摘要
目的探讨胰腺胃肠间质瘤(pGISTs)的临床病理特征及预后影响因素。方法回顾性分析2015年8月至2019年10月间广西医科大学附属肿瘤医院确诊的3例pGISTs。通过PubMed、中国知网、万方及维普数据库检索国内外相关文献,进行文献复习。记录患者的性别、年龄、肿瘤大小、肿瘤部位、肿瘤囊实性、治疗方式、核分裂象、基因突变、生存状态和生存时间等,分析肿瘤囊实性与临床病理参数的相关性,应用Kaplan-Meier法计算患者总体生存率和无疾病生存率,采用单因素及多因素Cox回归模型分析影响pGISTs预后的独立危险因素。结果本组3例合并文献报道71例,总共纳入74例pGISTs。其中男性36例,女性38例,发病年龄55(19~84)岁,肿瘤长径为8 cm(2~35 cm);71例患者记录了肿瘤部位,30例(42.3%)位于胰头部;63例记录了肿瘤的囊实性,33例(52.4%)为实性;74例记录了治疗方式,60例(81.1%)为根治性手术切除;59例记录肿瘤组织有核分裂象,33例(55.9%)为<5个/50高倍镜视野(HPF);14例行基因突变检测,11例(78.6%)为c-kit外显子基因突变。相关性分析显示,肿瘤的囊实性特征与肿瘤部位、肿瘤长径和核分裂象有显著相关性,而与患者年龄、性别、肿瘤组织学类型、Ki-67指数及改良美国国立卫生研究院(mNIH)风险度分级无显著相关性。51例根治术后患者5年总生存率为88.8%,5年无病生存率为60.3%;接受姑息治疗患者1年总生存率为51.9%,1年病死率为33.3%。单因素Cox回归分析结果显示,男性(P=0.083)、核分裂象>5个/50HPF(P=0.008)、CD_(34)阴性(P=0.055)是pGISTs术后复发的危险因素;多因素Cox回归分析结果显示,核分裂象>5个/50HPF是pGISTs预后的独立危险因素(P=0.023)。Kaplan-Meier生存分析显示,核分裂象≤5个/50HPF(P=0.3075)患者有更高的生存率(P=0.0003),而≤10个/50HPF的患者与>10个/50HPF的预后差异无统计学意义。结论pGISTs好发于胰头,通常发现时肿瘤体积
Objective To explore the clinicopathological characteristics and prognosis of pancreatic gastrointestinal interstitial tumors(pGISTs).Methods Three cases of pGISTs diagnosed in the Affiliated Tumor Hospital of Guangxi Medical University from August 2015 to October 2019 were analyzed retrospectively.Relevant literatures at home and abroad were searched and reviewed through PubMed,China knowledge Network,Wanfang and VIP databases.The sex,age,tumor size,tumor location,cystic or solid tumor,mode of treatment,mitosis,gene mutation,survival status and survival time were recorded,and the correlation between tumor cystic-solid characteristics and clinicopathological parameters was analyzed.Kaplan-Meier′s method was used to calculate the overall survival(OS)rate and disease-free survival(DFS)rate.Univariate and multivariate Cox regression models were used to analyze the independent risk factors affecting the prognosis of pGISTs.Results In this group,3 cases were combined with 71 cases reported in the literature,and a total of 74 cases of pGISTs were included.Among them,36 cases were male and 38 were female,the age of onset was 55(19-84)years,and the diameter of the tumor was 8 cm(2-35 cm).The tumor location of 71 patients was recorded by literature;30 cases(42.3%)were located in the head of the pancreas.The solid-cystic characteristics of tumor in 63 patients were recorded by literature,and 33 cases(52.4%)were solid.The mode of treatment of 74 patients was recorded,and 60 cases(81.1%)underwent radical resection.The mitosis figures of 59 patients were recorded,and 33 cases(55.9%)were<5/50 high power field of vision(HPF).The gene mutation of 14 patients was recorded,and 11 cases(78.6%)were c-kit exon gene mutation.Correlation analysis showed that the cystic-solid characteristics of the tumor were significantly correlated with tumor location,tumor diameter and mitosis figures,but not with age,sex,histological type,Ki-67 index and modification National Institutes of Health(mNIH)classification.The 5-year OS rate of 51 patien
作者
韦猛
白涛
陈洁
王小波
符洪源
莫运海
黎乐群
吴飞翔
Wei Meng;Bai Tao;Chen Jie;Wang Xiaobo;Fu Hongyuan;Mo Yunhai;Li Lequn;Wu Feixiang(Department of Hepatobiliary Surgery,Affiliated Tumor Hospital of Guangxi Medical University,Key Laboratory of High-Incidence-Tumor Prevention&Treatment,Ministry of Education,Nanning 530021,China)
出处
《中华胰腺病杂志》
CAS
2022年第2期98-106,共9页
Chinese Journal of Pancreatology
基金
国家自然科学基金(81860502)
区域性高发肿瘤早期防治研究教育部重点实验室子课题(GKE2019-06、GKE-ZZ202004)。
关键词
胰腺
胃肠间质瘤
突变
危险性评估
预后
Pancreas
Gastrointestinal stromal tumors
Mutation
Risk assessment
Prognosis
