中华普通外科杂志
中華普通外科雜誌
중화보통외과잡지
CHINESE JOURNAL OF GENERAL SURGERY
2009年
4期
273-277
,共5页
郑松%黄科儿%陶德友%潘月龙
鄭鬆%黃科兒%陶德友%潘月龍
정송%황과인%도덕우%반월룡
胃肠道间质肿瘤%原癌基因蛋白质c-kit%基因突变%预后%血小板衍生生长因子受体α
胃腸道間質腫瘤%原癌基因蛋白質c-kit%基因突變%預後%血小闆衍生生長因子受體α
위장도간질종류%원암기인단백질c-kit%기인돌변%예후%혈소판연생생장인자수체α
Gastrointestinal stromal tumors%Proto-oncogene protein c-kit%Gene mutation%Prognosis:Platelet-derived growth factor receptor α
目的 探讨腹腔内胃肠道外间质瘤(EGIST)中c-kit和血小板衍生生长因子受体α(PDGFR-α)基因突变、临床病理特征和预后的影响因素.方法 应用免疫组织化学方法检测23例EGIST中CD117、CD34和Ki-67蛋白的表达,应用PCR扩增和基因测序的方法检测c-kit和PDGFR-α基因突变,结合临床病理特征分析影响EGIST患者预后的相关因素.采用Kaplan-Meier法和COX比例风险模型比较不同因素对生存的影响.结果 本组c-kit基因的突变率为44%,均为第11号外显子突变;PDGFR-α基因的突变率是13%,均为第18号外显子的突变(D842V点突变).CD117表达阳性率是100%,CD34表达阳性率为74%.Ki-67指数:＜1%者占30%,1%～5%者占44%,＞5%者占26%.生存分析显示,核分裂象数目(P=0.025)和Ki-67指数(P=0.032)与疾病相关生存时间相关.结论 EGIST有着与GIST相似的c-kit和PDGFR-α基因突变位点,并且c-kit基因突变频率也相近,但是PDGFR-α基因突变频率较GIST稍高.可以将EGIST作为GIST的一个特殊亚型.结合核分裂象和Ki-67指数对EGIST进行分级是判断预后的一个较好的标准.
目的 探討腹腔內胃腸道外間質瘤(EGIST)中c-kit和血小闆衍生生長因子受體α(PDGFR-α)基因突變、臨床病理特徵和預後的影響因素.方法 應用免疫組織化學方法檢測23例EGIST中CD117、CD34和Ki-67蛋白的錶達,應用PCR擴增和基因測序的方法檢測c-kit和PDGFR-α基因突變,結閤臨床病理特徵分析影響EGIST患者預後的相關因素.採用Kaplan-Meier法和COX比例風險模型比較不同因素對生存的影響.結果 本組c-kit基因的突變率為44%,均為第11號外顯子突變;PDGFR-α基因的突變率是13%,均為第18號外顯子的突變(D842V點突變).CD117錶達暘性率是100%,CD34錶達暘性率為74%.Ki-67指數:＜1%者佔30%,1%～5%者佔44%,＞5%者佔26%.生存分析顯示,覈分裂象數目(P=0.025)和Ki-67指數(P=0.032)與疾病相關生存時間相關.結論 EGIST有著與GIST相似的c-kit和PDGFR-α基因突變位點,併且c-kit基因突變頻率也相近,但是PDGFR-α基因突變頻率較GIST稍高.可以將EGIST作為GIST的一箇特殊亞型.結閤覈分裂象和Ki-67指數對EGIST進行分級是判斷預後的一箇較好的標準.
목적 탐토복강내위장도외간질류(EGIST)중c-kit화혈소판연생생장인자수체α(PDGFR-α)기인돌변、림상병리특정화예후적영향인소.방법 응용면역조직화학방법검측23례EGIST중CD117、CD34화Ki-67단백적표체,응용PCR확증화기인측서적방법검측c-kit화PDGFR-α기인돌변,결합림상병리특정분석영향EGIST환자예후적상관인소.채용Kaplan-Meier법화COX비례풍험모형비교불동인소대생존적영향.결과 본조c-kit기인적돌변솔위44%,균위제11호외현자돌변;PDGFR-α기인적돌변솔시13%,균위제18호외현자적돌변(D842V점돌변).CD117표체양성솔시100%,CD34표체양성솔위74%.Ki-67지수:＜1%자점30%,1%～5%자점44%,＞5%자점26%.생존분석현시,핵분렬상수목(P=0.025)화Ki-67지수(P=0.032)여질병상관생존시간상관.결론 EGIST유착여GIST상사적c-kit화PDGFR-α기인돌변위점,병차c-kit기인돌변빈솔야상근,단시PDGFR-α기인돌변빈솔교GIST초고.가이장EGIST작위GIST적일개특수아형.결합핵분렬상화Ki-67지수대EGIST진행분급시판단예후적일개교호적표준.
Objective To evaluate prognostic significance of c-kit and PDGFR-α gene mutation in extragastrointestinal stromal tumors(EGIST). Methods Paraffin embedded tissue specimens from 23 EGISTs were tested for CD117,CD34 and Ki-67 expression by immunohistochemical method.EGIST cases were also tested for the presence of c-kit exons 9,11,13,17 mutations and PDGFR-α exons 12,18 mutations.Kaplan-meier survival rate was used to evaluate the prognostic factors. Results Of 23 cases of EGIST,23(100%)were positive for CD117,17(74%)were positive for CD34.For Ki-67 labeling index(Ki-67 LI):30%were＜1%,44%were between 1%-5%,26%were＞5%.C-kit mutations were detected in 44% of EGIST patients and all were of exon 11 mutations.PDGFR-α mutations were found in 13%of all the 23 cases and all were of exon 18 mutations(The commonest type of mutation D842V).Survival analysis indicated that mitotic count and Ki-67 index were significant predictors for survival.Conclusion The pattern of c-kit and PDGFR-α mutation in EGIST was essentially similar to that in GIST.But the mutation frequency of PDGFR-α was slightly higher in EGIST than in GIST.EGIST could be a special subtype of GIST.The results of this study also show combination of mitotic counts and Ki-67 labeling index may be useful for predicting the prognosis of EGIST.
