375例胃肠道间质瘤的临床特点及预后分析

发布时间：2018-04-02 10:45

  本文选题：胃肠道间质瘤　切入点：临床特点　出处：《山西医科大学》2017年硕士论文

【摘要】：目的:综合分析375例胃肠道间质瘤(Gastrointestinal Stromal Tumors GISTs)的发病特点、影像学表现、病理特征、治疗及预后因素,以提高对该疾病的临床认识及诊疗水平。方法:收集山西省肿瘤医院及我院2010年1月至2016年8月期间收治的375例经病理确诊为胃肠道间质瘤患者的病例资料,回顾性分析这些患者的发病年龄、性别、临床表现、影像学检查、肿瘤部位及大小、浸润深度、病理表现、转移及治疗方式,并通过随访了解其预后情况,分析影响GISTs预后的相关因素。结果:(1)共375例患者纳入本组研究,其中男性178例,女性197例;中位发病年龄为58岁,年龄最小者23岁,最大者85岁。(2)临床表现多不典型,常见临床表现为腹部不适、消化道出血、腹部包块及肿瘤压迫等相关症状,偶可因急腹症或肿瘤合并感染就诊。体检或偶然发现者占16.27%。(3)本病可通过消化道造影、腹部彩超、CT及MRI、超声内镜等检查初步了解肿瘤的一般情况,但确诊依赖于病理,镜下GISTs细胞形态差异明显,恶性程度高的肿瘤边界多不清晰,直接浸润或与周围组织炎性粘连。(4)本组肿瘤大小不一,最小者0.3cm,最大者33cm;其中肿瘤直径10cm者占19.2%,均为高度危险组。(5)GISTs多原发于胃肠道,常见发病部位依次为胃小肠结直肠食管GIST,胃肠道外GISTs较少见。对本组原发于胃肠道不同部位GISTs的生物学分析及比较可知,小肠GISTs比胃GISTs更容易浸润浆膜及发生远处转移,差异有统计学意义(P0.05),而食管和胃GISTs的生物学行为差异不显著(P0.05)。(6)本组375例病理资料示梭形细胞瘤272例(72.5%),上皮细胞瘤61例(16.3%),混合细胞型42例(11.2%);核分裂数:≤5/50HPF 228例(60.8%),5/50HPF 147例(39.2%)。免疫组化示CD117阳性率95.73%,CD34阳性率69.9%,DOG-1阳性率93.6%。(7)不同部位肿瘤与NIH分级、Miettinen分级均有统计学意义(P0.05),NIH分级较Miettinen分级更能评估预后情况。(8)GISTs患者的预后受多因素影响。单因素显示肿瘤大小、肿瘤部位、是否转移、Ki-67、核分裂数、NIH分级、Miettinen分级及手术方式这8项因素对预后有统计学意义(P0.05);多因素显示是否转移及手术方式与预后密切相关,可能为预后独立危险因素。结论:GISTs多见于中老年人,临床表现不典型,具有恶性倾向,确诊依赖于病理活检,临床特点、危险度分级可大致预测预后情况,早期发现及诊治仍是改善预后的重要着手点,手术治疗是GISTs的一线治疗手段,对术后复发或转移者,可给予靶向药物辅助治疗提高生存率。
[Abstract]:Objective: to analyze the pathogenetic features, imaging features, pathological features, treatment and prognostic factors of Gastrointestinal Stromal Tumors GISTs in 375 cases. Methods: 375 cases of gastrointestinal stromal tumors (GIST) were collected from Shanxi Cancer Hospital and our hospital from January 2010 to August 2016. The age, sex, clinical manifestation, imaging examination, tumor location and size, depth of invasion, pathological manifestation, metastasis and treatment of these patients were retrospectively analyzed. Results: a total of 375 patients (178 males and 197 females) were included in the study. The median age of onset was 58 years old, the youngest was 23 years old, the oldest was 85 years old. The common clinical manifestations are abdominal discomfort, gastrointestinal hemorrhage, abdominal mass and tumor compression. The CT, MRI and endoscopic examination of abdominal color Doppler ultrasound were used to understand the general situation of the tumor, but the diagnosis depended on pathology. The morphologic difference of GISTs cells was obvious under the microscope, and the boundary of the tumor with high malignancy degree was not clear. The tumor size varied from 0.3 cm to 33 cm, in which the diameter of tumor was 19.2cm, and most of them were primary gastrointestinal tract in high risk group. The most common sites were gastroenteric colorectal esophagus (GIST) and gastrointestinal GISTs. The biological analysis and comparison of GISTs in different parts of gastrointestinal tract showed that small intestinal GISTs was more likely to infiltrate serosa and distant metastasis than gastric GISTs. The difference was statistically significant (P 0.05), but there was no significant difference in the biological behavior of GISTs between esophagus and stomach (P 0.05. 6) the pathological data of 375 cases showed that 272 cases of spindle cell tumor, 61 cases of epithelial cell tumor, 42 cases of mixed cell type were involved in 72.5%, 16. 3%, and 42 cases of mixed cell type respectively. Mitotic number: 鈮，

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