胃肠间质瘤的病理特征及与预后的相关性  

Correlation between pathological features and prognosis of patients with gastrointestinal stromal tumor

作　　者：叶海主 何连君 刘晓平[1] 赵文英[1] YE Hai -zhu et al(Department of Medical Oncology, The first Affiliated Hospital of Wannan Medical College, Wuhu 241001, China)

机构地区：[1]皖南医学院弋矶山医院肿瘤内科,安徽芜湖241001

出　　处：《牡丹江医学院学报》2017年第4期1-5,共5页Journal of Mudanjiang Medical University

摘　　要：目的分析胃肠间质瘤(GIST)的临床病理特征并研究其与预后的相关性。方法收集本院2012年1月至2013年1月经病理确诊为GIST的病例44例,回顾性研究GIST患者临床病理特征并使用单因素和多因素生存分析这些临床病理特征对GIST患者预后的影响。结果病灶可位于黏膜下层、肌层、浆膜外及肠系膜,腔内或腔外生长,无包膜或假包膜,以类圆形居多,高度侵袭危险性者常伴出血、坏死、囊性变;镜下梭形细胞型占88.64%例(39/44),上皮样细胞型占9.09%例(4/44)、混合型占2.27%例(1/44);免疫组化显示CD117、CD34和DOG1表现出高表达的特点,分别为90.01%(40/44)、77.27%(34/44)、95.45%(42/44);Desmin、SMA、S-100和Ki-67的表达阳性率分别为31.82%(14/44)、13.64%(6/44)、6.82%(3/44)和9.09%(4/44);单因素分析表明肿瘤大小、核分裂数、NIH危险分度、手术方式和是否接受甲磺酸伊马替尼治疗是影响GIST患者生存率的危险因素,3年生存率比较差异有统计学意义(P<0.05);多因素生存分析可见肿瘤大小、核分裂数、NIH危险分度是影响患者预后的独立危险因素。结论 GIST患者癌细胞多以梭形细胞为主,CD117、CD34和DOG1的检测对GIST的诊断具有重要意义,肿瘤大小、核分裂数、NIH危险分度是影响其预后的独立危险因素。Objective To analyze the clinicopathologic features of gastrointestinal stromal tumors （GIST） and to study its corre- lation with prognosis. Methods To analyze the clinicopathologic features of gastrointestinal stromal tumors （GIST） and to study its correlation with prognosis. Results The lesions of patients with GIST could be located in the submucosa, muscularis, tunica serosa and mesentery. The lesions were most in the round, and the mass had no envelope or pseudo capsule, the growth of lesions were to the outside of the film or in the digestive cavity. A few lesions had cystic change, necrosis and hemorrhage. Under the microscope, spindle cell type accounted for 88.64% cases （39/44） , epithelioid cell type 9.09% cases （4/44） , 2.27% cases of mixed type （1/44）. Im- munohistoehemical results showed that CD117, CD34 and DOG1 showed higher expression, 90.01% （40/44） , 77.27 % （34/44） , 95.45% （42/44） respectively. The positive expression rate of Desmin, SMA, S - 100 and Ki -67 were 31.82% （ 14/44）, 13.64% （6/44） , 6.82% （3/44） and 9.09% （4/44） , respetively. Single factor analysis results showed there were significant differences in survival rates of different tumor size, number of nucleus division, NIH risk of malignant degree , selection of operation mode and whether to accept imatinib mesylate in the treatment of patients with 3 years （ P 〈 0.05 ）. Multivariate regression analysis showed that different tumor size, number of nucleus division, NIH risk of malignant degree were the independent influence factors of prognosis of patients. Conclusion In GIST patients, most of the cancer cells were spindle cells, and the expression of CDl17, CD34 and DOG1 was of great significance in the diagnosis of GIST. The tumor size, the number of nucleus division, and the NIH risk of malignant de- gree were independent risk factors for the prognosis.

关 键 词：胃肠间质瘤 CD117 CD34 DOG1 预后 

分 类 号：R73[医药卫生—肿瘤]