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背景:胃肠道间质瘤(GISTs)是胃肠道间叶细胞肿瘤,过去常被诊断为胃肠道平滑肌瘤或神经鞘瘤。目的:探讨GIST的临床病理特征和预后因素。方法:回顾性分析143例GIST患者的临床病理资料,以及其中131例患者的随访资料,分析临床病理因素与预后的关系。结果:143例GIST中,恶性占71.3%,交界性和良性分别占23.8%和4.9%。免疫组化检测结果显示,CD117和CD34的阳性表达率分别为91.6%和85.3%。患者总体1、3、5年生存率分别为90.8%、74.0%和54.6%;恶性患者的5年生存率显著低于交界性和良性患者(44.0%对88.9%和100%,P<0.01);接受根治性切除术者的术后5年生存率显著优于局部肿瘤切除者(67.9%对38.5%,P<0.01)。多因素生存分析表明,肿瘤大小、细胞核分裂像、肿瘤性质和手术方式是GIST的独立预后因素(P<0.05)。结论:加强对GIST的认识,正确诊断,合理采用手术治疗,对改善GIST患者的预后有着深远的意义。
BACKGROUND: Gastrointestinal stromal tumors (GISTs) are gastrointestinal mesenchymal tumors that used to be diagnosed as gastrointestinal leiomyoma or schwannoma. Objective: To investigate the clinicopathological features and prognostic factors of GIST. Methods: The clinical and pathological data of 143 patients with GIST were retrospectively analyzed, and the follow-up data of 131 patients were analyzed retrospectively. The relationship between clinicopathological factors and prognosis was analyzed. Results: Of the 143 GIST cases, 71.3% were malignant and 23.8% and 4.9% were borderline and benign, respectively. The results of immunohistochemistry showed that the positive rates of CD117 and CD34 were 91.6% and 85.3% respectively. The 1-year, 3-year and 5-year overall survival rate was 90.8%, 74.0% and 54.6% respectively. The 5-year survival rate of malignant patients was significantly lower than that of borderline and benign patients (44.0% versus 88.9% and 100%, P <0.01) . The 5-year survival rate of patients undergoing radical resection was significantly better than that of local tumor resection (67.9% versus 38.5%, P <0.01). Multivariate survival analysis showed that tumor size, mitosis, tumor characteristics and surgical approach were independent prognostic factors of GIST (P <0.05). Conclusion: To strengthen understanding of GIST, correctly diagnose and reasonably adopt surgical treatment has far-reaching significance in improving the prognosis of patients with GIST.