胃肠道间质瘤40例临床病理分析

目的探讨胃肠道间质瘤(GIST)的基本临床病理、良恶标准、组织学类型、预后的判断以及组织发生等问题.方法对我院1999～2004年曾被诊断为胃肠道间质瘤的40例患者进行临床和病理分析.结果 40例中胃恶性间质肿瘤16例,小肠恶性间质肿瘤15例,大肠肿瘤3例,盆腔肿瘤3例,后腹膜肿瘤2例,食道肿瘤1例.肿瘤大小0.2～25 cm,平均7.8 cm.其中4例发生了转移.免疫组化的阳性表达结果:CD117阳性率为90.0%,CD34阳性率45.0%,S-100阳性率10.0%,VEGF阳性率70.0%,VEGFR-2阳性率80.0%.其中CD117与CD34共表达率为40.0%(16/40),CD117与S-100共表达率为7.5%(3/40),CD34与S-100共表达率为2.5%(1/40).结论 GIST的主要恶性指标有肿瘤最大径、核分裂像(HPF).在GIST的诊断中,只要CD117表达即可诊断为狭义的GIST,并将真正的平滑肌肿瘤与雪旺细胞瘤区别出来.VEGF也是一种衡量肿瘤生长和转移的重要指标.     

胃间质瘤79例临床病理分析

目的 探讨胃肠道间质瘤(GIST)的临床表现、诊断和治疗方法以及与预后相关的因素.方法 回顾性分析79例发生于胃的GIST的临床和病理资料,分析影响预后的相关因素.结果 临床表现无特异性,多通过超声内镜、CT、消化道钡餐造影等影像学检查发现肿瘤,明确诊断需通过病理组织学及免疫组化检查,79例中,CD+117 73例 (93%)、CD+34 66例(83%),经手术治疗5年生存率83%,5年无瘤生存率72%.结论 发生于胃的GIST首选治疗方法是手术切除,肿瘤出血、坏死及Fletcher分型是影响预后的重要指标.     

胃肠间质瘤的临床病理及其免疫组织化学特征探讨

目的探讨胃肠间质瘤(GIST)的诊断标准、良恶性参考指标和预后因素。方法对34例GIST的临床表现、病理组织形态进行观察,应用免疫组织化学Envision法检测其CD117、CD34、a-SMA、S-100蛋白等的表达状况,并结合随访资料,对其生物学行为进行分析。结果GIST患者平均年龄58.9岁。最常见症状为腹痛和消化道出血。大体上肿瘤境界清楚,切面灰白,部分区可见出血、坏死囊性变等继发性改变。镜下梭形细胞25例,上皮样细胞4例,梭形或上皮样细胞5例。CD117和CD34多弥漫强阳性。阳性率为94.1%、79.4%。a-SMA、S-100阳性率分别为29.4%、35.3%。34例GIST中,良性7例,交界性16例,恶性11例。良性与交界性随访23例健在,恶性11例随访9例,3例无瘤生存,4例复发与转移,2例死亡。结论GIST好发中老年,瘤细胞形态多变,排列结构多样。免疫组织化学特征CD117、CD34阳性。肿瘤临床和病理形态、CD117和CD34表达是诊断GIST的要点。肿瘤直径大于5cm,核分裂像大于5/50HPF可作为良恶性参考指标。肿瘤性坏死、核分裂大于5/50HPF及肿瘤大小是预后的重要因素。     

恶性胃肠道间质瘤46例临床分析

目的：评价恶性胃肠道间质瘤（GIST）的临床特征。方法：对46例恶性GIST进行回顾性临床分析。并比较免疫组化染色vimentin,CD34,S-100,desmin和SMA的表达情况。结果：原发肿瘤部位主要为胃（贲门），小肠和大肠；主要症状和体征有腹痛，腹部肿块，贫血和黑便；比较恶性GIST组与良性GIST组患者的原发肿瘤部位，临床表现和免疫组化检测结果无明显差别，与良性GIST相比，恶性GIST组患者肿瘤增长迅速（中位直径10cm)，易转移。结论：恶性GIST的预后差，对于复发或转移者缺乏有效的治疗方法，需要寻找新的有效药物和治疗方法来提高治疗水平。     

胃肠道间质瘤39例临床病理分析

目的　探讨胃肠道间质瘤 (gastrointestinalstromaltumor ,GIST)的临床病理特点及免疫组化表型特征。 方法　对 3 9例GIST进行组织学、免疫组化观察。结果　肿瘤具有梭形和 (或 )上皮样细胞成份 ,间质可有团丝样纤维(SP) ,CD 117表达者 3 5例 (89.7% ) ,CD3 4表达者 2 8例 (71.8% )。结论　GIST可能起源于卡哈尔细胞或向卡哈尔细胞分化 ,组织学上类似于平滑肌肿瘤或神经鞘瘤 ,CD117、CD3 4是较为特异且敏感的标记物。     

胃肠道间质瘤中血管生成拟态初步研究

目的：研究胃肠道间质瘤中是否存在血管生成拟态及临床意义.方法：收集84例CIST标本及临床病理资料．CD31／PAS双重染色结合CD117、CD31免疫组化染色证实VM存在，分析VM与患者临床病理指标之间的关系结果：84例GIST中21例具有VM；核分裂数≥5个／50HPF组和〈5个／50HPF组和有无肝转移组间VM阳性率差别有统计学意义（P=0．000，0．008）。极低危／低危组、中危组和高危组三组VM阳性率分别为5．9%，12．5％，39.5％，三组之间VM阳性率差异有统计学意义（P=0．010，0．020）Kaplan—Meier生存分析提示有VM组和无VM组生存时间差异有统计学意义（P=0．0000）.Cox比例风险模型分析表明有VM、肿瘤大小≥10cm和出血是影响GIST患者预后的危险因素（P=-0．000．0．005，0．032）=结论：GIST中存在VM，VM是影响GIST患者预后的不利因素，有VM的患者易发生肝转移．预后比无VM的患者差、     

原发性胃肠间质肿瘤121例临床分析

目的:探讨胃肠间质肿瘤(gastrointestinal stromal tumor,GIST)的临床特征、治疗以及相关的预后因素.方法:对1999年7月-2007年6月121例原发性GIST患者的临床和病理特征、治疗以及预后情况进行了回顾性分析.结果:原发性GIST患者的男女之比为1.57:1,年龄26～83岁,中位年龄61岁.常见肿瘤部位以胃和小肠多见.CD117阳性114例,CD34阳性94例.121例患者均接受了外科治疗,其中完全切除84例,31例行淋巴结清扫或活检术,获检274枚淋巴结中只有2枚被检出有转移.68例患者于术后接受了3～38个月伊马替尼的治疗.121例患者中有106例接受了7～85个月的随访,1、3、5年累计无进展生存率分别为88.8%、55.6%和35.9%,总生存率分别为97.8%、71.8%和57.0%.单因素生存分析显示,生存率与肿瘤部位、肿瘤大小、核分裂相数目、危险度分级、手术方式以及是否接受伊马替尼治疗有关.分层分析结果显示,完全切除术后危险度分级和伊马替尼治疗是影响术后无复发生存时间的因素.多因素回归分析结果显示,肿瘤大小、核分裂相数、危险度分级、完全切除以及伊马替尼治疗是影响生存预后的独立危险因素.结论:肿瘤大小和核分裂相数是GIST的2个重要的预后因素.完全切除与GIST预后独立相关,但并不提倡常规进行系统淋巴结清扫;伊马替尼可提高GIST的3年生存率,完全切除术后给予伊马替尼治疗可延缓复发或转移.     

腹腔胃肠道外间质瘤临床病理分析

为了研究腹腔胃肠外间质瘤（gastrointestinal stromal tumor,EGIST）的临床病理、免疫组化、鉴别诊断和预后,对7例腹腔EGIST用光镜观察,免疫组化SP法检测CD117和CD34等的表达并进行随访。结果肿瘤直径平均17.2 cm,组织形态、免疫表型等与GIST相似,以短梭形细胞型为主,细胞密集,有不同程度的异形性,结构类似于平滑肌肿瘤。CD117阳性表达率为100%（7/7）,CD34为71.4%（5/7）。随访6例,有4例术后2年内死亡。初步研究结果提示,腹腔EGIST好发于中老年人,具有GIST类似的组织学特征及免疫表型,恶性潜能高,预后较差,手术切除是主要的治疗方式。     

胃肠道间质瘤35例临床病理特点及预后分析

目的探讨胃肠道间质瘤（GIST）的临床病理特点及预后的关系。方法采用免疫组织化学法（sP法）检测35例原发性GIST患者瘤细胞c—kit蛋白（CD117）、CD34波形蛋白、结蛋白、S-100、Syn等蛋白表达情况。结果35例GIST患者中，良性8例、交界性7例、恶性20例。位于小肠者均为交界性及恶性GIST，其恶性度与其他部位的肿瘤比较差异有统计学意义（P〈0．05）。所有病例CD117、波形蛋白均阳性，22例CD34阳性，而结蛋白、FN、GFAP均阴性。24例α-SMA、ACT阳性，16例S-100阳性，其中3例Syn、NSE阳性。交界性及恶性肿瘤伴出血坏死明显者与良性者比较差异有统计学意义（P〈0．01）。随访19例，良性及交界患者治疗效果较好，恶性肿瘤患者则差。结论GIST好发于中老年人。几乎所有GIST均表达CD117及波形蛋白，大部分表达CD34。肿瘤的恶性程度及预后与其发生部位、大小、出血坏死、细胞异型性及核分裂活性密切相关。     

胃肠道间质瘤的临床病理特征和预后相关因素分析

目的探讨胃肠道间质瘤（gastrointestinal stromal tumor，GIST）的临床病理特征和预后相关因素，评价Fletcher等推荐的GIST生物学行为分级法的应用价值。方法复阅切片，以免疫组化方法检测CD117、CD34和S—100蛋白的表达。结合患者临床病理特征和GIST生物学行为分级分析影响GIST患者预后的相关因素。结果确诊44例GIST患者。患者中位生存时间41．7个月，1、3和5年总体生存率分别为80．2％、57．2％和39．8％。单因素分析显示，肿瘤最大径〉5cm、肿瘤性坏死、组织学类型混合型、肿瘤细胞高密集度、核分裂象计数≥5／50HPF、手术未完整切除、复发或转移瘤以及浸润性生长显著降低生存（P〈0．05）。44例GIST生物学行为分级：极低度侵袭危险性7例，低度侵袭危险性8例，中度侵袭危险性10例，高度侵袭危险性19例。单因素分析显示，不同侵袭危险性组患者生存率差异有显著性（X^2=28．376，P=0．000）。结论准确判断GIST患者预后有赖于综合分析患者临床病理特征。Fletcher等推荐的GIST生物学行为分级法能够准确评价GIST患者的预后，具有较好的临床应用价值。     

Validation of the Joensuu risk criteria for primary resectable gastrointestinal stromal tumour – The impact of tumour rupture on patient outcomes

Background

Approval of imatinib for adjuvant treatment of gastrointestinal stromal tumours (GIST) raised discussion about accuracy of prognostic factors in GIST and the clinical significance of the available risk stratification criteria.

Methods

We studied the influence of a new modification of the NIH Consensus Criteria (the Joensuu risk criteria), NCCN-AFIP criteria, and several clinicopathological factors, including tumour rupture, on relapse-free survival (RFS) in a prospectively collected tumour registry series consisting of 640 consecutive patients with primary, resectable, CD117-immunopositive GIST. The median follow-up time after tumour resection was 39 months. None of the patients received adjuvant imatinib.

Results

The median RFS time after surgery was 50 months. In univariable analyses, high Joensuu risk group, tumour mitotic count >5/50 HPF, size >5 cm, non-gastric location, tumour rupture (7% of cases; P = 0.0014) and male gender had adverse influence on RFS. In a multivariable analysis mitotic count >5/50HPF, tumour size >5 cm and non-gastric location were independent adverse prognostic factors. Forty, 151, 86 and 348 patients were assigned according to the Joensuu criteria to very low, low, intermediate and high risk groups and had 5-year RFS of 94%, 94%, 86% and 29%, respectively.

Conclusion

The Joensuu criteria, which include 4 prognostic factors (tumour size, site, mitotic count and rupture) and 3 categories for the mitotic count, were found to be a reliable tool for assessing prognosis of operable GIST. The Joensuu criteria identified particularly well high risk patients, who are likely the proper candidates for adjuvant therapy.     

Ki-67在CD117阳性的中、高危险度胃肠道间质瘤中的表达及其意义

 目的　探讨Ki-67在CD117阳性的中、高危险度胃肠道间质瘤（GIST）中的表达及其临床意义。方法　检测Ki-67在CD117阳性的中危险度（GIST）18例、高危险度GIST 25例中的表达,与随访结果对照,并与极低危险度和低危险度组33例比较,分析Ki-67指数（LI）与危险度的关系。结果　中、高危险度组随访40例,其中26例健在,高危组7例、中危组5例死于GIST,另2例死于其他原因。Ki-67 LI> 5 %在危险度中、高组与极低和低组间表达差异有统计学意义（P＜0.01）,Ki-67 LI还与核分裂象计数（MI）（＞5／50 HPF）、肿瘤大小（＞5 cm）相关（P＜0.05）,与部位无关（P＞0.05）。结论　Ki-67 LI＞5 %与肿瘤大小＞5 cm、MI＞5／50 HPF一起可作为CD117阳性的GIST中、高危险度的有用评价指标。     

Clinical utility of the new American Joint Committee on Cancer staging system for gastrointestinal stromal tumors: current overall survival after primary tumor resection

BACKGROUND:

The objectives of the current study were to assess the reliability of the new revision of the American Joint Committee on Cancer (AJCC) staging system for gastrointestinal stromal tumors (GISTs) based on the National Comprehensive Cancer Network‐Armed Forces Institute of Pathology risk classification and to analyze the factors that influence after resection for primary GISTs in 2 AJCC groups: patients with GISTs originating from the stomach and omentum (G‐GISTs) and patients with other primary GISTs located mainly in the small bowel (nongastric GISTs [NG‐GISTs]).

METHODS:

The authors prospectively analyzed a group of 640 patients with primary, CD117‐positive GISTs who underwent surgery with curative intention (R0/R1 resection), including 340 G‐GISTs (55.5%) and 300 NG‐GISTs (44.5%). Factors were explored that had an effect on disease‐free survival time (DFS), which was calculated from the date of radical operation to the date of recurrence or last follow‐up. The median follow‐up was 39 months.

RESULTS:

Compared with NG‐GISTs, G‐GISTs were characterized by a significantly lower median size (5.3 cm and 8.5 cm, respectively; P < .0001) and lower mitotic activity (median, 3 in 50 high‐power fields [HPF] vs 5 in 50 HPF; P < .0001), and they were diagnosed in older patients (median age, 62 years vs 57 years; P = .002). The most commonly detected mutations in G‐GIST were those located in KIT exon 11 (60.5%) and platelet‐derived growth factor receptor alpha (PDGFRA) exon 18 (19%) versus KIT exons 11 and 9 in NG‐GISTs (72% and 17.4%, respectively). The prognosis of patients who had G‐GISTs was significantly better compared that of patients who had NG‐GISTs, with 5‐year DFS rates of 69% (median, 83 months) versus 43% (median, 33 months), respectively (P < .00001). The most significant prognostic factors that correlated with shorter DFS in both G‐GISTs and NG‐GISTs were primary tumor size >5 cm and >10 cm (P < .0001) and mitotic index >5 in 50 HPF and >10 in 50 HPF (P < .0001). The 5‐year DFS rates in G‐GISTs according to AJCC stage categories were as follows: 96% for stage IA tumors, 92% for stage IB tumors, 51% for II tumors, 22% for stage IIIA tumors, and 22% for stage IIIB tumors (P < .0001). The 5‐year DFS rates in NG‐GISTs according to AJCC categories were as follows: 92% for stage I tumors, 66% for stage II tumors, 28% for IIIA tumors, and 16% for IIIB tumors (P < .0001). The high prognostic significance of the AJCC classification also was confirmed for overall survival data, including the impact of therapy with tyrosine kinase inhibitors.

CONCLUSIONS:

The reliability of AJCC risk classification after resection of primary GIST was confirmed for DFS and overall survival. Patients with primary G‐GISTs had a better prognosis than patients with NG‐GISTs. In both groups, primary tumor size and mitotic activity were the most important prognostic factors in terms of DFS. Cancer 2011;. © 2011 American Cancer Society.     

24例与癌并发的胃肠间质瘤临床病理分析

  目的  研究与消化道癌并发的胃肠间质瘤(gastrointestinal stromal tumor, GIST)的临床病理特点。  方法  对胜利石油管理局胜利医院、胜利油田中心医院、东营市人民医院2002年1月至2012年12月收治的157例胃肠间质瘤病例, 观察CD117、CD34、SMA免疫组织化学标记的表达。观察并发胃肠道癌病例的临床病理特点, 重点观察肿瘤异型性、核分裂活性、细胞增殖活性标记物Ki-67的表达特点, 与未并发胃肠道癌的病例进行比较。  结果  157例中并发胃肠道癌者24例, 占15.3%。其中男14例, 女10例, 男女之比为1.4:1。年龄41岁~66岁, 中位年龄55岁。24例中7例位于食管中段或下段, 15例位于胃壁, 2例位于空肠。肿瘤直径0.6~3.8 cm, 平均(1.50±0.85) cm, 4例有轻度异型性, 其余无异型性。核有丝分裂0~5个/50HPF, 平均(0.79±1.83)个/ 50 HPF, Ki-67指数0~7.72, 平均2.16±3.26。并发癌瘤包括食管癌5例, 胃食管交界处癌2例, 胃癌15例, 肠癌2例。作为对照, 未并发消化道癌的胃肠道间质瘤患者133例, 其中男74例, 女59例, 男女之比为1.25:1。年龄43~71岁, 中位年龄54岁。114例发生于胃, 13例位于肠, 6例食管。肿瘤直径2.4~15.5 cm, 平均(6.11±7.09) cm。82例显示不同程度的异型性, 68例诊断为中危险度, 14例为高危险度。核有丝分裂0~53个/50 HPF, 平均(3.81±23.67)个/50 HPF。Ki-67指数0~39.21, 平均6.22±16.96。并发癌的胃肠间质瘤较未并发癌者比较, 男女病例比值较高, 瘤体平均直径较小, 核分裂指数和Ki-67阳性指数显著较低(分别为t=1.981, P < 0.05;t=1.993 5, P < 0.05)。  结论  15.3%胃肠间质瘤是并发癌。并发的胃肠间质瘤多数没有特殊临床症状, 因癌手术后标本大体检查时发现。其增殖活性显著低于未并发癌的胃肠间质瘤, 可能属于发生早期的肿瘤      

Gastrointestinal Stromal Tumors—A Morphological and Immunohistochemical Study

Purpose

The rationale of this study was to assess the morphological and immunohistochemical characteristics of gastrointestinal stromal tumor (GIST) along with their risk stratification.

Methods

Record of 36 cases diagnosed as GIST over a period of 2 years (January 2007 to December 2008) was retrieved. Slides were reviewed for histological typing, immunohistochemical staining, and mitotic count. Cases were divided into very low, low, intermediate, and high-risk groups according to the Fletcher method of risk stratification (Table 1; Fletcher et al. (Int J Surg Pathol 10:81–89, 2002)). Mean, median, and mode were calculated for quantitative variables like age, tumor size, and mitotic count by using SPSS version 14. Frequencies and percentages were also calculated for qualitative variables like results of immunohistochemistry, tumor site, and histological subtypes.

Results

Out of 36 patients, 14 patients were male, and 22 were female. A total of 14 (39%) patients had tumor size between 2 and 5 cm, 13 (36%) patients had size between 5 and 10 cm, and 9 (25%) patients had size >10 cm. There was no tumor less than 2 cm in size. Twenty-one patients (58%) had mitoses <5/50 high power fields (HPF) while seven (20%) had mitoses between 5 and 10/50 HPF and eight (22%) >10/50 HPF. Thirty-one (86%) of cases were strongly positive for CD117 while CD34 was positive in 81% of the cases. Most frequent histological type was hypercellular spindle cell type, and most frequent site of presentation was stomach. Seven patients fell into low risk, ten patients intermediate risk, and 19 patients in high risk groups. There were no patients in very low risk group.

Conclusion

By using microscopy and immunohistochemical techniques, GISTs can be diagnosed accurately and treated efficiently. Risk stratification and histological subtyping have emerged as efficient tools to predict malignant behavior.     

Clinicopathological features and treatment outcome of oesophageal gastrointestinal stromal tumour (GIST): A large,retrospective multicenter European study

BackgroundOesophageal gastrointestinal stromal tumours (GISTs) account for ≤1% of all GISTs. Consequently, evidence to guide clinical decision-making is limited.MethodsClinicopathological features and outcomes in patients with primary oesophageal GIST from seven European countries were collected retrospectively.ResultsEighty-three patients were identified, and median follow up was 55.0 months. At diagnosis, 59.0% had localized disease, 25.3% locally advanced and 13.3% synchronous metastasis. A biopsy (Fine Needle aspiration n = 29, histological biopsy n = 31) was performed in 60 (72.3%) patients. The mitotic count was low (<5 mitoses/50 High Power Fields (HPF)) in 24 patients and high (≥5 mitoses/50 HPF) in 27 patients. Fifty-one (61.4%) patients underwent surgical or endoscopic resection. The most common reasons to not perform an immediate resection (n = 31) were; unresectable or metastasized GIST, performance status/comorbidity, patient refusal or ongoing neo-adjuvant therapy. The type of resections were enucleation (n = 11), segmental resection (n = 6) and oesophagectomy with gastric conduit reconstruction (n = 33), with median tumour size of 3.3 cm, 4.5 cm and 7.7 cm, respectively. In patients treated with enucleation 18.2% developed recurrent disease. The recurrence rate in patients treated with segmental resection was 16.7% and in patients undergoing oesophagectomy with gastric conduit reconstruction 36.4%. Larger tumours (≥4.0 cm) and high (>5/5hpf) mitotic count were associated with worse disease free survival.ConclusionBased on the current study, enucleation can be recommended for oesophageal GIST smaller than 4 cm, while oesophagectomy should be preserved for larger tumours. Patients with larger tumours (>4 cm) and/or high mitotic count should be treated with adjuvant therapy.     

Helpful parameter for malignant potential of gastrointestinal stromal tumors (GIST)

BACKGROUND: Although a series of histopathological criteria have been suggested, the prediction of the malignant potential of gastrointestinal stromal tumors (GIST) is still difficult. The older literature called all gastrointestinal stromal tumors smooth muscle tumors or mixed GIST with true smooth muscle tumors. Reports on GIST including homogeneous cases were rare. METHODS: We examined 73 cases of GIST, which were immunohistochemically positive for c-kit and/or CD34, and mainly focused on the correlation between mitotic count and the other clinicopathological features to establish any helpful and reproducible parameters to indicate the malignant potential and to be used practically and objectively in the routine histopathological diagnosis of GIST. RESULTS: The results showed that there was a statistically significant difference in mitotic count between benign and malignant groups. Other proposed parameters, such as high cellularity, tumor size > or =5 cm, stomach and intestinal location, hemorrhage, necrosis, p53 expression and Ki-67 labeling index >10%, were frequently observed in tumors with mitotic figure. Three patients with one mitotic figure in 50HPF died from metastasis or recurrence of the tumors. CONCLUSIONS: Ki-67 index and cellularity should be used as predictors for the malignant potential of GIST. When other morphological features appear benign, mitotic count might also be a helpful practical factor in the prediction of the malignant potential of GIST.     

Does Immunohistochemistry Provide Additional Prognostic Data in Gastrointestinal Stromal Tumors?

Background: To investigate the predictive and prognostic effects of clinicopathologic and immunohistochemical(IHC) features in patients with gastrointestinal stromal tumours (GISTs). Materials and Methods: Fifty-sixpatients who were diagnosed with GIST between 2002 and 2012 were retrospectively evaluated. Relationshipsbetween clinicopathologic/immunohistochemical factors and prognosis were investigated. Results: Medianoverall survival (OS) of the whole study group was 74.9 months (42.8-107.1 months), while it was 95.2 monthsin resectable and 44.7 months in metastatic patients respectively (p=0.007). Epitheliolid tumor morphology wassignificantly associated with shortened OS as compared to other histologies (p=0.001). SMA(+) tumours weresignificantly correlated with low (<10/50HPF) mitotic activity (p=0.034). Moreover, SMA(+) patients tendedto survive longer and had significantly longer disease-free survival (DFS) times than SMA (-) patients (37.7months vs 15.9 months; p=0.002). High Ki-67 level (≥30%) was significantly associated with shorter OS (34 vs95.2 months; 95%CI; p=0.001). CD34 (-) tumours were significantly associated with low proliferative tumours(Ki-67<%10) (p=0.026). Median PFS (progression-free survival) of the patients who received imatinib was 36months (27.7-44.2 months). CD34 (-) patients had significantly longer PFS times than that of negative tumours;(50.8 vs 29.8 months; p=0.045). S100 and desmin expression did not play any role in predicting the prognosisof GISTs. Multivariate analysis demonstrated that ≥10/50HPF mitotic activity/HPF was the only independentfactor for risk of death in GIST patients. Conclusions: Despite the negative prognostic and predictive effect ofhigh Ki-67 and CD34 expression, mitotic activity remains the strongest prognostic factor in GIST patients. SMApositivity seems to affect GIST prognosis positively. However, large-scale, multicenter studies are required toprovide supportive data for these findings.     

胃肠道间质瘤预后多因素分析

目的探讨胃肠道间质瘤的相关预后因素。方法复阅切片,重新诊断,从肿瘤的两点取材,构建组织微阵列。以免疫组织化学染色检测CD117、CD34、SMA、Desmin及S-100 5种蛋白的表达,分析各临床病理变量与预后的关系。结果194例患者1,3,5年生存率分别为93．5％、72．1％和63．2％;单因素分析显示,患者的预后与肿瘤大小、核分裂相数目、肿瘤坏死、肿瘤部位、肿瘤细胞密集程度、肿瘤细胞类型、核异型性、出血、手术方式、周围脏器组织有无侵犯、黏膜有无受侵、性别等因素有关（P〈0．05）;多因素分析显示,周围组织肿瘤侵犯、肿瘤坏死、肿瘤大小、核分裂相数目及性别是影响预后的重要因素。结论肿瘤大小及核分裂相数目是影响预后的重要因素,但准确判别预后尚应结合肿瘤坏死、性别、肿瘤部位及其他病理参数进行。