CAJ | 학술논문

目的探讨胃胃肠间质瘤(GIST)合并胃癌患者的临床病理特点及预后影响因素.方法回顾性分析2000年4月至2010年6月间在福建医科大学附属协和医院接受手术治疗的122例原发性胃GIST患者的临床资料,其中合并胃癌者(合并组)26例,无合并胃癌者(无合并组)96例.比较两组患者中胃GIST的临床病理特点,并对全组患者的预后进行单因素及多因素分析.结果与无合并组相比,合并组患者GIST肿瘤最大直径更小(P＜0.01)、核分裂像更少(P＜0.05)、Fletcher分级更低(合并组76.9％为极低-低危者,P＜0.01).合并组患者术前诊断率明显低于无合并组(23.1％比97.9％,P＜0.01)；5年生存率(58.0％)低于无合并组(79.4％) (P=0.027).单因素预后分析显示,肿瘤最大直径(P＜0.01)、核分裂像(P＜0.01)、Fletcher分级(P＜0.01)、是否合并胃癌(P＜0.05)与患者预后有关；多因素预后分析显示,Fletcher分级(P＜0.05)和是否合并胃癌(P＜0.01)是影响患者预后的独立因素.结论胃GIST合并胃癌的患者其GIST的Fletcher分级大多为极低或低侵袭危险度,对预后影响较小,其生存时间主要取决于胃癌.
목적 탐토위위장간질류(GIST)합병위암환자적림상병리특점급예후영향인소.방법 회고성분석2000년4월지2010년6월간재복건의과대학부속협화의원접수수술치료적122례원발성위GIST환자적림상자료,기중합병위암자(합병조)26례,무합병위암자(무합병조)96례.비교량조환자중위GIST적림상병리특점,병대전조환자적예후진행단인소급다인소분석.결과 여무합병조상비,합병조환자GIST종류최대직경경소(P＜0.01)、핵분렬상경소(P＜0.05)、Fletcher분급경저(합병조76.9％위겁저-저위자,P＜0.01).합병조환자술전진단솔명현저우무합병조(23.1％비97.9％,P＜0.01)；5년생존솔(58.0％)저우무합병조(79.4％) (P=0.027).단인소예후분석현시,종류최대직경(P＜0.01)、핵분렬상(P＜0.01)、Fletcher분급(P＜0.01)、시부합병위암(P＜0.05)여환자예후유관；다인소예후분석현시,Fletcher분급(P＜0.05)화시부합병위암(P＜0.01)시영향환자예후적독립인소.결론 위GIST합병위암적환자기GIST적Fletcher분급대다위겁저혹저침습위험도,대예후영향교소,기생존시간주요취결우위암.
Objective To evaluated the clinicopathologic features and prognostic factors of gastric gastrointestinal stromal tumor (GIST) with synchronous gastric cancer.Methods The clinicopathologic records of 122 patients with gastric GIST who underwent surgical treatment from April 2000 to June 2010 were analyzed retrospectively.Twenty-six patients presented synchronous gastric cancer (group A),while 96 patients did not (group B).The clinicopathologic features of gastric GIST were compared between the two groups.Potential prognostic factors were evaluated by univariate and multivariate analyses.Results Gastric GIST in group A were assoicated with smaller tumor diameter (P＜0.01),lower mitotic count(P＜0.05),lower Fletcher classification(P＜0.01),and lower rate of pre-operative diagnosis (23.1％ vs.97.9％,P＜0.01).On univariate analysis, maximum tumor diameter (P＜0.01),mitotic count (P＜0.01),Fletcher classification (P＜0.01) and synchronous gastric cancer (P＜0.05) were the predictive factors of survival.Multivariate analysis showed that Fletcher classification (P＜0.05) and synchronous gastric cancer (P＜0.01) were independent prognostic factors.Conclusions In patients with synchronous gastric GIST and gastric cancer, Fletcher classification of GIST is usually very low or low invasion risk and has minimal impact on the prognosis.Survival depends primarily on the gastric cancer.