胃肠道外间质瘤预后因素分析
|
摘要
目的探讨胃肠道外间质瘤(EGIST)的临床特征及影响预后的因素。方法回顾性分析2006年11月至2017年5月间辽宁省肿瘤医院收治的首次进行外科治疗且经病理证实的47例胃肠道外间质瘤患者的临床及随访资料,与本中心的254例胃肠间质瘤(GIST)患者资料进行对比。结果 EGIST与GIST患者在年龄(χ~2=6.394,P <0.011),肿瘤大小(χ~2=60.941,P <0.001),组织学类型(χ~2=30.081,P <0.001),CD117表达(χ~2=52.99,P <0.001),CD34表达(χ~2=37.21,P <0.001)、Dog-1表达(χ~2=24.57,P <0.001),是否坏死(χ~2=10.38,P=0.006)、改良NIH危险度分级(χ~2=56.12,P <0.001)之间差异有统计学意义。EGIST患者1、2、3年生存率分别为84.6%、78.3%、63.4%;接受R0切除的EGIST患者25例(53.2%)。R0切除患者的生存率明显高于非R0切除患者(χ~2=5.104,P=0.024)。其中,25例R0切除的患者中显示不同核分裂像、不同肿瘤直径大小、是否伴坏死与EGIST患者的预后未体现统计学意义(χ~2=2.067,P=0.151;χ~2=1.355,P=0.244;χ~2=0.912,P=0.34)。结论 EGIST患者症状隐匿,不易早诊断,首次就诊时肿瘤体积往往较大。是否R0切除关系到患者的预后。
Objective To explore clinical features and prognostic factors of extragastrointestinal stromal tumors(EGIST). Methods The clinical and follow-up data of 47 patients with extragastrointestinal stromal tumors admitted to Liaoning Cancer Hospital for the first time from November 2006 to May 2017 were retrospectively analyzed, and compared with 254 cases of gastrointestinal stromal tumor(GIST) in our center. Results EGIST and GIST patients showed significant differences in age(χ~2=6.394, P < 0.011),tumor size(χ~2=60.941, P < 0.001), histological type(χ~2=30.081, P < 0.001), CD117 expression(χ~2=52.99,P < 0.001), CD34 expression(χ~2=37.21, P < 0.001), Dog-1 expression(χ~2=24.57, P < 0.001), necrosis(χ~2=10.38, P=0.006), and NIH score(χ~2=56.12, P < 0.001). One year, two years and three years survival rates of all EGIST patients were 84.6%、78.3%、63.4% respectively; 25 patients(51.4%) were with R0 resection. The survival rate of patients with R0 resection was significantly higher than that of patients without R0 resection(χ~2=5.104, P=0.024). Among them, the prognosis of 25 patients with R0 resection showed no statistical significance in patients with different mitotic figures, tumor diameters, necrosis(χ~2=2.067, P=0.151;χ~2=1.35, P=0.244; χ~2=0.912, P=0.34). Conclusion EGIST symptoms are dormant and difficult to diagnose,with large volume at first. R0 resection is associated with prognosis.
Objective To explore clinical features and prognostic factors of extragastrointestinal stromal tumors(EGIST). Methods The clinical and follow-up data of 47 patients with extragastrointestinal stromal tumors admitted to Liaoning Cancer Hospital for the first time from November 2006 to May 2017 were retrospectively analyzed, and compared with 254 cases of gastrointestinal stromal tumor(GIST) in our center. Results EGIST and GIST patients showed significant differences in age(χ~2=6.394, P < 0.011),tumor size(χ~2=60.941, P < 0.001), histological type(χ~2=30.081, P < 0.001), CD117 expression(χ~2=52.99,P < 0.001), CD34 expression(χ~2=37.21, P < 0.001), Dog-1 expression(χ~2=24.57, P < 0.001), necrosis(χ~2=10.38, P=0.006), and NIH score(χ~2=56.12, P < 0.001). One year, two years and three years survival rates of all EGIST patients were 84.6%、78.3%、63.4% respectively; 25 patients(51.4%) were with R0 resection. The survival rate of patients with R0 resection was significantly higher than that of patients without R0 resection(χ~2=5.104, P=0.024). Among them, the prognosis of 25 patients with R0 resection showed no statistical significance in patients with different mitotic figures, tumor diameters, necrosis(χ~2=2.067, P=0.151;χ~2=1.35, P=0.244; χ~2=0.912, P=0.34). Conclusion EGIST symptoms are dormant and difficult to diagnose,with large volume at first. R0 resection is associated with prognosis.
引文
[1]Lim KT,Tan KY.Current research and treatment for gastrointestinal stromal tumors[J].World J Gastroenterol,2017,23(27):4856-4866.
[2]Joensuu H,Fletcher C,Dimitrijevic S,et al.Management of malignant gastrointestinal stromal tumours[J].Lancet Oncol,2002,3(11):655-664.
[3]Agaimy A,Wunsch PH.Gastrointestinal stromal tumours:a regular origin in the muscularis propria,but an extremely diverse gross presentation.A review of 200 cases to critically re-evaluate the concept of so-called extra-gastrointestinal stromal tumours[J].Langenbecks Arch Surg,2006,391(4):322-329.
[4]Soreide K,Sandvik OM,Soreide JA,et al.Global epidemiology of gastrointestinal stromal tumours(GIST):A systematic review of population-based cohort studies[J].Cancer Epidemiol,2016,40:39-46.
[5]Barros A,Linhares E,Valadao M,et al.Extragastrointestinal stromal tumors(EGIST):a series of case reports[J].Hepatogastroenterology,2011,58(107-108):865-868.
[6]Antonopoulos P,Leonardou P,Barbagiannis N,et al.Gastrointestinal and extragastrointestinal stromal tumors:report of two cases and review of the literature[J].Case Rep Gastroenterol,2014,8(1):61-66.
[7]Steigen SE,Eide TJ.Gastrointestinal stromal tumors(GISTs):a review[J].APMIS,2009,117(2):73-86.
[8]Barros A,Linhares E,Valadao M,et al.Extragastrointestinal stromal tumors(EGIST):a series of case reports[J].Hepatogastroenterology,2011,58(107-108):865-868.
[9]De Matteo RP,Lewis JJ,Leung D,et al.Two hundred gastrointestinal stromal tumors:recurrence patterns and prognostic factors for survival[J].Ann Surg,2000,231(1):51-58.
[2]Joensuu H,Fletcher C,Dimitrijevic S,et al.Management of malignant gastrointestinal stromal tumours[J].Lancet Oncol,2002,3(11):655-664.
[3]Agaimy A,Wunsch PH.Gastrointestinal stromal tumours:a regular origin in the muscularis propria,but an extremely diverse gross presentation.A review of 200 cases to critically re-evaluate the concept of so-called extra-gastrointestinal stromal tumours[J].Langenbecks Arch Surg,2006,391(4):322-329.
[4]Soreide K,Sandvik OM,Soreide JA,et al.Global epidemiology of gastrointestinal stromal tumours(GIST):A systematic review of population-based cohort studies[J].Cancer Epidemiol,2016,40:39-46.
[5]Barros A,Linhares E,Valadao M,et al.Extragastrointestinal stromal tumors(EGIST):a series of case reports[J].Hepatogastroenterology,2011,58(107-108):865-868.
[6]Antonopoulos P,Leonardou P,Barbagiannis N,et al.Gastrointestinal and extragastrointestinal stromal tumors:report of two cases and review of the literature[J].Case Rep Gastroenterol,2014,8(1):61-66.
[7]Steigen SE,Eide TJ.Gastrointestinal stromal tumors(GISTs):a review[J].APMIS,2009,117(2):73-86.
[8]Barros A,Linhares E,Valadao M,et al.Extragastrointestinal stromal tumors(EGIST):a series of case reports[J].Hepatogastroenterology,2011,58(107-108):865-868.
[9]De Matteo RP,Lewis JJ,Leung D,et al.Two hundred gastrointestinal stromal tumors:recurrence patterns and prognostic factors for survival[J].Ann Surg,2000,231(1):51-58.