Liu Xuechao, Qiu Haibo, Zhang Peng, Feng Xingyu, Chen Tao, Li Yong, Tao Kaixiong, Li Guoxin, Sun Xiaowei, Zhou Zhiwei
Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.
Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.
Chin J Cancer Res. 2018 Feb;30(1):61-71. doi: 10.21147/j.issn.1000-9604.2018.01.07.
We aimed to evaluate the clinicopathologic characteristics, immunohistochemical expression and prognostic factors of patients with primary gastrointestinal stromal tumors (GISTs).
Data from 2,570 consecutive GIST patients from four medical centers in China (January 2001-December 2015) were reviewed. Survival curves were constructed by the Kaplan-Meier method, and Cox regression models were used to identify independent prognostic factors.
Of the included patients, 1,375 (53.5%) were male, and the patient age range was 18 to 95 (median, 58) years. The tumors were mostly found in the stomach (64.5%), small intestine (25.1%) and colorectal region (5.1%). At the time of diagnosis, the median tumor size was 4.0 (range: 0.1-55.0) cm, and the median mitotic index per 50 high power fields (HPFs) was 3 (range: 0-254). Of the 2,168 resected patients, 2,009 (92.7%) received curative resection. According to the modified National Institutes of Health (NIH) classification, 21.9%, 28.9%, 14.1% and 35.1% were very low-, low-, intermediate- and high-risk tumors, respectively. The rate of positivity was 96.4% for c-Kit, 87.1% for CD34, 96.9% for delay of germination 1 (DOG-1), 8.0% for S-100, 31.0% for smooth muscle actin (SMA) and 5.1% for desmin. However, the prognostic value of each was limited. Multivariate analysis showed that age, tumor size, mitotic index, tumor site, occurrence of curative resection and postoperative imatinib were independent prognostic factors. Furthermore, we found that high-risk patients benefited significantly from postoperative imatinib (P<0.001), whereas intermediate-risk patients did not (P=0.954).
Age, tumor size, mitotic index, tumor site, occurrence of curative resection and postoperative imatinib were independent prognostic factors in patients with GISTs. Moreover, determining whether intermediate-risk patients can benefit from adjuvant imatinib would be of considerable interest in future studies.
我们旨在评估原发性胃肠道间质瘤（GIST）患者的临床病理特征、免疫组化表达及预后因素。
回顾了来自中国四个医疗中心（2001年1月至2015年12月）连续2570例GIST患者的数据。采用Kaplan-Meier法构建生存曲线，并使用Cox回归模型确定独立预后因素。
纳入患者中，1375例（53.5%）为男性，患者年龄范围为18至95岁（中位数为58岁）。肿瘤大多位于胃（64.5%）、小肠（25.1%）和结直肠区域（5.1%）。诊断时，肿瘤大小中位数为4.0（范围：0.1 - 55.0）cm，每50个高倍视野（HPF）的有丝分裂指数中位数为3（范围：0 - 254）。在2168例接受手术切除的患者中，2009例（92.7%）接受了根治性切除。根据改良的美国国立卫生研究院（NIH）分类，极低、低、中、高风险肿瘤分别占21.9%、28.9%、14.1%和35.1%。c-Kit阳性率为96.4%，CD34阳性率为87.1%，抗增殖细胞核抗原Ki-67阳性率为96.9%，S-100阳性率为8.0%，平滑肌肌动蛋白（SMA）阳性率为31.0%，结蛋白阳性率为5.1%。然而，各指标的预后价值有限。多因素分析显示，年龄、肿瘤大小、有丝分裂指数、肿瘤部位、根治性切除的发生情况及术后伊马替尼是独立预后因素。此外，我们发现高危患者术后伊马替尼治疗获益显著（P<0.001），而中危患者则未获益（P = 0.954）。
年龄、肿瘤大小、有丝分裂指数、肿瘤部位、根治性切除的发生情况及术后伊马替尼是GIST患者的独立预后因素。此外，确定中危患者是否能从辅助性伊马替尼治疗中获益将是未来研究中相当值得关注的问题。
