不同危险分级胃间质瘤的超声内镜特征分析
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摘要
目的分析不同危险分级胃间质瘤(GISTs)的超声内镜(EUS)特征的差异性及其影响因素。方法收集经EUS检查、并经病理明确诊断为胃GISTs病人142例,分析其一般资料及EUS特征,总结不同危险分级胃GISTs的EUS特征的差异性及其影响因素。结果 142例胃GISTs中,71例位于胃底(50.0%),60例位于胃体(42.3%),11例位于胃窦(7.7%)。胃GISTs直径为0.50～8.00cm,平均(2.42±1.63)cm。根据术后病理肿瘤大小及核分裂象,分为高危组10例(7.0%)、中危组15例(10.6%)、低危组47例(33.1%)、极低危组70例(49.3%)。138例(97.0%)起源于固有肌层,1例起源于黏膜肌层(0.7%),3例起源于黏膜下层(2.0%)。85例表现为回声不均(59.9%),32例存在液化表现(22.5%),18例存在钙化(12.7%),13例病变表面溃疡形成(9.2%)。单因素分析显示,不同危险分级组肿瘤大小(F=7.872,P<0.01)、起源层次(χ~2=14.994,P<0.05)、回声异质性(χ~2=21.472,P<0.01)、边界不清(χ~2=9.970,P<0.05)、表面溃疡(χ~2=21.352,P<0.01)、液化(χ~2=23.388,P<0.01)发生率差异有统计学意义,而年龄、性别、肿瘤位置、钙化、小叶间隔差异无统计学意义(P>0.05)。将低危、极低危归类为低危组,中危、高危分级归类为较高危险分级GISTs,Logistic多因素回归分析显示,EUS下病变回声不均匀(OR=5.07,95%CI=2.42～10.62,P<0.01)、边界不规则(OR=6.80,95%CI=1.46～31.6,P<0.05)、存在液化(OR=7.80,95%CI=2.79～21.79,P<0.01)的GISTs为较高危险分级的风险增加。结论 EUS显示内部回声不均、液化、边界不规则的胃GISTs病人病理较高危险分级的概率增加。
Objective To analyze the endoscopic ultrasonographic (EUS) features of gastric stromal tumors (GISTs) with different risk classifications and their influencing factors. Methods The clinical data of 142 patients were collected whose GISTs were diagnosed by EUS and further confirmed by pathology.The general data and EUS features were then analyzed,and the differences in EUS features between GISTs with different risk classifications and their influencing factors were summarized as well.Results Of the 142 cases of GISTs,71(50.0%)were located in the gastric fundus,60(42.3%)in the gastric body,and 11(7.7%)in the gastric antrum.The diameter of GISTs ranged from 0.50 cm to 8.00 cm,with a mean of(2.42±1.63)cm.According to the size and mitotic count of postoperative tumors,10 patients(7.0%)were assigned to high-risk group,15(10.6%)to medium-risk group,47(33.1%)to low-risk group,and 70(49.3%)to extremely low-risk group.Of all the cases,138(97.0%)originated from the muscularis propria,1(0.7%)from the muscularis mucosa,and 3(2.0%)from the submucosa.Eighty-five cases(59.9%)showed echo heterogeneity,32(22.5%)had liquefaction,18(12.7%)had calcification,and 13(9.2%)had surface ulceration.Univariate analysis showed that there were significant differences regarding tumor size(F=7.872,P<0.001),layer of origin(χ~2=14.994,P<0.05),echo heterogeneity(χ~2=21.472,P<0.01),unclear boundary(χ~2=21.352,P<0.01),surface ulceration(χ~2=21.352,P<0.01),and liquefaction(χ~2=23.388,P<0.01)in GISTs with different risk classifications.However,there were no significant differences in age,gender,tumor location,calcification,and interlobular septum(P>0.05).The low-,and extremely low-risk GISTs were categorized as lower-risk GISTs,The medium-,and high-risk GISTs were categorized as higher-risk GISTs.Logistic multivariate regression analysis showed that echo heterogeneity(OR=5.07,95%CI=2.42-10.62,P<0.01),irregular boundary(OR=6.80,95% CI=1.46-31.6,P<0.05),and liquefaction(OR=7.80,95% CI=2.79-21.79,P<0.01)were associated with an increased risk of higher risk classification.The differences between their influencing factors were significant.Conclusion EUS showed an increased risk of higher risk classification in GISTs with echo heterogeneity,liquefaction,and irregular boundary.
Objective To analyze the endoscopic ultrasonographic (EUS) features of gastric stromal tumors (GISTs) with different risk classifications and their influencing factors. Methods The clinical data of 142 patients were collected whose GISTs were diagnosed by EUS and further confirmed by pathology.The general data and EUS features were then analyzed,and the differences in EUS features between GISTs with different risk classifications and their influencing factors were summarized as well.Results Of the 142 cases of GISTs,71(50.0%)were located in the gastric fundus,60(42.3%)in the gastric body,and 11(7.7%)in the gastric antrum.The diameter of GISTs ranged from 0.50 cm to 8.00 cm,with a mean of(2.42±1.63)cm.According to the size and mitotic count of postoperative tumors,10 patients(7.0%)were assigned to high-risk group,15(10.6%)to medium-risk group,47(33.1%)to low-risk group,and 70(49.3%)to extremely low-risk group.Of all the cases,138(97.0%)originated from the muscularis propria,1(0.7%)from the muscularis mucosa,and 3(2.0%)from the submucosa.Eighty-five cases(59.9%)showed echo heterogeneity,32(22.5%)had liquefaction,18(12.7%)had calcification,and 13(9.2%)had surface ulceration.Univariate analysis showed that there were significant differences regarding tumor size(F=7.872,P<0.001),layer of origin(χ~2=14.994,P<0.05),echo heterogeneity(χ~2=21.472,P<0.01),unclear boundary(χ~2=21.352,P<0.01),surface ulceration(χ~2=21.352,P<0.01),and liquefaction(χ~2=23.388,P<0.01)in GISTs with different risk classifications.However,there were no significant differences in age,gender,tumor location,calcification,and interlobular septum(P>0.05).The low-,and extremely low-risk GISTs were categorized as lower-risk GISTs,The medium-,and high-risk GISTs were categorized as higher-risk GISTs.Logistic multivariate regression analysis showed that echo heterogeneity(OR=5.07,95%CI=2.42-10.62,P<0.01),irregular boundary(OR=6.80,95% CI=1.46-31.6,P<0.05),and liquefaction(OR=7.80,95% CI=2.79-21.79,P<0.01)were associated with an increased risk of higher risk classification.The differences between their influencing factors were significant.Conclusion EUS showed an increased risk of higher risk classification in GISTs with echo heterogeneity,liquefaction,and irregular boundary.
引文
[1]荣光宏,刘芝兰,马颖才,等.819例上消化道黏膜下病变的超声内镜诊断分析[J].中华消化内镜杂志,2017,34(6):437-438.
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[15]史良玉,王玉平,任茜,等.胃肠道间质瘤治疗的研究进展[J].医学综述,2017,23(19):3764-3768.
[16]林黛英,吴先衡,汪丹凤,等.胃肠道间质瘤CT表现与肿瘤危险程度的相关性评价[J].医学影像学杂志,2014,24(8):1342-1345.
[17]卢光荣,周羽!,钟金伟,等.不同侵袭危险性胃间质瘤的超声内镜图像特点比较及相关危险因素分析[J].中国内镜杂志,2016,22(1):1-4.
[18]HOU Y Y,LU S H,ZHOU Y,et al.Predictive values of clinical and pathological parameters for malignancy of gastrointestinal stromal tumors[J].Histology&Histopathology,2009,24(6):737-747.
[19]王晓凡,谭诗云,李明,等.术前超声内镜检查对胃间质瘤危险性判断及治疗方式选择分析[J].中华全科医师杂志,2014,13(6):452-456.
[20]PALAZZO L.Endosonographic features predictive of benign and malignant gastrointestinal stromal cell tumours[J].Gut,2000,46(1):88-92.
[21]JEON S W,PARK Y D,CHUNG Y J,et al.Gastrointestinal stromal tumors of the stomach:endosonographic differentiation in relation to histological risk[J].Journal of Gastroenterology and Hepatology,2007,22(12):2069-2075.
[22]CHEN T H,HSU C M,CHU Y Y,et al.Association of endoscopic ultrasonographic parameters and gastrointestinal stromal tumors(GISTs):can endoscopic ultrasonography be used to screen gastric GISTs for potential malignancy[J]?Scandinavian Journal of Gastroenterology,2015,51(3):1-4.
[23]郎翠翠,李玉红,董新茜.超声内镜下胃间质瘤特征与病理诊断相关性研究[J].中华消化内镜杂志,2011,28(6):305-308.
[24]彭春艳,吕瑛,徐桂芳,等.术前超声内镜对胃间质瘤的诊断及侵袭危险性评估价值研究[J].中华消化内镜杂志,2015,32(6):361-366.
[25]YU Qingxiang,HE Zhankun,WANG Jiang,et al.Clinical presentations of gastric small gastrointestinal stromal tumors mimics functional dyspepsia symptoms[J].World Journal of Gastroenterology,2014,20(33):11800-11807.
[26]KIM I H,KWAK S G,CHAE H D.Prognostic factors of patients withgastric gastrointestinal stromal tumor after curative resection:aretrospective analysis of 406consecutive cases in a multicenterstudy[J].Eur Surq Res,2015,55(1/2):12-23.
[27]DEMETRI G D,VON MEHREN M,ANTONESCU C R,et al.NCCN task force report:update on the management of patients with gastrointestinal stromal tumors[J].Journal of the National Comprehensive Cancer Network:JNCCN,2010,8(Suppl 2):S1.
[28]薛倩,文娟,王晶桐.超声内镜下胃间质瘤的影像特征及随访研究[J].中国超声医学杂志,2015,31(11):991-993.
[29]SAWAKI A,MIZUNO N,TAKAHASHI K,et al.Longterm follow up of patients with small gastrointestinal stromal tumors in the stomach using endoscopic ultrasonographyguided fine-needle aspiration biopsy[J].Digestive Endoscopy,2006,18(1):40-44.
[30]SEPE P S,BRUGGE W R.A guide for the diagnosis and management of gastrointestinal stromal cell tumors[J].Nature Reviews Gastroenterology&Hepatology,2009,6(6):363-371.
[2]KIM M N,KANG S J,KIM S G,et al.Prediction of risk of malignancy of gastrointestinal stromal tumors by endoscopic ultrasonography[J].Gut and Liver,2013,7(6):642-647.
[3]CROOM K F,PERRY C M.Imatinib mesylate:in the treatment of gastrointestinal stromal tumours[J].Drugs,2003,63(5):513-522.
[4]MUENST S,THIES S,WENT P,et al.Frequency,phenotype,and genotype of minute gastrointestinal stromal tumors in the stomach:an autopsy study[J].Human Pathology,2011,42(12):1849-1854.
[5]MURPHEY M D.World Health Organization classification of bone and soft tissue tumors:modifications and implications for radiologists[J].Seminars in Musculoskeletal Radiology,2007,11(3):201-214.
[6]FLETCHER C D,BERMAN J J,CORLESS C,et al.Diagnosis of gastrointestinal stromal tumors:a consensus approach[J].Human Pathology,2002,33(5):459-465.
[7]NILSSON B,PER BMMING,MEIS-KINDBLOM J M,et al.Gastrointestinal stromal tumors:the incidence,prevalence,clinical course,and prognostication in the preimatinib mesylate era:apopulation-based study in Western Sweden[J].Cancer,2005,103(4):821-829.
[8]ROSSI S,MICELI R,MESSERINI L,et al.Natural history of imatinib-naive GISTs:a retrospective analysis of 929cases with long-term follow-up and development of a survival nomogram based on mitotic index and size as continuous variables[J].American Journal of Surgical Pathology,2011,35(11):1646-1656.
[9]TATEISHI U,HASEGAWA T,SATAKE M,et al.Gastrointestinal stromal tumor-correlation of computed tomography findings with tumor grade and mortality[J].Journal of Computer Assisted Tomography,2003,27(5):792-798.
[10]VON M M,RANDALL R L,BENJAMIN R S,et al.Soft Tissue Sarcoma,Version 2.2018,NCCN clinical practice guidelines in oncology[J].Journal of the National Comprehensive Cancer Network:JNCCN,2018,16(5):536.
[11]中国临床肿瘤学会胃肠间质瘤专家委员会.中国胃肠间质瘤诊断治疗共识(2017年版)[J].肿瘤综合治疗(电子杂志),2018,4(1):31-43.
[12]FAULX A L,KOTHARI S,ACOSTA R D,et al.The role of endoscopy in subepithelial lesions of the GI tract[J].Gastrointestinal Endoscopy,2017,85(6):1117-1132.
[13]NISHIDA T,KAWAI N,YAMAGUCHI S,et al.Submucosal tumors:comprehensive guide for the diagnosis and therapy of gastrointestinal submucosal tumors[J].Digestive Endoscopy,2013,25(5):479-489.
[14]JI Feng,WANG Ziwei,WANG Lijun,et al.Clinicopathological characteristics of gastrointestinal mesenchymal tumors and diagnostic value of endoscopic ultrasonography[J].Journal of Gastroenterology and Hepatology,2008,23(8 Pt 2):e318-e324.
[15]史良玉,王玉平,任茜,等.胃肠道间质瘤治疗的研究进展[J].医学综述,2017,23(19):3764-3768.
[16]林黛英,吴先衡,汪丹凤,等.胃肠道间质瘤CT表现与肿瘤危险程度的相关性评价[J].医学影像学杂志,2014,24(8):1342-1345.
[17]卢光荣,周羽!,钟金伟,等.不同侵袭危险性胃间质瘤的超声内镜图像特点比较及相关危险因素分析[J].中国内镜杂志,2016,22(1):1-4.
[18]HOU Y Y,LU S H,ZHOU Y,et al.Predictive values of clinical and pathological parameters for malignancy of gastrointestinal stromal tumors[J].Histology&Histopathology,2009,24(6):737-747.
[19]王晓凡,谭诗云,李明,等.术前超声内镜检查对胃间质瘤危险性判断及治疗方式选择分析[J].中华全科医师杂志,2014,13(6):452-456.
[20]PALAZZO L.Endosonographic features predictive of benign and malignant gastrointestinal stromal cell tumours[J].Gut,2000,46(1):88-92.
[21]JEON S W,PARK Y D,CHUNG Y J,et al.Gastrointestinal stromal tumors of the stomach:endosonographic differentiation in relation to histological risk[J].Journal of Gastroenterology and Hepatology,2007,22(12):2069-2075.
[22]CHEN T H,HSU C M,CHU Y Y,et al.Association of endoscopic ultrasonographic parameters and gastrointestinal stromal tumors(GISTs):can endoscopic ultrasonography be used to screen gastric GISTs for potential malignancy[J]?Scandinavian Journal of Gastroenterology,2015,51(3):1-4.
[23]郎翠翠,李玉红,董新茜.超声内镜下胃间质瘤特征与病理诊断相关性研究[J].中华消化内镜杂志,2011,28(6):305-308.
[24]彭春艳,吕瑛,徐桂芳,等.术前超声内镜对胃间质瘤的诊断及侵袭危险性评估价值研究[J].中华消化内镜杂志,2015,32(6):361-366.
[25]YU Qingxiang,HE Zhankun,WANG Jiang,et al.Clinical presentations of gastric small gastrointestinal stromal tumors mimics functional dyspepsia symptoms[J].World Journal of Gastroenterology,2014,20(33):11800-11807.
[26]KIM I H,KWAK S G,CHAE H D.Prognostic factors of patients withgastric gastrointestinal stromal tumor after curative resection:aretrospective analysis of 406consecutive cases in a multicenterstudy[J].Eur Surq Res,2015,55(1/2):12-23.
[27]DEMETRI G D,VON MEHREN M,ANTONESCU C R,et al.NCCN task force report:update on the management of patients with gastrointestinal stromal tumors[J].Journal of the National Comprehensive Cancer Network:JNCCN,2010,8(Suppl 2):S1.
[28]薛倩,文娟,王晶桐.超声内镜下胃间质瘤的影像特征及随访研究[J].中国超声医学杂志,2015,31(11):991-993.
[29]SAWAKI A,MIZUNO N,TAKAHASHI K,et al.Longterm follow up of patients with small gastrointestinal stromal tumors in the stomach using endoscopic ultrasonographyguided fine-needle aspiration biopsy[J].Digestive Endoscopy,2006,18(1):40-44.
[30]SEPE P S,BRUGGE W R.A guide for the diagnosis and management of gastrointestinal stromal cell tumors[J].Nature Reviews Gastroenterology&Hepatology,2009,6(6):363-371.