小胃肠间质瘤的临床病理特征  

Clinicopathological features of small gastrointestinal stromal tumors

作　　者：高晓东[1] 薛安慰 方勇[1] 束平[1] 凌佳倩 胡健卫[2] 侯英勇[3] 沈坤堂[1] 秦净[1] 孙益红[1] 秦新裕[1] 

机构地区：[1]复旦大学附属中山医院普通外科,上海200032 [2]复旦大学附属中山医院内镜中心,上海200032 [3]复旦大学附属中山医院病理科,上海200032

出　　处：《中华胃肠外科杂志》2015年第4期338-341,共4页Chinese Journal of Gastrointestinal Surgery

基　　金：上海市科委科研基金（14140902302）

摘　　要：目的：探讨小胃肠间质瘤（小GIST，直径小于2 cm）的临床病理特点。方法回顾性分析上海复旦大学附属中山医院2009年1月至2014年7月经内镜下切除的418例小GIST患者的临床病理资料。利用NIH危险度分级和AFIP分级来评价小GIST的生物学行为；根据肿瘤大小和部位进行分组，比较不同因素的核分裂象和核异型；通过随访资料分析内镜切除的有效性。结果418例小GIST患者中，食管14例（3．3％），胃389例（93．1％），十二指肠5例（1．2％），直肠10例（2．4％）。梭形细胞为主者412例（98．6％），未见核分裂象者320例（76．5％）；389例胃小GIST中，肿瘤位于胃底部者245例（58．6％）。按肿瘤大小分组后，发现肿瘤越大核分裂象越多；1．5～1．9 cm组肿瘤的异型性显著增加；按部位分组后发现，肿瘤部位与核分裂象无关，胃小GIST的细胞异型性显著高于食管（P＝0．004），直肠小GIST的细胞异型性显著高于其他部位来源的小GIST。本组患者随访中位时间为32（4～69）月，1例（0．2％，直径大于或等于1．5 cm 胃底的肿瘤）在术后23月出现局部复发并进行了再次腹腔镜手术切除，其余均未发现复发转移。结论直径小于或等于0．4 cm的小GIST多属良性，可长期随访。直径大于或等于0．5 cm、特别是大于或等于1．5 cm的小GIST以及直肠小GIST（小于或等于0．4 cm除外）的生物学行为较差，存在高危险度或恶性的可能，应进行手术切除。内镜治疗小GIST是有效的。Objective To investigate the clinicopathological features of small gastrointestinal stromal tumors （GISTs） and to evaluate the efficacy of endoscopic therapy for GISTs. Methods Clinicopathological and follow-up data of 418 patients with GISTs undergoing endoscopic therapy in the Zhongshan Hospital between January 2009 and July 2014 were analyzed retrospectively. All the cases were evaluated by the NIH risk classification and AIFP classification , and were grouped according to the tumor size and location. Nuclear atypia and mitotic count were used to evaluate the biological behavior of small GIST. Efficacy of endoscopic therapy was analyzed with follow-up data. Results Out of 418 patients, GISTs located in the esophagus was 14 （3.3%）, in the stomach 389 （93.1%）, in the duodenum 5（1.2%）, in the rectum 10（2.4%）. A total of 412（98.6%） patients were mainly spindle cells, and mitosis was not found in 320（76.5%） patients. In 389 small stomach GIST, 245（58.6%） were in fundic region. Cases were divided into four groups according to the size and the result revealed the bigger the size, the more the mitotic count. Nuclear atypia in the 1.5-1.9 cm group was significantlyhigher compared to other groups. Cases were divided into four groups according to the location and the result revealed the mitotic count was not associated to the location. While the nuclear atypia of stomach GIST was significantly higher than that of esophageal GIST and the nuclear atypia of rectum GIST was significantly higher than that of other positions. The median follow-up was 32（4-69） months. One case （gastric fundus GIST, 〉1.5 cm） presented local recurrence 23 months after operation and underwent endoscopic resection again. No recurrence or metastasis was found in other patients. Conclusions Endoscopic resection technique is effective for small GISTs patients. The small GISTs with 0.4 cm diameter or less are often benign and should be followed up for long time. The small GISTs with 0.5 cm diameter or more poss

关 键 词：胃肠间质瘤 小 生物学行为 内镜治疗 预后 

分 类 号：R735[医药卫生—肿瘤]