胃间质瘤合并胃癌的临床分析及文献回顾(1)
[摘要] 目的 总结分析胃间质瘤合并胃癌的患者临床资料、病理特征以及随访资料。 方法 对韩国延世大学外科部1999年7月~2011年8月期间术后病理明确胃间质瘤合并胃癌的8例患者进行回顾性分析。 结果 8例胃间质瘤合并胃癌的患者中,男5例,女3例,中位年龄68.5岁。所有的患者均成功施行胃癌的根治切除,在32.8个月的中位随访期间,有6例患者(75.0%)保持无瘤生存状态,另2例患者(25.0%)出现胃癌远处转移。结论 在本组随访中,合并的胃间质瘤病理均未发现高恶性风险度,且随访期间无间质瘤复发,而胃癌的复发占据主要地位。因此,在这类胃间质瘤合并胃癌患者中,手术切除和后期治疗、随访观察主要依据胃癌来进行。
[关键词] 胃癌;胃间质瘤;随访;复发
[中图分类号] R735.2 [文献标识码] B [文章编号] 1673-9701(2016)09-0086-04
[Abstract] Objective To investigate the surgical outcome in patients who had synchronous occurrence of gastric adenocarcinoma (GC) and gastric stromal tumor(GST). Methods Eight patients with synchronous gastric adenocarcinoma and gastric stromal tumor were identified from our database. Patient characteristics, pathologic features, surgical outcomes were evaluated. Results Eight patients with synchronous GC and gastric GIST were identified from our database, including 5 men and 3 women, whose median age was 68.5 years. All the patients with gastric cancer were undernent radical gastrectomy. At a median follow-up of 32.8 months, 6 patients(75.0%) were alive without evidence of recurrence or distant metastases, whereas 2 (25.0%) had adenocarcinoma distant metastases. Conclusion In our study, there is no high risk grading in synchronous GSTs,and no patients have GST relapse. This indicates that GC may have a predominant influence in relapse. Decisions about surgical extent and further management should likely be made mainly according to GC in the occurrence of synchronous tumors.
[Key words] Gastric adenocarcinoma; Gastric stromal tumor; Follow up; Relapse
胃肠道间质瘤(gastrointestinal stromal tumor,GIST)是指以梭形细胞为主、缺乏明确肌性或神经分化特征的难以明确分化方向的间叶源性肿瘤,主要发生于胃肠道、肠系膜和腹膜[1]。其免疫学表现主要为CD117(80%~100%)和CD34(56%~83%)阳性,c-kit基因突变阳性对格列卫治疗有指导意义[2]。
胃间质瘤(gastric stromal tumor,GST)合并胃癌(gastric cancer,GC)的发生十分罕见,相关报道较少,均为病案报道[3-8]。目前,尚不明了这两种不同的病灶是偶然发生的还是基于某种原因而同时形成,也无从得知这类患者在接受手术治疗后,两种不同肿瘤的复发风险究竟哪个更高。本文将对8例胃间质瘤合并胃癌的患者进行分析,现报道如下。
1 资料与方法
1.1 一般资料
选择1999年7月~2011年8月期间于韩国延世大学外科部接受手术治疗的胃间质瘤患者共130例,其中合并胃癌8例;对这8例患者的临床资料、病理特征及随访资料进行回顾分析。
1.2 研究方法
所有的患者均成功施行根治性的部分或者远端胃癌根治术联合D2淋巴结清扫,其中进展期胃癌均予以化疗,所有的胃间质瘤均未给予伊马替尼治疗。胃癌分期根据 AJCC (2001)版,胃间质瘤危险度分级则按照NIH标准,分成极低危、低危、中危和高危[9]。标本常规在4%的甲醛溶液中固定并石蜡包埋,通过苏木精-伊红染色对胃癌病灶常规病检,而对胃间质瘤病灶采用免疫组化方法对CD117单克隆抗体测定(1:50,Dako,Copenhagen,Denmark)以及CD34单克隆抗体测定(1:50,Dako,Copenhagen,Denmark),同时进行突变分析。
1.3 观察指标
胃癌病灶和胃间质瘤病灶的病理特征,包含外观大小、病灶分布情况和各自的分期、分级情况及胃间质瘤的免疫组化结果、突变分析结果;随访期间,胃癌和胃间质瘤病灶的复发情况。
1.4 统计方法, 百拇医药(来集富 许文娜 王元宇 Sung Hoon Noh)
[关键词] 胃癌;胃间质瘤;随访;复发
[中图分类号] R735.2 [文献标识码] B [文章编号] 1673-9701(2016)09-0086-04
[Abstract] Objective To investigate the surgical outcome in patients who had synchronous occurrence of gastric adenocarcinoma (GC) and gastric stromal tumor(GST). Methods Eight patients with synchronous gastric adenocarcinoma and gastric stromal tumor were identified from our database. Patient characteristics, pathologic features, surgical outcomes were evaluated. Results Eight patients with synchronous GC and gastric GIST were identified from our database, including 5 men and 3 women, whose median age was 68.5 years. All the patients with gastric cancer were undernent radical gastrectomy. At a median follow-up of 32.8 months, 6 patients(75.0%) were alive without evidence of recurrence or distant metastases, whereas 2 (25.0%) had adenocarcinoma distant metastases. Conclusion In our study, there is no high risk grading in synchronous GSTs,and no patients have GST relapse. This indicates that GC may have a predominant influence in relapse. Decisions about surgical extent and further management should likely be made mainly according to GC in the occurrence of synchronous tumors.
[Key words] Gastric adenocarcinoma; Gastric stromal tumor; Follow up; Relapse
胃肠道间质瘤(gastrointestinal stromal tumor,GIST)是指以梭形细胞为主、缺乏明确肌性或神经分化特征的难以明确分化方向的间叶源性肿瘤,主要发生于胃肠道、肠系膜和腹膜[1]。其免疫学表现主要为CD117(80%~100%)和CD34(56%~83%)阳性,c-kit基因突变阳性对格列卫治疗有指导意义[2]。
胃间质瘤(gastric stromal tumor,GST)合并胃癌(gastric cancer,GC)的发生十分罕见,相关报道较少,均为病案报道[3-8]。目前,尚不明了这两种不同的病灶是偶然发生的还是基于某种原因而同时形成,也无从得知这类患者在接受手术治疗后,两种不同肿瘤的复发风险究竟哪个更高。本文将对8例胃间质瘤合并胃癌的患者进行分析,现报道如下。
1 资料与方法
1.1 一般资料
选择1999年7月~2011年8月期间于韩国延世大学外科部接受手术治疗的胃间质瘤患者共130例,其中合并胃癌8例;对这8例患者的临床资料、病理特征及随访资料进行回顾分析。
1.2 研究方法
所有的患者均成功施行根治性的部分或者远端胃癌根治术联合D2淋巴结清扫,其中进展期胃癌均予以化疗,所有的胃间质瘤均未给予伊马替尼治疗。胃癌分期根据 AJCC (2001)版,胃间质瘤危险度分级则按照NIH标准,分成极低危、低危、中危和高危[9]。标本常规在4%的甲醛溶液中固定并石蜡包埋,通过苏木精-伊红染色对胃癌病灶常规病检,而对胃间质瘤病灶采用免疫组化方法对CD117单克隆抗体测定(1:50,Dako,Copenhagen,Denmark)以及CD34单克隆抗体测定(1:50,Dako,Copenhagen,Denmark),同时进行突变分析。
1.3 观察指标
胃癌病灶和胃间质瘤病灶的病理特征,包含外观大小、病灶分布情况和各自的分期、分级情况及胃间质瘤的免疫组化结果、突变分析结果;随访期间,胃癌和胃间质瘤病灶的复发情况。
1.4 统计方法, 百拇医药(来集富 许文娜 王元宇 Sung Hoon Noh)