Lee J S, Nascimento A G, Farnell M B, Carney J A, Harmsen W S, Ilstrup D M
Division of Gastroenterologic and General Surgery, Mayo Clinic, Rochester, MN 55905, USA.
Surgery. 1995 Oct;118(4):653-60; discussion 660-1. doi: 10.1016/s0039-6060(05)80032-7.
Epithelioid gastric stromal tumors form a distinct histologic subset of gastric tumors whose malignant potential and prognosis are controversial.
Fifty-five patients with epithelioid gastric stromal tumors accounted for 11.5% of patients undergoing definitive operations for gastric stromal tumors from 1960 to 1986. Medical records and pathology slides were reviewed, and immunohistochemical staining and flow cytometry were performed. The Kaplan-Meier method was used to estimate survival. Survival curves were compared with log-rank tests and Cox proportional hazards model.
Of the 55 tumors, 40 were benign and 15 (27%) were malignant. Mean follow-up was 10.5 years. Ten patients died of their disease. No patient with a benign tumor had recurrence of metastasis, but all patients with high-grade malignancy had died of disease within 3 years after diagnosis. Seventy-five percent of proximal tumors were malignant. Extent of resection had no impact on survival (p = 0.5).
The best determinant of tumor behavior was histologic grade. Twenty-seven percent of patients had malignant tumors, and 67% of these died of disease. Other significant prognostic factors included a mitotic count greater than 5/10 high-power fields, size larger than 6 cm, aneuploidy, and higher S-phase fraction (p < 0.01). Proximal lesions were more likely to be malignant. Extent of surgical treatment had no effect on survival.
上皮样胃间质瘤是胃肿瘤中一个独特的组织学亚群，其恶性潜能和预后存在争议。
55例上皮样胃间质瘤患者占1960年至1986年因胃间质瘤接受确定性手术患者的11.5%。回顾病历和病理切片，并进行免疫组化染色和流式细胞术检测。采用Kaplan-Meier法估计生存率。生存曲线采用对数秩检验和Cox比例风险模型进行比较。
55例肿瘤中，40例为良性，15例（27%）为恶性。平均随访10.5年。10例患者死于疾病。良性肿瘤患者无复发转移，但所有高级别恶性肿瘤患者在诊断后3年内均死于疾病。75%的近端肿瘤为恶性。切除范围对生存率无影响（p = 0.5）。
肿瘤行为的最佳决定因素是组织学分级。27%的患者患有恶性肿瘤，其中67%死于疾病。其他重要的预后因素包括有丝分裂计数大于5/10高倍视野、肿瘤大小大于6 cm、非整倍体和较高的S期分数（p < 0.01）。近端病变更易发生恶变。手术治疗范围对生存率无影响。
