胃间质瘤63例临床分析

目的总结胃间质瘤（胃GIST）的临床病理及免疫组织化学（免疫组化）特征，探讨胃GISTs诊断与治疗的方法及影响其预后的因素。方法总结1997年1月至2007年5月北京大学第一医院普通外科收治的63例经手术治疗的胃GISTs患者的临床资料，并进行Flecther侵袭危险性分级和预后分析。结果B超、CT及内镜超声（EUS）对本组患者的术前诊断准确率分别为72．2％、81．0％和94．3％。F=6．065，P〈0．05；差异有统计学意义。CD117阳性率88．9％，CD34阳性率95．1％。开腹或腹腔镜行胃部分切除38例，近端胃大部切除4例，远端胃大部切除8例；全胃切除13例，其中联合胆囊切除3例，联合胰体尾及脾切除7例；联合左肝外侧叶切除1例，行D：淋巴结清扫12例（均无淋巴结转移）。全组病例1、3、5年生存率分别为96．4％、84．7％和71．7％。单因素分析显示，侵袭危险性分级和肿瘤大小是影响患者生存的因素（P〈0．05）；而性别、年龄、核分裂像、免疫组化表达情况、是否联合脏器切除以及是否行淋巴结清扫与预后元关（P〉0．05）。多因素分析显示，侵袭危险性分级是胃GIST的独立预后因素（P=0．041）。结论术前EUS诊断准确率最高。建议用Fletcher侵袭危险性分级方法来判断胃GISTs的生物学行为及其预后。

Clinical analysis of 63 cases with gastric gastrointestinal stromal tumors

Objective To analyze the clinicopathological characteristics of gastric gastrointestinal stromal tumors (gastric GISTs) and to explore the diagnosis, treatment and prognosis of gastric GISTs. Methods Clinical data of 63 cases with gastric GISTs from January 1997 to May 2007 were analyzed retrospectively. All patients were treated by surgery. All the 63 cases were grouped according to the Fletcher 4-tier system for predicting the aggressiveness of GISTs. Survival was calculated by Kaplan-Meier method. Univariate and multivariate analyses were performed using log-rank analysis and Cox regression model respectively to evaluate the prognostic factors. Results The accuracy of preoperative ultrasonography, CT and EUS was 72.2%, 81.0% and 94.3% respectively. The diagnostic accuracy of EUS was significantly higher than those of ultrasonagraphy and CT (X2=6.065, P<0.05). Of the 63 gastric GISTs, 31 cases (49.20%) were at fundus. Immunohistochemistry staining revealed that the positive rates of CD117 and CD34 were 88.9% and 95.1% respectively. The 1-, 3- and 5-year total survival rates of 63 patients were 96.4%, 84.7% and 71.7% respectively. Univariate analysis revealed that the differences of Fletcher classification and tumor size were significant. No significant differences in gender, age, mitotic index, immunohistochemistry expression and multi-organ resection existed among the groups. Multivariate analysis demonstrated that Fletcher classification was the independent poor prognostic factor for survival. Conclusions The preoperative diagnostic accuracy of EUS is significantly higher than those of ultrasonography and CT. Fletcher classification is reasonable and feasible to evaluate the prognosis of gastric GISTs.