胃肠道基质细胞瘤临床诊治和预后  

Treatment and prognostic factors of gastrointestinal stromal tumors

作　　者：方孙阳[1] 俞学军[1] 董怡民[1] 陈新创 罗衡桂[1] 朱春芳[1] 

机构地区：[1]中国医科大学绍兴华宇医院普通外科,浙江绍兴312000 [2]浙江省绍兴市第五人民医院,浙江绍兴312000

出　　处：《中国普通外科杂志》2006年第2期137-139,共3页China Journal of General Surgery

摘　　要：目的探讨胃肠道基质细胞瘤的临床诊断、治疗和预后。方法回顾性分析1 9 9 5—2 0 0 5年收治的3 1例胃肠道基质细胞瘤临床和病理资料。结果根据Fletcher风险分级,极低风险3例,低风险5例,中风险1 5例,高风险8例。CD 1 1 7,CD 3 4,desm in,SMA,S-1 0 0蛋白阳性表达率分别为93.5%,8 7.1%,3 8.7%,3 5.5%,2 5.8%,其阳性表达率与肿瘤危险程度无关(χ2=0.3 5,0.1 2,0.03,0.0 5,0.0 1,均P>0.0 5)。肿瘤是否浸润黏膜肌层或浆膜层与肿瘤危险程度相关(χ2=4.87,P<0.05)。结论用Fletcher分级对胃肠道基质瘤分级评价更为科学合理。中、高危险程度者复发率26.0%,明显高于极低和低风险者(P<0.0 0 1)。根治性手术是治疗胃肠道基质瘤最佳选择。肿瘤浸润黏膜肌层或浆膜层是危险的重要指标。核分裂相是判断预后的独立预后因素。Objective To study the clinical manifestations, diagnosis , treatment and prognosis of gastrointestinal stromal tumors （ GISTs ）. Methods Clinical and pathological data of 31 cases of GISTs admitted from 1995 to 2005 were retrospectively studied. Results Using Fletcher＇s classification , tumors were divided in very low risk（3/31,9. 68%） , low risk （5/31,16. 13%） , intermediate risk （15/ 31,48. 39% ） , and high risk （ 8/31 , 25. 81% ）. The positive expression rate of CD117 , CD34, desmin,SMA and S-100 protein was 94%, 87%, 39%, 35% 26%, respectively. There was no significant difference in the expression of CDll7, CD34, desnin, SMA and S-100 protein among all the different risk groups （ X^2 = 0.35 , 0. 12,0.03,0.05 , 0.01 , P 〉 0.05 ）. The infiltration of tumor to the muscularis mucosa or serosa layers was significantly correlated with the risk of GISTs （ X^2 = 4. 87 , P 〈 0. 05 ）. Conclusions Fletcher＇s classification is scientific and rational for assessment of the stage of GISTs. Recurrence rate of intermediate risk and high risk cases was 26.0% which was much higher than that of very low risk and low risk case （ P 〈 0.001 ）. Complete surgical excision of the GISTs is the best choice for cure. The infiltration of tumor to the muscularis mucosa or serosa layers is an important indicator of the risk of GISTs. Mitotic rate is an independent factor that may predict the prognosis of GISTs.

关 键 词：胃肠肿瘤/诊断 基质瘤/诊断 预后 

分 类 号：R735[医药卫生—肿瘤] R730.262[医药卫生—临床医学]