CAJ | 학술논문

目的探讨胃肠间质瘤(GIST)的临床诊治经验,分析其病理特征和影响GIST预后的因素.方法回顾性分析1999年1月至2007年12月间经手术治疗的181例GIST患者的临床病理及随访资料,根据Fletcher推荐的生物学行为分级法进行分组,比较不同因素对生存率的影响并进行预后分析.结果本组GIST病变部位:胃107例(59.1%),小肠51例(28.2%),结直肠等其他部位23例(12.7%);伴有肝转移7例.172例(95.0%)术前通过影像学检查明确病灶部位,其中胃镜53.5%(92/172),CT 34.3%(59/172),超声内镜或胶囊内镜17.4%(30/172).瘤体长径0.5～30.0 cm不等,平均7.0 cm.CD117阳性171例(94.5%),CD34阳性156例(86.2%).外科手术完全切除176例,其中合并联合脏器切除26例;姑息性切除或活检术5例.全组患者1、3、5年生存率分别为95.2%、87.9%和78.5%.单因素分析显示,年龄、肿瘤大小、肿瘤原发部位、核分裂像数目、Fletcher分级和是否合并联合脏器切除对生存率有影响(P<0.05);多因素分析显示,Fletcher分级和肿瘤大小是影响预后的因素.术后有8例高危患者和3例复发转移患者服用伊马替尼后病情稳定.结论内镜和CT是GIST有效的诊断手段,用Fietcher分级法来判断GIST的生物学行为和预测预后是简单、有效的方法,外科手术仍是目前GIST的主要治疗方法,而结合靶向治疗将成为改善GIST预后的重要手段.
목적 탐토위장간질류(GIST)적림상진치경험,분석기병리특정화영향GIST예후적인소.방법 회고성분석1999년1월지2007년12월간경수술치료적181례GIST환자적림상병리급수방자료,근거Fletcher추천적생물학행위분급법진행분조,비교불동인소대생존솔적영향병진행예후분석.결과 본조GIST병변부위:위107례(59.1%),소장51례(28.2%),결직장등기타부위23례(12.7%);반유간전이7례.172례(95.0%)술전통과영상학검사명학병조부위,기중위경53.5%(92/172),CT 34.3%(59/172),초성내경혹효낭내경17.4%(30/172).류체장경0.5～30.0 cm불등,평균7.0 cm.CD117양성171례(94.5%),CD34양성156례(86.2%).외과수술완전절제176례,기중합병연합장기절제26례;고식성절제혹활검술5례.전조환자1、3、5년생존솔분별위95.2%、87.9%화78.5%.단인소분석현시,년령、종류대소、종류원발부위、핵분렬상수목、Fletcher분급화시부합병연합장기절제대생존솔유영향(P<0.05);다인소분석현시,Fletcher분급화종류대소시영향예후적인소.술후유8례고위환자화3례복발전이환자복용이마체니후병정은정.결론 내경화CT시GIST유효적진단수단,용Fietcher분급법래판단GIST적생물학행위화예측예후시간단、유효적방법,외과수술잉시목전GIST적주요치료방법,이결합파향치료장성위개선GIST예후적중요수단.
Objective To investigate the therapeutic experience of gastrointestinal stromal tumors (GIST) and to analyze the pathological features and prognostic factors of GIST. Methods The clinicopathologieal and follow-up data of 181 patients with GIST admitted in Renji Hospital between January 1999 and December 2007 were analyzed retrospectively. All the cases were grouped according to Fletcher's risk scheme. Life table and COX regression model were used to evaluate the prognostic factors. Results Out of 181 tumors, 107(59.1%) were located in stomach, 51 (28.2%) in intestine and 23 (12.7%) in colorectum or other sites. Distant metastases,including liver metastases were found in 7 patients intraoperatively. Tumor size ranged from 0.5 to 30 cm with the mean of 7.02 cm. The positive rate of CD117 was 94.5% (171/181) and that of CD34 was 86.2% (156/181). One hundred and seventy-six patients underwent complete resections, including multi-organ resections in 26 patients. The other patients underwent palliative operations. The 1-, 3-and 5-year overall survival rates of 181 patients were 95.2%, 87.9% and 78.5% respectively. Univariate analysis revealed age, tumor size, primary organ of tumor, mitotic count, Fletcher's classification and multi-organ resection were associated with survival rate. No significant difference of sex was existed among groups. COX hazard proportional model revealed that advanced stage and large tumor size indicated worse prognosis. Eight patients with high risk of recurrence and 3 patients with recurrence and metastasis were stable after receiving imatinib therapy. Conclusions The diagnosis of GIST depends on endoscope and CT. Fletcher's classification is simple and effective to evaluate GIST behavior and prognosis. Surgical resection is still the main therapy for GIST and targeted therapy will play a more important role for prognosis in the future.