守切除治疗，33%采用根治性切除治疗。中位随访6年无局部复发。偶然发现肿瘤的患者均未复发。3例有症状的患者死于转移性肝病。每例复发患者的肿瘤MI为2或更高，该组的复发率为16%。我们得出结论，每50个高倍视野中有两个或更多有丝分裂的有症状胃和小肠肿瘤有显著的复发风险，并且MI的常规病理评估可能识别出一部分可能从密切随访和进一步治疗考虑中获益的患者。
