胃肠间质瘤135例临床诊治分析

目的探讨胃肠道平滑肌肿瘤与胃肠间质瘤(GIST)的关系及外科治疗的效果。方法重新调出1993-2003年间收治的资料完整的86例胃肠道平滑肌瘤或平滑肌肉瘤患者的病理组织重新病理复检,结合2000年1月至2005年7月确诊GIST的71例病例资料进行分析。并完成随访。结果86例原诊断胃肠道平滑肌瘤或平滑肌肉瘤的患者共有78例完成免疫组化检测,有64例(82.1%)被纠正诊断为GIST。共计135例GIST患者中,男性65例,女性70例;平均发病年龄53岁。均接受手术治疗,130例(96.3%)为完全切除;术后总体5年生存率为79.7%。完全切除者术后总体生存率与首诊转移、肿瘤大小、核分裂和术后复发转移有关(P<0.01);无病生存率的多因素回归分析中发现,完全切除术后无病生存率与首诊已有转移和核分裂数有关(P<0.01)。结论既往胃肠道平滑肌肿瘤大部分应纠正诊断为GIST。GIST以外科治疗为主。完全切除很重要。首诊肿瘤转移和核分裂数是独立的预后因素。

Diagnosis and treatment of gastrointestinal stromal tumors:report of 135 cases

Objective To analyze the relationships between smooth-muscle tumors of gastrointestinal (GI) tract and gastrointestinal stromal tumors (GISTs),and the efficacy of surgical management.Methods The clinical and pathological data of 135 cases of GISTs were collected, including cases of Ieiomyomas/leiomyosareoma between 1993 and 2003 and GIST between Jan.2000 and Jul.2005.The surgical outcomes were analyzed retrospectively.Results 82.1% of former leiomyomas/ leiomyosareomas was corrected to GISTs.Overall 5-year survival rate was 79.7%.Univariate analysis revealed preoperative metastasis,tumor size,mitotic index,and postoperative metastasis or recurrence were correlated with overall survival in patients with completed resection.Multivariate analysis showed that only postoperative metastasis or recurrence were the indicators of poor prognosis,but without statistical significance (P=0.064).However,multivariate analysis for disease-free survival showed that preoperative metastasis and mitotic index were two independent predictors of poor prognosis (P=0.001 and P<0.001).Conclusions Most former leiomyomas/leiomyosarcomas of GI tract should be corrected to the diagnosis of GISTs.Complete surgical resection is the choice of treatment for GISTs. Preoperative metastasis and mitotic index are two independent predictors of poor prognosis.