108例胃肠道间质瘤患者复发转移危险因素分析

目的探讨胃肠道间质瘤(gastrointestinal stromal tumor,GIST)复发转移危险因素。方法回顾性分析108例经手术证实的GIST患者的临床资料,并分析影响其复发转移的危险因素。结果 108例患者4年累计复发转移率为29.63%,单因素分析显示肿瘤大小、核分裂象数、肿瘤原发部位、术后服用伊马替尼、Ki67指数与GIST复发转移有关(P0.05),多因素分析显示肿瘤大小、核分裂象数、肿瘤原发部位、术后服用伊马替尼是影响GIST复发转移的独立危险因素。结论肿瘤大小、核分裂象、肿瘤原发部位是GIST复发转移的独立危险因素,术后伊马替尼分子靶向治疗可明显降低GIST复发转移风险。     

原发局限性小肠间质瘤患者的临床特征及预后分析

目的 回顾性分析影响原发局限性小肠间质瘤预后的临床因素.方法 收集并回顾分析瑞金医院2003年1月至2007年9月收治并经手术完全切除的89例原发性小肠间质瘤患者病例的临床及病理资料.随访术后肿瘤复发情况.分析各临床及病理因索对患者无病生存率的影响.结果89例患者均完成随访.15例患者术后肿瘤复发,其中9例因肿瘤复发死亡.Kaplan-Meier 单因素生存分析表明,肿瘤大小、肿瘤核分裂象数和肿瘤生物侵袭危险程度分级与患者无病生存期相关(P值分别=0.000、0.006和0.000).COX多因素回归分析证实,肿瘤大小和肿瘤核分裂象数是影响患者无病生存期的独立预后因素.结论 肿瘤大小、肿瘤核分裂象数和肿瘤生物侵袭危险程度分级与小肠间质瘤复发相关.肿瘤大小和肿瘤核分裂象数对预测小肠间质瘤复发具有一定的临床价值.     

胃肠道间质瘤患者术后复发的影响因素分析

目的探讨胃肠道间质瘤（GIST）手术治疗后复发的影响因素,为术后治疗方案制定、降低患者的复发率提供理论依据。方法对42例GIST患者进行随访,分析影响术后复发的相关因素。结果肿瘤直径、肿瘤坏死、浸润生长、核分裂相数目、手术方式及使用甲磺酸伊马替尼（格列卫）辅助治疗对复发率有显著影响（P〈0．05）。结论肿瘤浸润生长、核分裂相数目、手术方式及使用格列卫辅助治疗是影响GIST患者术后复发的独立因素。     

胃肠间质瘤个体化治疗策略的探讨

胃肠间质瘤（GIST）是最常见的胃肠道间叶源性肿瘤，多见于胃和小肠，GIST多具有恶性潜能，生物学行为可以从良性到高度恶性不等。GIST的预后与肿瘤的发病部位、瘤体大小、核分裂数以及肿瘤是否破裂密切相关，伊马替尼辅助治疗明显延长了GIST患者的生存时间。近年对于GIST患者实施个体化治疗的理念也得到了越来越多的重视，本文就GIST个体化治疗的策略研究进行阐述。     

胃肠道间质瘤临床病理特征和预后因素分析

背景：胃肠道间质瘤（GISTs）是胃肠道间叶细胞肿瘤，过去常被诊断为胃肠道平滑肌瘤或神经鞘瘤。目的：探讨GIST的临床病理特征和预后因素。方法：回顾性分析143例GIST患者的临床病理资料，以及其中131例患者的随访资料，分析临床病理因素与预后的关系。结果：143例GIST中，恶性占71．3％，交界性和良性分别占23．8％和4．9％。免疫组化检测结果显示，CDll7和CD34的阳性表达率分别为91．6％和85．3％。患者总体1、3、5年生存率分别为90．8％、74．0％和54．6％；恶性患者的5年生存率显著低于交界性和良性患者（44．0％对88．9％和100％，P〈0．01）；接受根治性切除术者的术后5年生存率显著优于局部肿瘤切除者（67．9％对38．5％，P〈0．01）。多因素生存分析表明，肿瘤大小、细胞核分裂像、肿瘤性质和手术方式是GIST的独立预后因素（P〈0．05）。结论：加强对GIST的认识，正确诊断，合理采用手术治疗，对改善GIsT患者的预后有着深远的意义。     

胃肠道间质瘤患者生存和预后因素综合分析

目的 探讨影响胃肠道间质瘤(GIST)患者生存和预后的因素.方法 复阅153例患者切片,以免疫组化法检测CD117、CD34、血小板衍生生长因子受体-α和Ki-67蛋白表达,结合临床病理特征和GIST生物学行为分级,分析影响GIST患者生存和预后的相关因素.采用卡普兰一迈耶(Kaplan Meier)法和Cox比例风险模型比较不同因素对生存的影响.结果 患者1、3、5年生存率分别为94.1%、7 6.3%和6 5.9%.单因素分析显示,患者预后与肿瘤直径(χ2=40.5 6 5,P＜0.01)、肿瘤部位(χ2=13.245,P＜0.01)、核分裂象数目(χ2=22.6 26,P＜0.01)、危险度分级(χ2=19.186,P＜0.01)、肿瘤有无坏死(χ2=28.6 6 5,P＜0.01)、手术方式(χ2 9.110,P＜0.01)和Ki 6 7指数(χ2=1 5.9 5 3,P＜0.01)有关.多因素分析表明,肿瘤直径＞10 cm、位于肠道、核分裂象数目＞10/50 HPF、危险度分级属高度危险性、肿瘤有坏死及Ki 6 7指数＞5%与预后呈明显负相关.且Ki 6 7指数、肿瘤大小及核分裂象数目是GIST预后的强预告因子.结论 GIST生物学行为分级法对评价GIST患者预后具有较好的临床价值;判断GIST患者预后需结合Ki-67指数和肿瘤部位等因素,为治疗提供依据.     

胃肠间质瘤诊断及外科治疗分析（附95例报告）

目的观察胃肠间质瘤（GIST）的诊断及外科治疗效果。方法回顾性分析1993—2002年收治的59例胃肠道平滑肌肿瘤患者和2003—2007年收治的49例GIST患者的临床资料。结果诊断为胃肠道平滑肌瘤或平滑肌肉瘤的59例中有46例（78．0％）被纠正诊断为GIST。95例GIST患者均行手术治疗,行肿瘤完全切除术78例;术后总体58生存率为79．7％。完全切除术后无病生存率与首诊已有转移和核分裂数有关（P〈0．01）。结论既往（2002年以前）诊断的胃肠平滑肌肿瘤大部分应纠正诊断为GIST。治疗GIST应以手术治疗为主,首诊肿瘤转移和核分裂数是独立的预后因素。     

125例结直肠癌患者预后因素分析

目的探讨影响结直肠癌预后的因素。方法回顾性分析125例结直肠癌患者的临床及病理资料。用Kaplan—Meier法计算生存期并绘制生存曲线,分析性别、年龄、原发部位、组织类型、原发肿瘤的浸润深度（T）、区域淋巴结转移（N）、远处转移（M）、癌胚抗原（CEA）、肝功能指标等与预后的关系,Cox回归模型行多因素预后分析。结果125例患者中5例失访,19例存活,101例死亡。总生存期为2—108个月,1、3、5年生存率分别为82．1％、50。4％、25．2％,中位生存期为36个月。组织类型、区域淋巴结转移、远处转移、Duke’s分期、CEA及总蛋白与预后密切相关,肿瘤部位与预后无显著相关性。结论影响结直肠癌患者预后的主要因素为区域淋巴结转移、远处转移、肿瘤组织类型、血清CEA与总蛋白水平。     

原发性胃肠道间质瘤病例与预后分析

目的 分析胃肠道间质瘤(GIST)的临床特征、治疗效果及手术方式和伊马替尼辅助治疗对预后的影响.方法 回顾性分析2004年1月至2010年4月收治的214例原发性GIST患者的临床资料.比较手术方式和伊马替尼对GIST患者生存情况的影响.计数资料采用x2检验,生存率比较采用寿命表法和Kaplan-Meier曲线计算.结果 214例GIST患者1、3、5年的生存率分别为93.0％、87.0％、80.0％;按美国国立卫生署(NIH)风险分级比较术后生存率差异有统计学意义(x2=22.058,P＜0.05);不同核分裂象数生存率比较差异有统计学意义(x2=26.599,P＜0.05),核分裂象数＞10/50高倍视野者生存率最低;胃肠道内GIST患者生存率高于胃肠道外GIST患者,差异有统计学意义(x2=68.139,P＜0.05);完整切除肿瘤后局部复发患者生存率高于广泛复发者,差异有统计学意义(x2=4.409,P＜0.05);完整切除肿瘤后服用伊马替尼组生存率明显高于未服用伊马替尼组.结论 GIST仍以外科治疗为主,手术完整切除肿瘤和术后服用伊马替尼可改善患者预后,提高生存率.     

丝切蛋白1在胃肠道间质瘤组织中的表达及其临床意义

[目的]探究丝切蛋白1(cofilin-1)在胃肠道间质瘤(GIST)组织中的表达水平与临床指标间的相关性。[方法]选取96例GIST患者术后病理切片组织进行免疫组化染色,检测其中cofilin-1的表达水平,结合临床数据及病理结果,分析cofilin-1与GIST组织临床指标间的相关性。[结果]96例GIST患者年龄、性别及肿瘤发生部位与cofilin-1的表达均无显著相关(P0.05);GIST患者肿瘤浸润深度、肿瘤直径、病理性核分裂象及其危险度分级与cofilin-1的表达呈正相关(P0.05,r0);GIST患者肿瘤浸润深度、肿瘤直径、病理性核分裂象及其危险度分级均为cofilin-1表达的危险因素,差异均有统计学意义(P0.05,OR1),其中肿瘤浸润深度及其危险度分级皆为cofilin-1表达的独立危险因素,差异均有统计学意义(P0.05,OR1)。[结论]cofilin-1的表达与GIST的浸润深度、肿瘤大小、病理性核分裂象及其危险度分级呈正相关,其中肿瘤浸润深度及其危险度分级为独立危险因素,cofilin-1有望成为预示GIST的发生、进展、转移以及评估其预后的生物标志物以及崭新的诊疗靶标。     

Long-Term Surgical Outcome of 1057 Gastric GISTs According to 7th UICC/AJCC TNM System: Multicenter Observational Study From Korea and Japan

The aim of this study was to evaluate the treatment and prognosis of gastric gastrointestinal stromal tumors (GISTs) according to the 7th UICC/AJCC tumor-node-metastasis (TNM) system and the modified National Institutes of Health (NIH) risk classification. The study cohort consisted of 1057 patients with gastric GIST who underwent surgery between January 2000 and December 2007 from 13 institutions in Korea and 2 in Japan. Clinicopathologic characteristics, surgical outcomes, recurrence, and 5-year recurrence-free survival were evaluated.The mean age of the patients was 58.6 years. Thirty patients (2.8%) had distant metastasis preoperatively. Median tumor size was 4.0 cm. Complete resection (R0 resection) was achieved in 1018 patients (96.3%). Eighty-six patients (8.1%) had postoperative complications, and 2 patients (0.2%) died within 30 days after surgery. According to the 7th UICC/AJCC TNM system, 5-year recurrence-free survival rates were 95% to 99% in stage I, 94.1% in stage II, 74.1% in stage IIIA, 48.6% in stage IIIB, and 50.0% in stage IV patients. On survival analysis of high-risk patients according to the TNM system, the 5-year recurrence-free survival rates were 91.6% in stage II, 74.1% in stage IIIA, and 48.6% in stage IIIB patients. Independent factors of recurrence following surgery for gastric GIST were gender, tumor size, mitotic count, and radicality on multivariate analysis.The treatment outcome and prognosis of gastric GIST in Korea and Japan seem more favorable compared to those in Western countries. Compared to the modified NIH risk classification, the 7th UICC/AJCC TNM system is more reflective of the 5-year recurrence-free survival of patients with gastric GIST.     

Prognosis and prognostic factors of papillary thyroid carcinoma in patients under 20 years

Age is an important prognostic factor of papillary thyroid carcinoma (PTC). In this study, we investigated the prognosis and prognostic factors of PTC in patients younger than 20 years. We enrolled 110 patients who underwent initial surgery at Kuma Hospital between 1987 and 2008. Tumor size > 4 cm, metastatic node ≥ 3 cm, and significant extrathyroid extension were more frequently detected in 8 patients with distant metastasis at diagnosis than in 102 patients without distant metastasis. Ten- and 20-year lymph node recurrence-free survival (LN-RFS) and distant recurrence-free survival (DRFS) rates were 84 and 80%, and 95 and 89%, respectively. Metastatic node ≥ 3 cm, age ≤ 16 years, tumor size > 4 cm, and male gender affected LN-RFS, and the former two had an independent prognostic value in multivariate analysis. Metastastic node ≥ 3 cm, significant extrathyroid extension, age ≤ 16 years, tumor size > 4 cm, and a male gender predicted a poor DRFS, and the former two were independent prognostic factors. To date, only 2 patients have died of PTC. These findings suggest that, in the subset of PTC patients younger than 20 years, metastatic node ≥ 3 cm, significant extension, and age ≤ 16 were important signs of aggressiveness of carcinoma, and careful treatment is necessary for patients with these characteristics, although the cause-specific survival was excellent.     

老年患者胃肠道间质瘤预后因素分析

目的 探讨老年胃肠道间质瘤(GIST)预后相关的临床及病理因素. 方法 根据Kaplan-Meier 法和Cox比例风险模型对收集到的44例GIST老年患者的预后与相关临床及病理因素进行回顾性评估分析.结果 根据Kaplan-Meier法单因素分析得知GIST的预后与肿瘤的生长部位、大小、核分裂像,以及GIST的生物学行为分级标准有关.根据多因素分析Cox比例风险模型得知肿瘤的大小、核分裂像、GIST的生物学行为分级标准是独立的预后因素. 结论 老年GIST患者的预后分析帮助制定患者的治疗策略,并有利于消除影响预后的危险因素.     

Clinical manifestations and prognostic factors in patients with gastrointestinal stromal tumors

AIM: To investigate the incidence of CD117-positive immunohistochemical staining in previously diagnosed gastrointestinal (GI) tract stromal tumors (GIST) and to analyze the tumors‘ dinical manifestations and prognostic factors. METHODS: We retrospectively reviewed 91 cases with a previous diagnosis of GI stromal tumor, leiomyoma, or leiomyosarcoma. Tissue samples were assessed with CDl17, CD34, SMA and Sl00 immunohistochemical staining. Clinical and pathological characteristics were analyzed for prognostic factors. RESULTS: CDl17 was positive in 81 (89%) of 91 tissuesamples. There were 59 cases (72.8%) positive for CD34, 13 (16%) positive for SMA, and 12 (14.8%) positive for S100. There was no gender difference in patients with CD117-positive GIST. Their mean age was 65 years. There were 44 (54%) tumors located in the stomach and 29 (36%) in the small intestine. The most frequent presenting symptoms were abdominal pain and GI bleeding. The mean tumor size was 7.5±5.7 cm. There were 35 cases (43.2%) with tumors >5 cm. The tumor size correlated significantly with tumor mitotic count and resectability. Tumor size, mitotic count, and resectability correlated significantly with tumor recurrence and survival. There was recurrent disease in 39% of our patients, and their mean survival after recurrence was 16.6 months. Most recurrences were at the primary site or metastatic to the liver. Twenty-six percent of our patients died of their disease.CONCLUSION: Traditional histologic criteria are not specific enough to diagnose GIST. This diagnosis must be confirmed with CDl17 immunohistochemical staining. Prognosis is dependent on tumor size, mitotic count, and resectability.     

Elevated (> or = 10%) MIB-1 proliferative index correlates with poor outcome in gastric stromal tumor patients: a study of 35 cases

Mitotic activity and tumor size are currently regarded as the most powerful prognostic indicators for patients with gastrointestinal stromal tumor (GIST). This retrospective study evaluated the prognostic accuracy of MIB-1 proliferative index (PI) in combination with these two indicators in 35 GIST patients. Within a high-risk group, determined initially by tumor size and mitotic count, overall survival was significantly shorter for patients whose tumors had PI 10% MIB-1 positive cells. When tumor location (gastric versus small intestine) was taken into account, a combination of tumor size, mitotic count, and PI 10% identified a subgroup of patients with significantly shorter survival for gastric (but not small intestinal) GIST. Based on our results, MIB-1 immunostaining, when used in combination with tumor size and mitotic count, appears to be a powerful tool for identifying patients, especially those with gastric tumors, at high risk of recurrence and early tumor-related death.     

SLITRK3 expression correlation to gastrointestinal stromal tumor risk rating and prognosis

AIM: To assess the influence of SLIT and NTRK-like family member 3 (SLITRK3) on the prognosis of gastrointestinal stromal tumor (GIST) and determine whether SLITRK3 can help improve current risk stratification systems.METHODS: We hypothesized that SLITRK3 could be used as a prognostic molecular biomarker for GIST. 35 fresh tumor samples and 417 paraffin-embedded specimens from GIST patients were utilized. SLITRK3 mRNA expression in GIST tumor tissue was detected by real-time polymerase chain reaction, and SLITRK3 protein levels were estimated by immunohistochemistry. The correlation of SLITRK3 expression with various tumor clinicopathological characteristics and follow-up data were analyzed.RESULTS: GIST tumors had high expression of SLITRK3 compared with adjacent normal tissues and the expression level gradually increased with risk grade. SLITRK3 protein expression was closely associated with gastrointestinal bleeding, tumor site, tumor size, mitotic index, and National Institutes of Health (NIH) classification. Survival analysis showed that SLITRK3 expression was closely correlated with overall survival and disease-free survival of GIST patients. Multivariate analysis also identified SLITRK3 expression, mitotic index, and NIH stage as significant risk factors of GIST recurrence.CONCLUSION: SLITRK3 expression is a highly significant predictor of GIST recurrence and metastasis. Combinations of SLITRK3 and NIH stage have strong predictive and prognostic value, and are feasible markers for clinical practice in gastrointestinal stromal tumor.     

Surgical outcomes and immunohistochemical features for gastrointestinal stromal tumors (GISTS) of the stomach: with special reference to prognostic factors

BACKGROUND/AIMS: Stomach is the most common site of gastrointestinal stromal tumors (GISTs). But the preoperative pathologic diagnosis is often difficult to make and it is hard to decide an appropriate surgical extent and also adjuvant therapy due to obscure malignant potential. Our purpose was to observe the outcomes for the patients with GIST of the stomach and reveal the significant prognostic factors. METHODOLOGY: Forty patients operated for primary GIST of the stomach expressing CD 117 were studied. We evaluated immunohistochemical and clinicopathologic features, and analyzed them to reveal the significant prognostic factors. The surgical outcomes of the patients were also investigated. RESULTS: Multivariate analysis for disease-free survival disclosed mitotic activity was the only independent factor, but the immunohistochemical features did not have any prognostic value. Among the patients with recurrence, all of the patients treated with imatinib mesylate (formerly STI-571) have survived until now, but half of the untreated patients died. CONCLUSIONS: In gastric GISTs, most important prognostic factor is mitotic count, not tumor size. We suggest that the wider application of imatinib mesylate to clinically malignant gastric GIST as adjuvant therapy may contribute to the improvement of outcomes.     

Clinical and prognostic significance of raf kinase inhibitory protein expression in gastrointestinal stromal tumors

AIM To detect the expression of Raf kinase inhibitory protein(RKIP) in gastrointestinal stromal tumors(GISTs) and to analyze its relationship with clinicopatholgical characteristics and prognosis of this disease.METHODS Sixty-three patients with pathologically diagnosed GISTs who underwent surgical resection at the Shengjing Hospital of China Medical University from January 2011 to January 2015 and had complete clinical,pathological,and follow-up data were included. Immunohistochemical method was used to detect the expression of RKIP in GIST tissue samples from these patients. KaplanMeier method was used to calculate the survival rate of 60 patients with complete follow-up data,and Cox regression analysis was performed to identify factors affecting the prognosis of patients GISTs to evaluate further the diagnostic and prognostic value of RKIP in GISTs.RESULTS In GIST tissues,RKIP positive signals,manifesting as brownish yellow or brown granules,were located in the cytoplasm or on the membrane. Of 63 tissue samplesincluded in this study,34(54%) were positive and 29(46%) were negative for RKIP expression. Statistical analysis showed that RKIP expression in GISTs was significantly associated with tumor size,National Institutes of Health(NIH) risk grade,and mucosal invasion,but had no significant association with age,gender,tumor location,or the number of mitotic figures. Univariate Kaplan-Meier analysis revealed that the 1-,3-,and 5-year survival rates were 94.4%,89.2%,and 80.5% for patients with positive RKIP expression,and 88.6%,68.2%,and 48.2% for patients with negative RKIP expression,suggesting that patients with high RKIP expression had significantly higher survival rates than those with low expression(Log-rank test,P = 0.0015). Cox regression analysis demonstrated that NIH risk grade was significantly associated with the prognosis of GISTs(P = 0.037),suggesting that NIH risk grade is a significant predictor of the prognosis of GISTs. RKIP expression had a tendency to predict the survival of GISTs(P = 0.122),suggesting that RKIP expression may have appreciated value to predict the prognosis of GISTs.CONCLUSION This study demonstrated that:(1) RKIP expression in GISTs is associated with tumor size,NIH risk grade,and mucosal invasion,and low or no expression of RKIP predicts a high malignancy potential;(2) high RKIP correlates positively with the survival of patients with GISTs; and(3) RKIP expression has appreciated value for predicting the survival of patients with GISTs,although it is not an independent prognostic factor in GISTs.