CAJ | 학술논문

目的探讨胃肠道间质瘤(GIST)的分级和分期方法方法依据自建的新的方法用12项指标对613例GIST进行了分级和分期的研究.此12项指标包括2项肉眼播散指标(包括肝转移和腹膜播散),5项显微镜下播散指标(包括淋巴结转移,血管、脂肪、神经和黏膜浸润),以及5项组织形态学指标(包括核分裂象≥10/50 HPF、肌层浸润、肿瘤性坏死、围绕血管呈簇状排列和明显异形).结果在293例无上述指标的患者中,5年无瘤生存率(DFS)和5年总生仔率(OS)分别为99.3％和100.0％,此组被划分为非恶性GIST,不需要进一步分级.在318例患者中发现至少1项至6项上述指标,另2例患者有7项上述指标.此320例患者术后5年DFS和5年OS分别为43.9％(中位6.7年)和59.7％(中位9.3年).有无肉眼播散(P＜0.01)和有无镜下播散(P=0.001)的患者DFS显示差异有统计学意义.在无肉眼播散的患者中,DFS和OS与恶性指标数相关(均P＜0.01),但在有肉眼播散的患者中,DFS和OS与恶性指标数无关(分别为P=0.882和0.441) 结论恶性GIST可以依据无或有肉眼播散划分为临床Ⅰ期和Ⅱ期.临床Ⅰ期GIST可依据恶性指标数分级.临床Ⅱ期GIST预后差,预后与恶性指标数无关,不再分级.此种分级和分期与预后密切相关.
목적 탐토위장도간질류(GIST)적분급화분기방법 방법 의거자건적신적방법용12항지표대613례GIST진행료분급화분기적연구.차12항지표포괄2항육안파산지표(포괄간전이화복막파산),5항현미경하파산지표(포괄림파결전이,혈관、지방、신경화점막침윤),이급5항조직형태학지표(포괄핵분렬상≥10/50 HPF、기층침윤、종류성배사、위요혈관정족상배렬화명현이형).결과 재293례무상술지표적환자중,5년무류생존솔(DFS)화5년총생자솔(OS)분별위99.3％화100.0％,차조피화분위비악성GIST,불수요진일보분급.재318례환자중발현지소1항지6항상술지표,령2례환자유7항상술지표.차320례환자술후5년DFS화5년OS분별위43.9％(중위6.7년)화59.7％(중위9.3년).유무육안파산(P＜0.01)화유무경하파산(P=0.001)적환자DFS현시차이유통계학의의.재무육안파산적환자중,DFS화OS여악성지표수상관(균P＜0.01),단재유육안파산적환자중,DFS화OS여악성지표수무관(분별위P=0.882화0.441) 결론 악성GIST가이의거무혹유육안파산화분위림상Ⅰ기화Ⅱ기.림상Ⅰ기GIST가의거악성지표수분급.림상Ⅱ기GIST예후차,예후여악성지표수무관,불재분급.차충분급화분기여예후밀절상관.
Objective To investigate the clinical stage and histological grade of gastrointestinal stromal tumors.Methods Twelve clinical and pathological parameters were assessed in 613 patients with follow-up information.These parameters were classified into two gross spread parameters including liver metastasis and peritoneal dissemination,five microscopic spread parameters including lymph node metastasis,vascular,fat,nerve and mucosal infiltration,aud five histological parameters including mitotic count ≥ 10 per 50 high-power fields,muscularis propria infiltration,coagulative necrosis,perivascular pattern and severe nuclear atypia.Results The accumulated 5-year disease-free survival (DFS) and overall survival (OS) of 293 patients without any of these predictive parameters of malignancy were 99.3％ and 100.0％,respectively.They were regarded as nonmalignant and further evaluations on the stage and grade of these tumors were not performed.At least one and at most seven predictive parameters of malignancy were identified in 320 patients.For these patients,the accumulated 5-year DFS and OS rates were 43.9％ (mean 6.7 years) and 59.7％ (mean 9.3 years),respectively.The DFS showed significant difference between patients with and without gross spread (P ＜ 0.01),with and without microscopic spread (P =0.001).DFS and OS were associated with the number of predictive parameters of malignancy in patients without gross spread (P ＜ 0.01 for both DFS and OS),but not in patients with gross spread (P =0.882 and 0.441,respectively).Conclusions Malignant GIST could be divided into clinical stages Ⅰ and Ⅱ based on the absence and presence of gross spread,respectively.The degree of malignancy of patients in clinical stage Ⅰ could be graded according to the number of predictive parameters of malignancy.Patients in clinical stage Ⅱ were of the highest degree of malignancy regardless of the number of parameters.The staging and grading of gastrointestinal stromal tumors in this study are strongly associated with prognosis.