直径不大于2cm的胃肠道间质瘤临床病理特征分析

发布时间：2018-06-26 21:45

本文选题：胃肠道间质瘤 + 临床病理特征　；参考：《浙江大学》2017年硕士论文

【摘要】：背景:胃肠道间质瘤(Gastrointestinal stromal tumor,GIST)是胃肠道最常见的非上皮组织来源肿瘤,发病年龄大部分超过50岁,性别间无差异,主要发生于胃,现常以病理组织学观察联合CD117、CD34、DOG-1的免疫组化染色诊断。手术切除和伊马替尼辅助治疗是GIST目前最主要的治疗手段,内镜下治疗在临床上也逐渐推广应用。定义直径不超过2cm的GIST为小GIST。原发病灶位于胃外的小GIST一般建议一经发现,即予治疗,但国内外尚未对位于胃的小GIST是否需要治疗建立统一标准。方法:收集、观察并记录2007年1月至2016年7月在浙江大学医学院附属第一医院接受治疗并符合诊断标准的小GIST患者的临床病理信息,并根据GIST发生部位分为胃内组和胃外组、是否在其他肿瘤诊治过程中发现分为肿瘤伴发组和单纯GIST组以及按性别、年龄和肿瘤大小分组后比较各亚组的临床病理资料,利用修正的美国国立卫生研究院(National Institutes of Health,NIH)危险分级评价预后,分析分级标准的最佳临界点。结果:186例小GIST患者发病中位年龄60岁,平均59.6岁,男女比例为1.14:1.00(P=0.42),72.6%发生在胃,其中71例因其他肿瘤行外科手术时发现;肿瘤伴发组比单纯GIST组在接受治疗时肿瘤直径小(P0.01)、发病年龄大(P0.01),且在性别构成(P0.01)上存在差异;核分裂数中位数2/50高倍镜视野(High power field,HPF),不同大小肿瘤分组间存在显著性差异(P0.01),不同性别、原发部位以及年龄间无明显差异;2.2%患者预后具有中度危险性,以肿瘤大小为检验变量的接收者工作特征曲线(Receiver operating characteristic curve,ROC),曲线下面积(Area under the curve,AUC)=0.76,取1.5cm为分级标准时,约登指数最大(灵敏度=1,特异度=0.59)。结论:小GIST患者的临床特点基本符合总体特征;较大的肿瘤有较多核分裂数的倾向;直径小于1.5cm的GIST预后属于极低危险度,发现后不建议行治疗,可予定期超声内镜检查随访。
[Abstract]:Background: gastrointestinal stromal tumor (GIST) is the most common non-epithelial neoplasm in the gastrointestinal tract. The immunohistochemical diagnosis of CD117, CD34 and DOG-1 was often observed by histopathology. Surgical resection and imatinib adjuvant therapy are the most important methods of GIST at present. The GIST whose diameter does not exceed 2cm is defined as small GIST. The small GIST with primary lesion located outside the stomach is recommended to be treated as soon as it is discovered, but there is no uniform standard on whether the small GIST located in the stomach needs treatment at home and abroad. Methods: to collect, observe and record the clinicopathological information of small GIST patients who were treated in the first affiliated Hospital of Zhejiang University School of Medicine from January 2007 to July 2016 and were divided into intragastric group and extragastric group according to the location of GIST. Whether it was found in the diagnosis and treatment of other tumors that they were divided into tumor-associated group and GIST group, as well as the clinicopathological data of each subgroup after grouping according to sex, age and tumor size, The prognosis was evaluated by the revised National Institutes of Health (NIH) risk classification, and the optimal critical point of the classification criteria was analyzed. Results the median age was 60 years (mean 59.6 years) in 186 patients with small GIST. The ratio of male and female was 1.14: 1.00 (P < 0.42). 72.6% of them occurred in the stomach. Among them, 71 cases were found in surgery because of other tumors. The diameter of tumor was smaller (P0.01), the age of onset was older (P0.01), and the sex composition (P0.01) was different in the group with tumor associated with GIST than in the group of GIST alone. The median mitotic number was 2 / 50 high power field. There was significant difference among different tumor groups (P0.01). There was no significant difference in prognosis between different sex, primary location and age. The receiver's working characteristic curve (receiver operating characteristic curve) and area under the curve (Area under the curvev AUC) were 0.76. When 1.5cm was used as the grading standard, the maximum Jorden index was obtained (sensitivity 1, specificity 0. 59). Conclusion: the clinical characteristics of small GIST patients are basically consistent with the general characteristics, the larger tumors tend to have more mitotic numbers, and the prognosis of small GIST patients whose diameter is smaller than 1.5cm is very low risk. It is not recommended to be treated after discovery, and can be followed up by regular endoscopic ultrasonography.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735

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