摘要目的 探讨胃肠道间质瘤(GIST)的分级和分期方法 方法 依据自建的新的方法用12项指标对613例GIST进行了分级和分期的研究.此12项指标包括2项肉眼播散指标(包括肝转移和腹膜播散),5项显微镜下播散指标(包括淋巴结转移,血管、脂肪、神经和黏膜浸润),以及5项组织形态学指标(包括核分裂象≥10/50 HPF、肌层浸润、肿瘤性坏死、围绕血管呈簇状排列和明显异形).结果 在293例无上述指标的患者中,5年无瘤生存率(DFS)和5年总生仔率(OS)分别为99.3％和100.0％,此组被划分为非恶性GIST,不需要进一步分级.在318例患者中发现至少1项至6项上述指标,另2例患者有7项上述指标.此320例患者术后5年DFS和5年OS分别为43.9％(中位6.7年)和59.7％(中位9.3年).有无肉眼播散(P＜0.01)和有无镜下播散(P=0.001)的患者DFS显示差异有统计学意义.在无肉眼播散的患者中,DFS和OS与恶性指标数相关(均P＜0.01),但在有肉眼播散的患者中,DFS和OS与恶性指标数无关(分别为P=0.882和0.441) 结论 恶性GIST可以依据无或有肉眼播散划分为临床Ⅰ期和Ⅱ期.临床Ⅰ期GIST可依据恶性指标数分级.临床Ⅱ期GIST预后差,预后与恶性指标数无关,不再分级.此种分级和分期与预后密切相关.

abstractsObjective To investigate the clinical stage and histological grade of gastrointestinal stromal tumors.Methods Twelve clinical and pathological parameters were assessed in 613 patients with follow-up information.These parameters were classified into two gross spread parameters including liver metastasis and peritoneal dissemination,five microscopic spread parameters including lymph node metastasis,vascular,fat,nerve and mucosal infiltration,aud five histological parameters including mitotic count ≥ 10 per 50 high-power fields,muscularis propria infiltration,coagulative necrosis,perivascular pattern and severe nuclear atypia.Results The accumulated 5-year disease-free survival (DFS) and overall survival (OS) of 293 patients without any of these predictive parameters of malignancy were 99.3％ and 100.0％,respectively.They were regarded as nonmalignant and further evaluations on the stage and grade of these tumors were not performed.At least one and at most seven predictive parameters of malignancy were identified in 320 patients.For these patients,the accumulated 5-year DFS and OS rates were 43.9％ (mean 6.7 years) and 59.7％ (mean 9.3 years),respectively.The DFS showed significant difference between patients with and without gross spread (P ＜ 0.01),with and without microscopic spread (P =0.001).DFS and OS were associated with the number of predictive parameters of malignancy in patients without gross spread (P ＜ 0.01 for both DFS and OS),but not in patients with gross spread (P =0.882 and 0.441,respectively).Conclusions Malignant GIST could be divided into clinical stages Ⅰ and Ⅱ based on the absence and presence of gross spread,respectively.The degree of malignancy of patients in clinical stage Ⅰ could be graded according to the number of predictive parameters of malignancy.Patients in clinical stage Ⅱ were of the highest degree of malignancy regardless of the number of parameters.The staging and grading of gastrointestinal stromal tumors in this study are strongly associated with prognosis.