小肠间质瘤的临床病理特征分析及预后模型构建  

Clinicopathological features analysis and prognostic model construction of small intestinal stromal tumors

作　　者：单治理 陈鸿[1] 周晓俊[2] SHAN Zhili;CHEN hong;ZHOU Xiaojun(Department of General Surgery,Dushu Lake Hospital of Soochow University(Suzhou Dushu Lake Hospital),Suzhou 215000,China)

机构地区：[1]苏州大学附属独墅湖医院普外科,江苏苏州215000 [2]苏州大学附属第一医院普外科,215008

出　　处：《临床肿瘤学杂志》2023年第8期744-750,共7页Chinese Clinical Oncology

摘　　要：目的通过回顾性分析小肠间质瘤(SIST)患者的一般资料、术前辅助检查、临床表现,病理特征及影响复发和生存的因素,以期提高SIST的诊疗水平。方法分析接受手术切除的原发SIST患者的临床病理特征和辅助检查检出率;应用Kaplan-Meier曲线和Log-rank检验进行生存分析;采用Cox比例风险模型和Logistic回归模型进行多因素分析;绘制Nomogram图及校正曲线检验模型预测能力。结果本研究纳入132例SIST患者,首发症状以腹痛最常见,其次为消化道出血。术前辅助检查中以腹部增强CT检出率最高(阳性率为90.7%)。免疫组化显示CD117和DOG-1阳性率为97.0%和94.7%,CD34阳性率为68.9%,基因检测显示KIT和PDGFR-α突变率分别为91.2%和2.7%。术后口服3年伊马替尼的高危SIST患者的5年复发率、总生存率和无复发生存率分别为15.6%、87.2%和70.7%,5年累积复发率、总生存率和无复发生存率分别为24.2%、81.1%和64.7%。多因素分析结果提示男性、肿瘤最大径>5 cm和核分裂像>5/50 HPF是复发的独立危险因素;年龄和肿瘤最大径>5 cm是影响存活的独立危险因素;而术后口服伊马替尼是复发和生存的保护性因素。结论SIST患者首发症状多为腹痛和消化道出血,首选辅助检查推荐腹部增强CT。男性、肿瘤最大径>5 cm或核分裂像>5/50 HPF的SIST患者更易复发,预后较差。对于高危SIST患者,推荐术后辅助3年伊马替尼治疗,可明显改善预后。年龄>60岁、男性、肿瘤最大径>5cm以及核分裂像>5/50 HPF的SIST患者预后相对更差,应予以重视。Objective To evaluate the general data,preoperative auxiliary exaninations,clinical manifestation,and clinicopathological features and factors affecting recurrence and survival of patients with small intestinal stromal tumor(SIST),as to improve the diagnosis and treatment of SIST.Methods Clinicopathological characteristics and auxiliary examination detection rate of primary SIST patients undergoing surgical resection were analyzed.Kaplan-Meier curve and Log-rank test were performed to conduct survival analysis.Multiple factor analysis was conducted using Cox proportional risk model and logistic regression model.Nomogram diagrams and calibration curves were applied to test the predictive ability of the model.Results In the present study,the most common initial symptom of 132 patients with SIST was abdominal pain and followed by gastrointestinal bleeding.Preoperatively small intestine contrast-enhanced CT check had the highest detection rate(90.7%).Pathological and immunohistochemical staining showed that 97.0% of the patients were CD117 positive and 94.7%of them DOG-1 positive.The expression rate of CD34 in GIST was about 68.9%.KIT and PDGFR-αgene mutation rates were 91.2% and 2.7%.Of the patients belonging to moderate-or high-risk category with 3 years of adjuvant imatinib,the 5-year cumulative rates of recurrence overall survival and relapse-free survival were 15.6%,87.2%and 70.7%,respectively.The 5-year cumulative rate of recurrence was 24.2%.The 5-year overall survival and relapse-free survival rates were 81.1% and 64.7%,respectively.Cox regression analysis indicated that tumor diameter>5 cm and nuclear division>5/50 HPF can be independent risk factors for predicting SIST postoperative adverse outcome.However,postoperative oral imatinib was a protective factor for recurrence and survival.Conclusion SIST can appear a series of clinical manifestations and the most common initial symptom was abdominal pain and followed by gastrointestinal bleeding.Preoperatively small intestine contrast-enhanced CT check has the

关 键 词：小肠间质瘤 临床症状 病理特征 伊马替尼 预后模型 

分 类 号：R735.3[医药卫生—肿瘤]