胃肠道间质瘤患者87例病理学改变及其与预后的关系

目的探讨胃肠道间质瘤（gastrointestinal stromal tumor，GIST）患者病理学改变特征、临床分期及其与预后的关系。方法收集2000年6月至2009年1月本院收治的87例GIST患者临床病理、病理组织免疫组化及随访资料。Kaplan－Meier法计算生存率并进行单因素分析，COX回归法进行多因素分析。结果87例患者5年的无瘤生存率（disease－free survival，DFS）为65．8％；5年的总体生存率（overall survival，OS）为67．4％。免疫组化结果：CDll7阳性率：86．8％；CD34阳性率：88．1％；SMA阳性率：25％；S-100阳性率：5．26％。CDll7、CD34、SMA和S-100表达与无瘤生存期和总生存期间无相关关系。单因素分析结果提示：细胞密集程度、核异型程度、肿瘤原发部位、肿瘤大小、有丝分裂数目、NIH分级、Miettinen分级和TNM分期等因素与患者的无瘤生存期间有相关关系（P〈0．05）。多因素分析结果提示：细胞密集程度、有丝分裂数目、原发部位和TNM分期是影响无瘤生存的独立因素（P〈0．05）。TNM分期是影响患者无瘤生存率和总生存率的独立影响因素（P〈0．05）。结论细胞密集程度、核异型程度、肿瘤原发部位、肿瘤大小、有丝分裂数目以及NIH分级、Miettinen分级和TNM分期均可影响GIST患者的预后。细胞密集程度、有丝分裂数目、发病部位和TNM分期是影响GIST患者无瘤生存率的独立因素。

Relationship of pathological features with prognosis in 87 patients with gastrointestinal stromal tumor

Objective To investigate the relationship of pathological features and clinical staging with prognosis in patients with gastrointestinal stromal tumor(GIST).Methods Clinical pathological,immunohistochemical and follow-up information of 87 patients in Shanxi Cancer Hospital from June 2000 to January 2009 were collected.The primary location,size,distal metastasis,mitotic number,cell shape and density,nuclear atpyia and immunohistochemical results(CD117,CD34 and SMA S-100) were observed.Results Five-year disease-free survival(DFS) was 65.8% and five-year overall survival(OS) was 67.4% for all 87 patients.Immunohistochemical results showed that the positive rate of CD117,CD34,SMA and S-100 was 86.8%,88.1%,25% and 5.26%,respectively.CD117、CD34、SMA and S-100 had no statistical significance for DFS and OS.Univariate analysis showed that cell density,nuclear atpyia,primary location of the tumor,size of the tumor,mitotic number,NIH grading,Miettinen grading and TNM staging had effects on DFS(P < 0.05).Multivariate analysis showed that the cell density,mitotic number,primary location and TNM staging were independent factors of DFS(P < 0.05).TNM stage was the independent factor of DFS and OS(P < 0.05).Conclusions Cell density,nuclear atpyia,primary location of the tumor,size of the tumor,mitotic number,NIH grading,Miettinen grading and TNM staging all can influence prognosis of GIST patients who are not treated with imatinib.Cell density,primary location of the tumor,mitotic number and TNM stages are the independent factors of DFS in GIST patients.