胃肠间质瘤的预后因素分析

目的 探讨胃肠间质瘤（gastrointcstinal stromal tumors，GIST）病理组织特点及其免疫组化表达情况，并对影响GSIT患者预后因素进行分析，为临床GIST的诊疗提供依据。方法 收集经病理诊断的67例GIST患者临床病理资料并进行随访，所有GIST患者均行常规病理及免疫组化检查，对CD117、CD34、S-100、dog-1、desmin染色特点进行分析。运用Life-table法计算总生存期并绘制生存曲线加以比较，采用Cox风险比例模型分析影响预后的因素。结果 67例GIST中，病变位于胃41例，肠17例，胃肠道以外9例；组织学类型主要以梭型细胞型多见，为52例，其次为上皮细胞型12例，混合细胞型最少，为3例；免疫组化CD117阳性61例，CD34阳性52 例，S-100阳性28例，dog-1阳性65例，desmin阳性23例；发生于消化道的GIST其CD117、CD34、dog-1的表达均高于发生于消化道外者，二者差异均有统计学意义（P<0.05），而S-100及desmin的表达在二者间的差异无统计学意义（P＞0.05）。单因素及多因素分析均提示GIST预后与是否存在远处转移、危险度分级、格列卫治疗情况有关（P<0.05），而与患者年龄、性别、肿瘤部位、肿瘤直径和CD117的表达情况均无关（P＞0.05）。结论 GIST常见的组织学类型为梭型细胞型，胃为GIST最常见的发生部位，其次是肠，发生于腹膜外的GIST少见；CD117、CD34、dog-1在GIST中呈高表达，发生于消化道与消化道外的GIST其免疫组化分子的表达存在差异。远处转移、危险度分级和格列卫治疗情况是影响GIST患者预后的独立因素。

Prognosis analysis of gastrointestinal stromal tumor

Objective  To investigate the histopathological features，immunohistochemical expression and prognostic factors of gas-trointestinal stromal tumor （GIST）. Methods Clinical and pathological data were collected from 67 patients with gastrointestinal stromal tumors. All patients underwent routine pathological and immunohistochemical examination of CD117，while CD34，S-100，dog-100， desmin staining characteristics were also analyzed. Life-table method was used to estimate overall survival and survival plot curves. COX proportional hazards model was used to analyze the prognostic factors of GSIT. Results Of all the 67 cases，41 were located at stomach，17 were in bowel，and the other 9 were in the gastrointestinal tract. The most common seen histological type were fusiform common in 52 cases，followed by 12 cases of epithelial cell type，3 cases of mixed cell type. Immunohistochemistry results：61 were CD117-positive，52 were CD34-positive，65 weredog-1-positive，28 were S-100-positive and 23 were desmin-positive. The expression of  CD117，CD34，dog-1 were higher in the digestive tract than the other that are not（P<0.05）. Multivariate analysis showed that GIST prognosis was associated with distant metastasis，Gleevec treatment and risk classification（P<0.05），but not associated with sex，age，tumor location， tumor size，and CD117 expression（P＞0.05）. Conclusions  The most common type of GIST was spindle cells and stomach is the most common occurrence site，followed by intestine. CD117，CD34，dog-1 were highly expressed in the GIST. Risk classification， metastasis and Gleevec treatment were independent prognostic factors of GIST.