本文選題：胃腸道間質(zhì)瘤 + 臨床病理特征��； 參考：《浙江大學(xué)》2017年碩士論文

【摘要】：背景:胃腸道間質(zhì)瘤(Gastrointestinal stromal tumor,GIST)是胃腸道最常見的非上皮組織來源腫瘤,發(fā)病年齡大部分超過50歲,性別間無差異,主要發(fā)生于胃,現(xiàn)常以病理組織學(xué)觀察聯(lián)合CD117、CD34、DOG-1的免疫組化染色診斷。手術(shù)切除和伊馬替尼輔助治療是GIST目前最主要的治療手段,內(nèi)鏡下治療在臨床上也逐漸推廣應(yīng)用。定義直徑不超過2cm的GIST為小GIST。原發(fā)病灶位于胃外的小GIST一般建議一經(jīng)發(fā)現(xiàn),即予治療,但國內(nèi)外尚未對位于胃的小GIST是否需要治療建立統(tǒng)一標(biāo)準(zhǔn)。方法:收集、觀察并記錄2007年1月至2016年7月在浙江大學(xué)醫(yī)學(xué)院附屬第一醫(yī)院接受治療并符合診斷標(biāo)準(zhǔn)的小GIST患者的臨床病理信息,并根據(jù)GIST發(fā)生部位分為胃內(nèi)組和胃外組、是否在其他腫瘤診治過程中發(fā)現(xiàn)分為腫瘤伴發(fā)組和單純GIST組以及按性別、年齡和腫瘤大小分組后比較各亞組的臨床病理資料,利用修正的美國國立衛(wèi)生研究院(National Institutes of Health,NIH)危險分級評價預(yù)后,分析分級標(biāo)準(zhǔn)的最佳臨界點。結(jié)果:186例小GIST患者發(fā)病中位年齡60歲,平均59.6歲,男女比例為1.14:1.00(P=0.42),72.6%發(fā)生在胃,其中71例因其他腫瘤行外科手術(shù)時發(fā)現(xiàn);腫瘤伴發(fā)組比單純GIST組在接受治療時腫瘤直徑小(P0.01)、發(fā)病年齡大(P0.01),且在性別構(gòu)成(P0.01)上存在差異;核分裂數(shù)中位數(shù)2/50高倍鏡視野(High power field,HPF),不同大小腫瘤分組間存在顯著性差異(P0.01),不同性別、原發(fā)部位以及年齡間無明顯差異;2.2%患者預(yù)后具有中度危險性,以腫瘤大小為檢驗變量的接收者工作特征曲線(Receiver operating characteristic curve,ROC),曲線下面積(Area under the curve,AUC)=0.76,取1.5cm為分級標(biāo)準(zhǔn)時,約登指數(shù)最大(靈敏度=1,特異度=0.59)。結(jié)論:小GIST患者的臨床特點基本符合總體特征;較大的腫瘤有較多核分裂數(shù)的傾向;直徑小于1.5cm的GIST預(yù)后屬于極低危險度,發(fā)現(xiàn)后不建議行治療,可予定期超聲內(nèi)鏡檢查隨訪。
[Abstract]:Background: gastrointestinal stromal tumor (GIST) is the most common non-epithelial neoplasm in the gastrointestinal tract. The immunohistochemical diagnosis of CD117, CD34 and DOG-1 was often observed by histopathology. Surgical resection and imatinib adjuvant therapy are the most important methods of GIST at present. The GIST whose diameter does not exceed 2cm is defined as small GIST. The small GIST with primary lesion located outside the stomach is recommended to be treated as soon as it is discovered, but there is no uniform standard on whether the small GIST located in the stomach needs treatment at home and abroad. Methods: to collect, observe and record the clinicopathological information of small GIST patients who were treated in the first affiliated Hospital of Zhejiang University School of Medicine from January 2007 to July 2016 and were divided into intragastric group and extragastric group according to the location of GIST. Whether it was found in the diagnosis and treatment of other tumors that they were divided into tumor-associated group and GIST group, as well as the clinicopathological data of each subgroup after grouping according to sex, age and tumor size, The prognosis was evaluated by the revised National Institutes of Health (NIH) risk classification, and the optimal critical point of the classification criteria was analyzed. Results the median age was 60 years (mean 59.6 years) in 186 patients with small GIST. The ratio of male and female was 1.14: 1.00 (P < 0.42). 72.6% of them occurred in the stomach. Among them, 71 cases were found in surgery because of other tumors. The diameter of tumor was smaller (P0.01), the age of onset was older (P0.01), and the sex composition (P0.01) was different in the group with tumor associated with GIST than in the group of GIST alone. The median mitotic number was 2 / 50 high power field. There was significant difference among different tumor groups (P0.01). There was no significant difference in prognosis between different sex, primary location and age. The receiver's working characteristic curve (receiver operating characteristic curve) and area under the curve (Area under the curvev AUC) were 0.76. When 1.5cm was used as the grading standard, the maximum Jorden index was obtained (sensitivity 1, specificity 0. 59). Conclusion: the clinical characteristics of small GIST patients are basically consistent with the general characteristics, the larger tumors tend to have more mitotic numbers, and the prognosis of small GIST patients whose diameter is smaller than 1.5cm is very low risk. It is not recommended to be treated after discovery, and can be followed up by regular endoscopic ultrasonography.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735

【相似文獻】

相關(guān)期刊論文 前10條

1 雷嘉;胃腸道間質(zhì)瘤20例病理分析[J];河北醫(yī)藥;2001年06期

2 張德昌,王志純,艾書躍,李世紅,李士建,劉玉龍;胃腸道間質(zhì)瘤(附2例報告)[J];臨床腫瘤學(xué)雜志;2001年04期

3 許海鶯,陳宏穎;胃腸道間質(zhì)瘤20例臨床病理分析[J];齊齊哈爾醫(yī)學(xué)院學(xué)報;2001年01期

4 沈玉林,郭春君;胃腸道間質(zhì)瘤13例臨床病理分析[J];四川腫瘤防治;2001年03期

5 黃志勇,章宜芬,王寧,張華勇;胃腸道間質(zhì)瘤的研究進展[J];腫瘤學(xué)雜志;2001年04期

6 盧俊,吳亞光,蘇忠學(xué),穆慶嶺,吳太璜;胃腸道間質(zhì)瘤的診斷和治療[J];山東醫(yī)藥;2002年19期

7 李學(xué)民,何政,馬占明;胃腸道間質(zhì)瘤的診治[J];邯鄲醫(yī)學(xué)高等�？茖W(xué)校學(xué)報;2002年01期

8 石書紅 ,梁輝 ,俞學(xué)明;胃腸道間質(zhì)瘤42例臨床分析[J];交通醫(yī)學(xué);2002年03期

9 熊小亮;胃腸道間質(zhì)瘤研究進展[J];江西醫(yī)藥;2002年01期

10 于志強,朱立元,王有德;胃腸道間質(zhì)瘤的臨床分析[J];中華胃腸外科雜志;2002年01期

相關(guān)會議論文 前10條

1 于吉人;萬凱明;李甫強;劉小孫;楊偉歷;;184例胃腸道間質(zhì)瘤的臨床病理和免疫組化研究[A];2009年浙江省外科學(xué)學(xué)術(shù)年會論文匯編[C];2009年

2 張威;葉再元;邵欽樹;王躍東;許曉東;趙仲生;;胃腸道間質(zhì)瘤的臨床研究[A];2009年浙江省外科學(xué)學(xué)術(shù)年會論文匯編[C];2009年

3 劉良進;畢俊英;;多層螺旋CT診斷胃腸道間質(zhì)瘤17例分析[A];湖北省抗癌協(xié)會腫瘤影像專業(yè)委員會成立暨第一屆學(xué)術(shù)大會論文匯編[C];2009年

4 竺楊文;王躍東;李保軍;;胃腸道間質(zhì)瘤的腹腔鏡外科治療[A];2004年浙江省外科學(xué)學(xué)術(shù)年會論文匯編[C];2004年

5 韓少良;周宏眾;余作黔;程駿;陳哲京;姚建高;朱冠保;;胃腸道間質(zhì)瘤的臨床病理特點與外科治療[A];2005年浙江省外科學(xué)術(shù)會議論文匯編[C];2005年

6 楊景林;;胃腸道間質(zhì)瘤的新概念及研究進展[A];2006年貴州省醫(yī)學(xué)會消化及內(nèi)鏡學(xué)分會學(xué)術(shù)大會論文匯編[C];2006年

7 劉變英;王穎;李小會;楊嫦娥;王文英;;胃腸道間質(zhì)瘤的診斷和微創(chuàng)治療研究[A];第十七屆中國內(nèi)鏡醫(yī)師大會論文集[C];2007年

8 胡鳳玲;許國強;;胃腸道間質(zhì)瘤臨床分析[A];浙江省中西醫(yī)結(jié)合學(xué)會消化專業(yè)第八次學(xué)術(shù)年會暨省中西醫(yī)結(jié)合消化系疾病新進展學(xué)習(xí)班論文匯編[C];2007年

9 鄭志強;;胃腸道間質(zhì)瘤患者預(yù)后多因素分析[A];2008年浙江省外科學(xué)術(shù)年會論文匯編[C];2008年

10 伍小軍;方m錁，

本文編號：2071507