Chen Tsung-Hsing, Hsu Chen-Ming, Chu Yin-Yi, Wu Chi-Huan, Chen Tse-Ching, Hsu Jun-Te, Yeh Ta-Sen, Lin Chun-Jung, Chiu Cheng-Tang
a Department of Gastroenterology and Hepatology , Linkou Chang Gung Memorial Hospital, Chang Gung University College of Medicine , Taoyuan , Taiwan ;
b Graduate Institute of Clinical Medical Sciences, Chang Gung University , Taoyuan , Taiwan ;
Scand J Gastroenterol. 2016 Mar;51(3):374-7. doi: 10.3109/00365521.2015.1095350. Epub 2015 Oct 22.
Previous research shows that only 10-30% of gastrointestinal stromal tumors (GISTs) are malignant. Nonetheless, some reports suggest that all of them have some degree of potential for malignancy. Endoscopic ultrasonography (EUS) is a useful technique for differentiation of subepithelial lesions in the gastrointestinal tract. We explored EUS characteristics that might predict the malignancy potential of GISTs.
In this retrospective review of the medical records from 1999 through 2007, patients who had gastric stromal tumors diagnosed prior to surgery using EUS were enrolled. The EUS images, procedure records and tissue histopathology were reviewed. All patients were positive for C-kit.
Of the 110 patients enrolled, 57 were males, and 53 were females. Most (67%) of the GISTs were located in the gastric body. The lesion size ranged from 6.3 to 150 mm (mean ± SD: 39.73 ± 22.49 mm). The high-risk GIST group had 19 (17.3%) patients, the intermediate-risk group had 12 (10.9%) patients and the low/very low-risk group had 79 (71.8%) patients. Thirty patients had cystic lesions (27.3%), while six patients had calcification in the lesion (5.5%). Additionally, 27 patients (24.5%) had surface ulceration visible on endoscopy. GISTs at high risk for malignancy were highly associated with lesion size (p < 0.0001), cystic change (p = 0.015) and surface ulceration (p = 0.036) but not with calcification (p = 0.667). We also found that mitosis was associated with lesion size (p < 0.0001) rather than other parameters. Age was not predictive of malignancy potential (p = 0.316). However, tumor size is the only one independent risk factor for malignancy (p ≤ 0.0001).
The preliminary results show that large gastric GISTs with cystic change and surface ulceration may associate with a risk of malignancy, warranting more aggressive management. Nevertheless, the tumor size is more important than other factors.
既往研究表明，只有10% - 30%的胃肠道间质瘤（GIST）是恶性的。然而，一些报告提示所有GIST都有一定程度的恶变潜能。内镜超声检查（EUS）是鉴别胃肠道上皮下病变的一种有用技术。我们探索了可能预测GIST恶变潜能的EUS特征。
在本次对1999年至2007年病历的回顾性研究中，纳入术前经EUS诊断为胃间质瘤的患者。对EUS图像、操作记录和组织病理学进行回顾。所有患者的C - kit均为阳性。
纳入的110例患者中，男性57例，女性53例。大多数（67%）GIST位于胃体部。病变大小范围为6.3至150 mm（均值±标准差：39.73±22.49 mm）。高危GIST组有19例（17.3%）患者，中危组有12例（10.9%）患者，低/极低危组有79例（71.8%）患者。30例患者有囊性病变（27.3%），6例患者病变中有钙化（5.5%）。此外，27例患者（占24.5%）在内镜下可见表面溃疡。恶变高危的GIST与病变大小（p < 0.0001）、囊性变（p = 0.015）和表面溃疡（p = 0.036）密切相关，但与钙化无关（p = 0.667）。我们还发现有丝分裂与病变大小相关（p < 0.0001），而与其他参数无关。年龄不能预测恶变潜能（p = 0.316）。然而，肿瘤大小是恶变的唯一独立危险因素（p≤0.0001）。
初步结果表明，伴有囊性变和表面溃疡形成的大胃GIST可能与恶变风险相关，需要更积极的处理。然而，肿瘤大小比其他因素更重要。
