胃间质瘤术后复发和转移的预测及治疗

目的 探讨胃间质瘤术后复发和转移预测因素及治疗方法.方法 回顾分析2002年12月至2010年12月期间共收治胃间质瘤患者49例,男性28例,女性21例,中位年龄59岁（33~74岁）,均行手术治疗,术后随访3年内11例复发转移,其中男性7例,女性4例,中位年龄55.5岁.收集11例复发及转移患者的临床资料,探讨该病复发转移的特点及影响预后的因素.结果 8年间49例胃间质瘤术后患者均获随访,平均随访时间为36个月（7~89个月）,11例出现复发或转移.此11例患者第一次手术后病理诊断明确,免疫组织化学显示：CD117（＋）11例,CD34（＋）10例,Vim（＋）10例,SMA（＋）4例,S-100（＋）2例,未见DES和CK表达.局部复发2例,4例出现肝转移,2例肝转移合并腹腔转移,2例腹膜后转移,1例腹腔广泛转移.单因素分析发现,肿瘤直径≥5 cm,核分裂象≥5/50 HPF,术中肿瘤破裂及高危患者是胃间质瘤复发转移的高危因素.结论 胃间质瘤高危患者及术中肿瘤破裂患者术后出现复发和转移的可能性大.术中完整切除肿瘤避免破裂及高危患者术后口服伊马替尼是预防复发和的重要方法.即使出现复发,转移也应积极再次手术.

Management of recurrent and metastatic gastric stromal tumors

Objective To investigate the predictive factors for post-operative recurrence and me- tastasis of gastric gastrointestinal stromal tumor （GIST）. Methods 11 cases of recurrent and meta- static GIST in our hospital between December 2002 and December 2010 were analyzed. The predictive factors for postoperative recurrence and metastasis were explored. Results Post-operative recurrence or metastasis occurred in 11 cases, including tumor recurrence in 2 cases, metastasized to liver tissue in 4 cases, metastasized to liver and abdominal cavity in 2 cases, metastasized to retroperitoneal cavity in 2 cases, 1 case of extensive intraperitoneal metastasis, and 2 dead patients. The Univariate analysis showed that tumor diameter~5cm, mitoses~5/50HPF, and other high-risk factors were associated with adverse outcome. Conclusion There are correlation between high-risk factors and the possibilities of postoperative recurrence or metastasis. Even if the patients present recurrence or metastasis, re-op- eration is still recommended. Patients with high-risk gastric GIST or recurrence developed can be trea- ted with imatinibe mesylate.