超声内镜下胃肠道间质瘤征象与Ki-67指数的相关性  

CORRELATION BETWEEN ENDOSCOPIC ULTRASONOGRAPHY SIGNS AND KI-67 INDEX IN GASTROINTESTINAL STROMAL TUMOR

作　　者：杨雪莲[1] 刘华[1] 李航[1] 李晓宇[1] 徐永红[1] YANG Xuelian;LIU Hua;LI Hang;LI Xiaoyu;XU Yonghong(Department of Gastroenterology,The Affiliated Hospital of Qingdao University,Qingdao 266003,China)

机构地区：[1]青岛大学附属医院消化内科,山东青岛266003

出　　处：《青岛大学学报（医学版）》2022年第4期535-539,共5页Journal of Qingdao University(Medical Sciences)

基　　金：国家自然科学基金青年科学基金项目(81802777)。

摘　　要：目的探讨超声内镜(EUS)征象、Ki-67指数对评估上消化道胃肠道间质瘤(GIST)恶性潜能的价值。方法收集196例原发性上消化道GIST病人EUS征象、临床病理及免疫组化资料,探讨Ki-67指数与危险分层的关系、EUS征象与Ki-67指数的关系。应用R软件构建可预测Ki-67指数的列线图模型,并用受试者工作特征(ROC)曲线和校正曲线评价模型的预测价值。结果Ki-67指数与GIST核分裂象数、肿瘤直径和危险分层呈正相关(r=0.259~0.373,P<0.05)。不同Ki-67分组EUS下GIST回声不均匀( χ^(2)=4.482,P<0.05)、有无液化( χ^(2)=18.920,P<0.01)和有无表面溃疡( χ^(2)=18.912,P<0.01)差异有显著性。二元logistic回归分析示,肿瘤直径(OR=1.045,95%CI=1.011~1.080,P<0.05)、液化(OR=3.219,95%CI=1.116~9.287,P<0.05)、表面溃疡(OR=3.009,95%CI=1.094~8.275,P<0.05)为预测Ki-67表达的独立危险因素。基于肿瘤直径、表面溃疡和液化构建的预测Ki-67表达的列线图模型的ROC曲线下面积(AUC)为0.739(95%CI=0.619~0.858)。结论Ki-67指数可用于评估GIST的危险分层;基于GIST的EUS征象建立的列线图模型可较好地预测其Ki-67表达,为术前评估GIST的恶性潜能提供参考。Objective To explore the value of endoscopic ultrasonography(EUS)signs and Ki-67 index in assessing the malignant potential of gastrointestinal stromal tumor(GIST)in the upper gastrointestinal tract.Methods The EUS signs,and clinicopathological and immunohistochemical data of 196 patients with primary GIST in the upper gastrointestinal tract were collected.The relationships between Ki-67 index and risk stratification and between EUS signs and Ki-67 index were explored.A nomogram model for predicting Ki-67 index was constructed by the R software,and the predictive value of the model was evaluated by the receiver operating characteristic(ROC)curve and the calibration curve.Results Ki-67 index was positively correlated with the mitotic index,tumor diameter,and risk stratification of GIST(r=0.259-0.373,P<0.05).There were significant diffe-rences in echo heterogeneity( χ^(2)=4.482,P<0.05),liquefaction( χ^(2)=18.920,P<0.01),and superficial ulceration( χ^(2)=18.912,P<0.01)of GIST on EUS between Ki-67 groups.The binary logistic regression analysis revealed that tumor diameter(OR=1.045,95%CI=1.011-1.080,P<0.05),liquefaction(OR=3.219,95%CI=1.116-9.287,P<0.05),and superficial ulceration(OR=3.009,95%CI=1.094-8.275,P<0.05)were independent risk factors for predicting Ki-67 expression.In the ROC curve of the nomogram model constructed for predicting Ki-67 expression based on tumor diameter,superficial ulceration,and liquefaction,the area under the curve was 0.739(95%CI=0.619-0.858).Conclusion Ki-67 index can be used to assess the risk stratification of GIST,and the nomogram model based on the EUS signs can better predict the expression of Ki-67 in GIST,which provides a reference for the preoperative assessment of malignant potential of GIST.

关 键 词：胃肠道间质肿瘤 KI-67抗原 腔内超声检查 列线图 

分 类 号：R735[医药卫生—肿瘤]