结直肠间质瘤的临床病理特点和外科处理

目的 探讨结直肠间质瘤的临床表现、组织学、免疫组化特点、外科处理和预后.＃方法对30例结直肠间质瘤患者的临床及病理学资料进行回顾性分析,按Fletcher肿瘤侵袭危险度评估分级将其分为极低度恶性、低度恶性、中度恶性、高度恶性四组,并用Cox多因素回归分析评估患者预后影响因素. 结果结直肠间质瘤发生在结肠4例(13%),直肠20例(67%),肛管6例(20%).免疫组化C-kit阳性表达率为87%.30例结直肠间质瘤全部行手术切除.29例(97%)获术后随访,随访时间4～130个月.3年生存率为73%,5年生存率为53%.Fletcher侵袭危险度评估分级与患者预后密切相关(B=4.226,P=0.02).结论 外科手术联合分子靶向治疗是结直肠间质瘤的最有效治疗手段,Fletcher侵袭危险度评估分级对具体术式的选择及患者预后有重要意义.

Clinicopathological characteristics and surgical management of colorectal stromal tumors

Objective To analyze clinical manifestations, histology, immunohistochemistry (IHC), surgical treatment and prognosis of colorectal stromal tumours. Methods The clinical and pathological data of 30 cases of colorectal stromal tumors were analyzed retrospectively. According to Fletcher proposed approach for defining risk group in GIST, these cases were grouped into VLR, LR, IR and HR.Cox multiple regression multiple factor analysis method was used to evaluate impact factors for prognosis.Results Radical resection was achieved in all 30 cases. Tumors located in the colon in 4 ( 13% ) cases, in the rectum in 20 (67%) cases, and within the anal canal in 6 (20%) cases. C-kit expression was positive in 86. 7% cases as determined by IHC. Postoperatively, 29 cases were followed-up from 4 to 130 mos. The Fletcher proposed approach for defining risk group in GIST was closely related to the survival rates ( B =4. 226,P =0. 02). The 3- and 5-year survival rate was 73% and 53% respectively. Conclusions Surgical resection and molecular target treatment is the treatment of choice for colorectal stromal tumors. The Fletcher's classification of malignancy risk group for colorectal stromal tumors is statistically related to the modus operandi and patients' survival rate.