CAJ | 학술논문

目的探讨Fletcher和Miettinen两种不同分级标准对胃肠道间质瘤(gastrointestinal stromal tumors,GIST)危险程度评估的价值.方法收集165例有完整临床病理及随访资料的GIST病例,应用Fletcher和Miettinen分级标准分别对165例和164例GIST的危险程度进行评估,应用Kaplan-Meier生存分析比较这两种标准在预测GIST恶性潜能中的价值.结果本组165例按Fletcher分级标准评估GIST,其中高危组59例(35.8%)、中危组49例(29.7%)、低危组43例(26.1%)和极低危组14例(8.5%);按Miettinen分级标准评估164例GIST,其中高危组68例(41.5%)、中危组23例(14.0%)、低危组60例(36.6%)和极低危组13例(7.9%).两种分级中高危组的生存时间和无瘤生存时间均显著低于极低危、低危和中危组(P<0.05);中危组的生存时间和无瘤生存时间都显著低于低危组(P<0.05).Fletcher标准中高危组的肠GIST与胃GIST的无瘤生存时间相比差异有统计学意义(P=0.022),中危组的肠GIST与胃GIST的生存时间相比差异有统计学意义(P=0.032);Miettinen标准中极低危、低危、中危和高危各组中,胃GIST与肠GIST的生存时间和无瘤生存时间相比差异均无统计学意义(P>0.05).结论 Fletcher分级标准相对简易,对GIST预后评估有一定的价值;Miettinen分级标准按不同发病部位评估更能精确判别GIST生物学行为,对高危患者的准确判断及术后靶向治疗具有重要指导作用.
목적 탐토Fletcher화Miettinen량충불동분급표준대위장도간질류(gastrointestinal stromal tumors,GIST)위험정도평고적개치.방법 수집165례유완정림상병리급수방자료적GIST병례,응용Fletcher화Miettinen분급표준분별대165례화164례GIST적위험정도진행평고,응용Kaplan-Meier생존분석비교저량충표준재예측GIST악성잠능중적개치.결과 본조165례안Fletcher분급표준평고GIST,기중고위조59례(35.8%)、중위조49례(29.7%)、저위조43례(26.1%)화겁저위조14례(8.5%);안Miettinen분급표준평고164례GIST,기중고위조68례(41.5%)、중위조23례(14.0%)、저위조60례(36.6%)화겁저위조13례(7.9%).량충분급중고위조적생존시간화무류생존시간균현저저우겁저위、저위화중위조(P<0.05);중위조적생존시간화무류생존시간도현저저우저위조(P<0.05).Fletcher표준중고위조적장GIST여위GIST적무류생존시간상비차이유통계학의의(P=0.022),중위조적장GIST여위GIST적생존시간상비차이유통계학의의(P=0.032);Miettinen표준중겁저위、저위、중위화고위각조중,위GIST여장GIST적생존시간화무류생존시간상비차이균무통계학의의(P>0.05).결론 Fletcher분급표준상대간역,대GIST예후평고유일정적개치;Miettinen분급표준안불동발병부위평고경능정학판별GIST생물학행위,대고위환자적준학판단급술후파향치료구유중요지도작용.
Objective To evaluate two different histopathological classification systems (Fletcher and Miettinen) for the risk in cases of gastrointestinal stromal tumors (GIST). Methods One hundred and sixty-five GIST cases with complete clinicopathologic and follow-up data were evaluated for their biologic potential by the histopathological classification systems of Fletcher, and among those, 164 cases GIST were evaluated by the histopathological classification systems of Miettinen. The implication of two classification systems were compared by survival analysis. Results Evaluated by Fletcher histopathological classification system, 59 cases (35. 8%) were graded as high risk, 49 cases (29. 7%) as intermediate risk, 43 cases (26. 1%) as low risk and 14 cases (8. 5%) were very-low risk. Evaluated by Miettinen's system, 68 cases (41.5%) were as high risk, 23 cases (14. 0%) were intermedatie risk, 60 cases (36. 6%) were low risk and 13 cases (7. 9%) were very-low risk. Evaluated by both two systems, the survival time and disease-free survival time of high risk GIST were lower than those of very-low, low and intermediate risk GIST(P <0. 05), the survival time and disease-free survival time of intermediate risk GIST were lower than those of low risk GIST(P<0. 05). According to Fletcher's system, in the high risk GIST, the disease-free survival time of small intestinal, colonic and rectal GIST was lower than that of gastric GIST(P = 0. 022), and in the intermediate risk GIST, the survival time of small intestinal, colonic and rectal GIST was lower than that of gastric GIST(P =0. 032). According to Miettinen's system, in the risk subgroup of GIST, the survival time and disease-free survival time of gastric, small intestinal, colonic and rectal GIST has no statistical difference(P > 0. 05). Conclusions Fletcher histopathological classification system is simple and easy to use, while Miettinen's system for evaluating biological potential by anatomic site is more accurate and predictive in the selection of high risk patients for target adjuvant treatment.