胃肠道间质瘤新版风险分级方案的应用与评价

Application and Evaluation of the NIH Grading Criteria for Localized Primary Gastrointestinal Stromal Tumors

  • 摘要: 参照美国国立卫生研究院(NIH)2008年推荐的风险分级方案,分析GIST患者临床病理特征对生存率的影响,探讨GIST的生物学行为和NIH方案对原发性局限性GIST风险分级的评估效能。方法:收集川北医学院附属医院病理科124例有完整临床病理资料的GIST,总结临床病理特征包括年龄、核分裂计数、肿瘤直径等,并对患者进行随访,应用新版NIH分级方案对本组病例进行风险分级,进行统计学分析。结果:124例GIST有13例为进展性(恶性)GIST,111例为原发性局限性GIST,平均年龄57岁;82例获得随访,其中进展性GIST 9例,原发性局限性GIST 73例。73例有随访资料的原发性局限性GIST患者中,肿瘤直径>5 cm(P=0.009),核分裂计数多于5个/50 HPF(P<0.001)提示生存率低;肿瘤大小在5.1~10.0 cm之间,非胃GIST比胃GIST的无病生存率低(P=0.011);发病年龄和性别与生存率无关;该组资料按新版NIH分级方案进行评估,高危组的总生存率和无病生存率显著低于极低、低和中度风险组(P<0.05),但极低、低、中度风险三组之间的总生存率和无病生存率差异无统计学意义。结论:按肿瘤最大径、核分裂计数及发病部位评估GIST危险程度的NIH分级方案能更准确地认识原发性局限性GIST的生物学行为;在GIST的病理诊断中,注明NIH分级有利于判断GIST的预后以及指导对GIST的临床治疗。

     

    Abstract: To evaluate the prognostic significance of various clinicopathologic parameters and the implication of the National Institutes of Health ( NIH ) grading criteria for gastrointestinal stromal tumors ( GISTs ). Methods: A total of 124 GISTs with complete clinicopathologic data were retrieved from the archived files of the Department of Pathology, Affiliated Hospital of North Sichuan Medical College. The clinical features, site of occurrence, tumor diameter, and mitotic index were studied and statistically analyzed. The biological potential based on the newly edited NIH grading criteria was evaluated. Results: Of the 124 cases, 13 were advanced ( malignant ) GISTs and 111 were localized, primary GISTs. The mean age of patients was 57 years. Follow-up information was available in 82 cases, 9 of which were advanced GISTs and 73 were localized, primary GISTs. For these 73 cases, survival analyses were conducted, and the large tumor size ( P = 0.009 ) and high mitotic index ( P < 0.001 ) were associated with lower survival. Statistical analysis shows that, with the largest tumor diameter at 5.1 to 10.0 cm, the non-gastric GIST had a lower disease-free survival ( DFS ) rate than gastric GIST ( P = 0.011 ). The survival rate had no correlation with age and sex. As evaluated by the new NIH ( 2008 ) grading criteria, the overall and DSF rates of high-risk GISTs were lower than those of the very low-risk, low-risk, and intermediate-risk ( P < 0.05 ). On the other hand, the overall and DSF rates of the very low-risk, low-risk, and intermediate-risk GISTs were not statistically different. Conclusion: The risk criteria for assessing the natural course of primary GISTs proposed by the NIH ( 2008 ) were validated. The indication of the NIH classification in the pathological diagnosis of GIST is beneficial to GIST prognosis assessment and provides guidance on its clinical treatment.

     

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