| 江 凡,王忠丹,宋明霞,等.小胃肠间质瘤临床病理特征及预后48例分析[J].肿瘤学杂志,2023,29(8):698-703. |
| 小胃肠间质瘤临床病理特征及预后48例分析 |
| Clinicopathological Features and Prognosis of 48 Cases with Small Gastrointestinal Stromal Tumor |
| 投稿时间：2023-01-18 |
| DOI：10.11735/j.issn.1671-170X.2023.08.B010 |
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| 中文关键词: 小胃肠间质瘤 临床病理特征 预后 |
| 英文关键词:small gastrointestinal stromal tumor clinicopathological features prognosis |
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| 中文摘要: |
| 摘 要：［目的］ 探讨小胃肠间质瘤（gastrointestinal stromal tumor， GIST）临床病理特征及预后。［方法］ 回顾性分析48例小GIST临床病理资料，分析患者预后，ROC曲线分析以确定预测恶性潜能的最佳肿瘤直径。［结果］ 48例小GIST患者，男性20例，女性28例；中位年龄63岁。临床表现以腹痛（31.25%）和无明显症状（25.00%）为主，好发于胃部（87.50%），其中21例合并其他恶性肿瘤。46例（95.83%）为梭形细胞型，1例为上皮细胞型，1例为混合细胞型。44例（91.67%）核分裂计数≤5/5 mm2，20例为中度或重度异型性，分别在1例、5例患者中检测到坏死、钙化灶。44例极低危险度，3例中危危险度，1例高危危险度。其中9例行基因检测，以C-KIT外显子11（W557-K558）缺失突变常见。相关性分析显示有丝分裂计数与肿瘤大小之间呈正相关（r=0.425，P=0.002 6）。ROC曲线分析提示0.75 cm是预测恶性效能最佳的肿瘤直径（曲线下面积为0.82，95%CI：0.714~0.943）。中位随访27个月后，1例患者局部复发，未见远处转移。［结论］ 小GIST多见于中老年人，最常见于胃，临床症状不典型，发病具有隐匿性。小GIST多为梭形细胞型，绝大部分表现为较低的核分裂计数，直径小于1 cm的间质瘤具有较低的恶性潜能。肿瘤大小和有丝分裂计数是影响小GIST预后的两个重要因素。肿瘤直径大于0.75 cm者应观察更积极。 |
| 英文摘要: |
| Abstract： ［Objective］ To analyze the clinicopathologic features and prognosis of small gastrointestinal stromal tumor(GIST). ［Methods］ The clinicopathologic data of 48 cases with small GIST were analyzed retrospectively. ROC curve was used to determine the tumor diameter for predicting malignant potential. ［Results］ There were 20 males and 28 females with a median age of 63 years. The main clinical manifestation was abdominal pain(31.25%) and 25.00% patients had no obvious symptoms. Most of tumors(87.50%) were located in the stomach， among which 21 cases were complicated with other malignant tumor. Pathologically 46 cases were spindle cell type(95.83%) ， 1 case was epithelial cell type and 1 case was mixed cell type. Nuclear fission were ≤5/5 mm2 were observed in 44 cases(91.67%) ， and moderately or severely heterotropic were in 20 cases. Necrotic and calcification foci were detected in 1 and 5 patients， respectively. There were 44 cases of very low risk， 3 cases of medium risk and 1 case of high risk. The deletion mutation of C-KIT exon 11(W557-K558) was common in 9 cases. Pearson correlation analysis show that mitotic count was positively correlated with tumor size(r=0.425， P=0.002 6). The area under ROC curve of tumor diameter of 0.75 cm for predicting malignant potential was 0.82（95%CI： 0.714~0.943， P<0.01). After a median follow-up of 27 months， 1 patient had local recurrence and no distant metastasis. ［Conclusion］ Small GIST occurs mostly in middle-aged and elderly people， most commonly in the stomach. The clinical symptoms are not typical and the onset is hidden. Most small GIST is spindle cell types， and most of them show a low nuclear fission. Tumor size and mitotic count are two important factors affecting prognosis of small GIST. Tumor diameter larger than 0.75 cm should be observed more actively. |
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