胃胃肠间质瘤合并胃癌患者的临床病理特点及预后影响因素

目的探讨胃胃肠间质瘤（GIST）合并胃癌患者的临床病理特点及预后影响因素。方法回顾性分析2000年4月至2010年6月间在福建医科大学附属协和医院接受手术治疗的122例原发性胃GIST患者的临床资料,其中合并胃癌者（合并组）26例,无合并胃癌者（无合并组）96例。比较两组患者中胃GIST的临床病理特点,并对全组患者的预后进行单因素及多因素分析。结果与无合并组相比,合并组患者GIST肿瘤最大直径更小（P〈0．01）、核分裂像更少（P〈0．05）、Fletcher分级更低（合并组76．9％为极低．低危者,P〈0．01）。合并组患者术前诊断率明显低于无合并组（23．1％比97．9％,P〈0．01）;5年生存率（58．0％）低于无合并组（79．4％）（P=0．027）。单因素预后分析显示,肿瘤最大直径（P〈0．01）、核分裂像（P〈0．01）、Fletcher分级（P〈0．01）、是否合并胃癌（P〈0．05）与患者预后有关：多因素预后分析显示,Fleteher分级（P〈0．05）和是否合并胃癌（P〈0．01）是影响患者预后的独立因素。结论胃GIST合并胃癌的患者其GIST的171etcher分级大多为极低或低侵袭危险度,对预后影响较小．其生存时间主要取决于胃癌。

Clinicopathologic features and prognostic factors of gastric gastrointestinal stromal tumor with synchronous gastric cancer

Objective To evaluated the clinicopathologic features and prognostic factors of gastric gastrointestinal stromal tumor （GIST） with synchronous gastric cancer. Methods The elinicopathologic records of 122 patients with gastric GIST who underwent surgical treatment from April 2000 to June 2010 were analyzed retrospectively. Twenty-six patients presented synchronous gastric cancer （group A）, while 96 patients did not （group B）. The elinieopathologic features of gastric GIST were compared between the two groups. Potential prognostic factors were evaluated by univariate and multivariate analyses. Results Gastric GIST in group A were assoieated with smaller tumor diameter （P〈0.01）, lower mitotic count（P〈0.05）, lower Fletcher classification（P〈0.01）, and lower rate of pre-operative diagnosis （23.1% vs. 97.9%, P〈0.01）. On univariate analysis, maximum tumor diameter （P〈0.01）, mitotic count （P〈0.01）, Fletcher classification （P〈0.01） and synchronous gastric cancer （P〈0.05） were the predictive factors of survival. Multivariate analysis showed that Fletcher classification （P〈0.05） and synchronous gastric cancer （P〈0.01） were independent prognostic factors. Conclusions In patients with synchronous gastric GIST and gastric cancer, Fletcher classification of GIST is usually very low or low invasion risk and has minimal impact on the prognosis. Survival depends primarily on the gastric cancer.