合并其他消化道恶性肿瘤的胃肠间质瘤临床病理特征及其诊治

目的探讨合并其他消化道恶性肿瘤的胃肠间质瘤（GIST）患者的临床病理特征及诊治方法。方法回顾性分析2004年9月至2012年11月间在上海仁济医院接受手术治疗的525例原发性GIST的临床资料，其中合并其他消化道恶性肿瘤者46例．未合并其他消化道恶性肿瘤者479例。结果合并其他消化道恶性肿瘤的46例GIST患者术前诊断率仅为2．2％（1／46），按NIH术后危险度分级，极低危患者36例（78-3％），低危患者9例（19．6％），高危患者1例（2．2％）。与未合并其他消化道肿瘤的GIST患者相比，合并者多见于老年患者（P=0．001），多发生于胃（P=0．000），肿瘤直径更小（P=0．000），核分裂像更少（P=0．000），危险度更低（P=0．000）。46例患者5年生存率为36．1％，显著低于未合并者的82．2％（P=0．000）。结论合并其他消化道恶性肿瘤的GIST大多为低危或极低危险度，对预后影响较小，其预后主要取决于合并的消化道恶性肿瘤，故对其治疗主要针对合并的恶性肿瘤，同时在不明显增加手术风险和术后并发症的情况下可考虑一并切除GIST。

Clinicopathological features and management of gastrointestinal stromal tumors complicated with synchronous other alimentary malignant tumor

Objective To explore the clinicopathologic features, treatment and prognosis of gastrointestinal stromal tumor （GIST） complicated with synchronous other alimentary malignant tumors. Methods Clinical data of 525 patients with GIST undergoing surgical treatment from August 2004 to November 2012 in Shanghai Renji Hospital were reviewed retrospectively, among whom 46 patients presented synchronous other alimentary malignancy. Results GIST and other alimentary malignancy coexisting cases were less likely to be screened out preoperatively（2.2%, 1/46） and associated with elder age（P=0.001 ）, more likely arise from stomach（P=0.000）, smaller tumor maximum diameter （P=0.000）, and lower mitotic count （P=0.000）. According to NIH postoperative risk classification, there were 36 at very low risk, 9 at low risk, and I at high risk. Although the risk of GIST recurrence was lower for GIST and other alimentay malignancy coexisting cases, their 5-year survival rate was lower than that of patients with GIST alone （36.1% VS. 82.2% ,P =0.000）. Conclusions GIST patients complicated with synchronous alimentary malignant tumor are usually low or very low risk and has minimal impact on the prognosis. Survival depends primarily on the synchronous alimentary malignant tumors. Therefore, it is reasonable to lay emphasis on the treatment of the alimentary malignant tumor, and perform synchronous resection of GIST if possible.