局限性胃肠道间质瘤危险程度分级标准的应用与评价  

Application and evaluation of biologic potential grading criteria for localized gastrointestinal stromal tumors

作　　者：史恩溢[1] 侯英勇[2] 谭云山[2] 周晓燕[1] 蔡旭[1] 陆永明[1] 朱雄增[1] 

机构地区：[1]复旦大学附属肿瘤医院病理科 [2]复旦大学附属中山医院病理科

出　　处：《中华病理学杂志》2007年第10期649-653,共5页Chinese Journal of Pathology

摘　　要：目的探讨 Fletcher 和 Miettinen 两种分级标准对局限性胃肠道间质瘤(GIST)危险程度的评估效能。方法收集220例有完整临床病理及随访资料的局限性 GIST,应用 Fletcher 和Miettinen 两种分级标准对肿瘤的危险程度进行评估,生存分析比较两种标准在预测肿瘤恶性潜能中的意义。结果该组资料按照 Fletcher 分级标准进行评估,高危组的总生存率和术后无复发、无转移生存率(无病生存率)显著低于极低、低和中危三组,但极低、低和中危三组之间总生存率和无病生存率差异无统计学意义。在高危组中,小肠和直肠 GIST 的总生存率和无病生存率显著低于胃 GIST;而在中危组中,小肠 GIST 的无病生存率显著低于胃 GIST。该组资料按照 Miettinen 分级标准进行评估,高危组的总生存率和无病生存率显著低于极低、低和中危三组,但极低、低和中危三组之间总生存率和无病生存率差异无统计学意义。在极低、低、中和高危各个危险组中,胃、小肠和直肠 GIST 之间总生存率及无病生存率差异均无统计学意义。结论 Fletcher 分级标准简明易用,但 Miettinen 分级标准按不同发病部位评估危险程度能更准确地认识局限性 GIST 的生物学行为,对正确选择高危患者进行靶向辅助治疗具有重要参考价值。Objective To evaluate the implication of Fletcher and Miettinen biologic potential grading criteria in native localized gastrointestinal stromal tumors （GISTs）. Methods Two hundred and twenty localized GISTs with complete clinicopathologic and follow-up data were evaluated for their biologic potential by Fletcher and Miettinen grading criteria. The implication of the two grading criteria were compared by survival analysis. Results Evaluated by Fletcher grading criteria, the overall and disease-free survival rate of high risk GISTs was lower than that of very-low, low and intermediate GISTs; while the overall and disease-free survival rate of very-low, low and intermediate risk GISTs had no statistical diffence. In the high risk GISTs, the overall and disease-free survival rate of small intestinal and rectal GISTs was lower than that of gastric GISTs ; while in the intermediate risk GISTs, the disease-free survival rate of small intestinal GISTs was lower than that of gastric GISTs. Evaluated by Miettinen grading criteria, the overall and disease-free survival rate of high risk GISTs was lower than that of very-low, low and intermediate GISTs; while the overall and disease-free survival rate of very-low, low and intermediate risk GISTs had no statistical difference. In the risk subgroup of GISTs, the overall and disease-free survival rate of gastric, small intestinal and rectal GISTs had no statistical difference. Conclusions Fletcher grading criteria is simple and easy to use; while Miettinen grading criteria for evaluating biological potential by anatomic site is more critical and has important reference implication for the selection of high risk patients for targeted adjuvant treatment.

关 键 词：胃肠道间质肿瘤 危险性评估 预后 

分 类 号：R735[医药卫生—肿瘤]