极低与低危险度胃肠间质瘤的病理及预后分析  

Analysis of pathological characteristics and prognosis for very low-and low-risk gastrointestinal stromal tumors

作　　者：刘莎莎 孙琳 李佳鑫 赵帅 刘慧敏 梁寒 孙燕 Shasha Liu;Lin Sun;Jiaxin Li;Shuai Zhao;Huimin Liu;Han Liang;Yan Sun(Department of Pathology,Tianjin Medical University Cancer Institute&Hospital,National Clinical Research Center for Cancer,Tianjin Key Laboratory of Digestive Cancer,Tianjin's Clinical Research Center for Cancer,Tianjin 300060,China;Department of Gastric Surgery,Tianjin Medical University Cancer Institute&Hospital,National Clinical Research Center for Cancer,Tianjin Key Laboratory of Digestive Cancer,Tianjin's Clinical Research Center for Cancer,Tianjin 300060,China)

机构地区：[1]天津医科大学肿瘤医院病理科,国家恶性肿瘤临床医学研究中心,天津市恶性肿瘤临床医学中心,天津市消化系统肿瘤重点实验室,天津市300060 [2]天津医科大学肿瘤医院胃部肿瘤科,国家恶性肿瘤临床医学研究中心,天津市恶性肿瘤临床医学中心,天津市消化系统肿瘤重点实验室,天津市300060

出　　处：《中国肿瘤临床》2024年第11期541-546,共6页Chinese Journal of Clinical Oncology

基　　金：国家自然科学基金项目(编号:81871990);天津市医学重点学科(病理学)建设项目(编号:TJYXZDXK-012A);天津市肿瘤研究所“肿瘤防治研究十四五专项计划”项目(编号:YZ-06)资助。

摘　　要：目的分析极低、低危险度胃肠间质瘤(gastrointestinal stromal tumors,GISTs)患者的预后情况及临床病理特征和基因突变特点。方法回顾性收集2011年1月至2020年12月于天津医科大学肿瘤医院经手术或内镜切除并经病理确诊的433例极低、低危GIST,进行病理和预后分析。结果与低危GIST相比,极低危GIST中胃部GIST、Ki-67指数≤3%、核分裂象0~1个/5 mm2的患者所占比例较高,而小肠GIST所占比例较低(均P<0.05)。118例进行了基因检测,极低危GIST与低危GIST的突变类型及KIT突变类型比较无显著性差异(均P>0.05)。对无其他伴发疾病的87例极低危和210例低危GIST病例进行随访,中位随访时间为86(27~158)个月。全部极低危GIST患者均未发现进展;3例低危GIST发现复发/转移,无进展生存期(progression-free survival,PFS)为27~84个月。此3例原发肿瘤的核分裂象均为4个/5 mm2,接近低与中危险度GIST核分裂象的临界值,均检测到KIT exon11突变;首次进展后经伊马替尼治疗,在随访结束时均生存,总生存期(overall survival,OS)为116~155个月。结论在低危险度GIST患者中,极少数核分裂象偏高的患者存在复发/转移的可能性,但复发/转移后通过靶向治疗、手术等治疗手段,仍可维持长时间、高质量的生存。极低危GIST患者术后进展的可能性极小,可适当延长随访间隔时间,以减少医疗成本、减轻患者和家属的心理负担。Objective To analyze the prognosis,clinicopathological characteristics,and genetic mutation features of patients with very low-and low-risk gastrointestinal stromal tumors(GISTs).Methods A retrospective data collection of 433 patients with very low-and low-risk GISTs,diagnosed by pathology after surgical or endoscopic resection at Tianjin Medical University Cancer Institute&Hospital,was conducted to analyze clinical pathology and prognosis.Results Compared with low-risk GIST,a higher proportion of patients with very low-risk GIST had gastric GISTs,a Ki-67 index≤3%,and 0–1 mitotic indexes/5 mm²,whereas the proportion of patients with small intestinal GIST was low(all P<0.05).Genetic testing was performed in 118 patients,and there was no significant difference in the mutation types and KIT mutation types between low-risk and very low-risk GISTs(all P>0.05).Patient follow-up was conducted on 87 very low-risk and 210 low-risk GIST patients without other concurrent diseases,with a median follow-up of 86(27–158)months.None of the patients with very low-risk GISTs showed progression;three cases of low-risk GIST had recurrence or metastasis,with progression-free survival(PFS)ranging from 27 to 84 months.The mitotic indices of the primary tumors in these three patients were all 4/5 mm²,which is close to the critical value between the low-and intermediate-risk GIST mitotic indices,and all had KIT exon11 mutations.After the first progression,these three patients were treated with imatinib,and all survived until the end of follow-up,with overall survival ranging from 116 to 155 months.Conclusions Among patients with low-risk GISTs,a very small number with high mitotic indices may have the potential for recurrence or metastasis,but after recurrence or metastasis,they can still maintain long-term,high-quality survival through targeted therapy,surgery,and other treatment methods.The possibility of postoperative progression in very low-risk patients with GIST is extremely low,and the follow-up interval can be appropriate

关 键 词：胃肠间质瘤 极低危险度 低危险度 预后 监测 

分 类 号：R735[医药卫生—肿瘤]