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目的探讨胃肠道间质瘤的生物学行为并对多因素进行预后分析。方法对194例胃肠道间质瘤构建组织微阵列,采用免疫组织化学EnVision法检测胃肠道间质瘤组织中CD117、CD34、a-SMA、desmin、S-100、p53、Ki-67、PCNA的表达,结合随访资料,对其生物学行为进行分析。结果全组1年3、年、5年生存率分别为93.5%、72.1%、63.2%。单因素分析,患者的预后与肿瘤部位、肿瘤大小、核分裂数、肿瘤有无坏死、出血、细胞密集程度、肿瘤细胞类型、核异型性、Ki-67标记指数、p53、性别等因素有关(P<0.05)。初治患者预后同时与手术方式、周围脏器组织有无侵犯及黏膜有无受侵等因素有关。多因素分析显示肿瘤大小、核分裂数、坏死、周围组织侵犯、性别是影响预后的重要因素。结论影响胃肠道间质瘤的预后因素较多,胃间质瘤肿瘤直径>10 cm,核分裂数>10个/50 HPF,肿瘤有坏死,黏膜受侵提示肿瘤恶性度较高,Ki-67标记指数≥5%及p53蛋白(+)有助于预测胃间质瘤侵袭行为;小肠间质瘤肿瘤直径>5 cm,均应高度警惕肿瘤的复发转移。CD34、SMA、desmin、PCNA、S-100蛋白阳性表达与预后无关。
Objective To investigate the biological behavior of gastrointestinal stromal tumors and prognostic analysis of multiple factors. Methods Tissue microarray was performed on 194 cases of gastrointestinal stromal tumors. The expressions of CD117, CD34, a-SMA, desmin, S-100, p53 and Ki-67 in gastrointestinal stromal tumors were detected by EnVision immunohistochemistry. PCNA expression, combined with follow-up data, analysis of their biological behavior. Results The 3-year, 5-year and 5-year survival rates of the whole group were 93.5%, 72.1% and 63.2% respectively. Univariate analysis showed that the prognosis of patients was related to the tumor location, tumor size, mitosis, tumor necrosis, bleeding, cell density, tumor cell type, nuclear atypia, Ki-67 index, p53, <0.05). The prognosis of patients with newly diagnosed at the same time with the surgical approach, whether the surrounding tissue invasion and invasion of mucosal factors. Multivariate analysis showed that the size of tumor, mitosis, necrosis, surrounding tissue invasion, gender is an important factor affecting the prognosis. Conclusions Gastrointestinal stromal tumors have many prognostic factors. Gastrointestinal stromal tumors have a diameter of> 10 cm and mitotic numbers> 10/50 HPF. The tumors are necrotic. Mucosal invasion indicates a high degree of malignancy. Ki-67 Marked index ≥ 5% and p53 protein (+) contribute to the prediction of gastric stromal tumor invasion; small intestinal stromal tumor diameter> 5 cm, should be highly vigilant tumor recurrence and metastasis. The positive expression of CD34, SMA, desmin, PCNA and S-100 protein had no relation with prognosis.