【摘要】：目的:通過評價(jià)CD117、CD34和DOG-1等在胃腸道間質(zhì)瘤中的表達(dá),來分析這些表達(dá)的蛋白對腫瘤的特異性識(shí)別和對高�；颊叩纳媛暑A(yù)測的影響。方法:回顧性分析皖南醫(yī)學(xué)院第一附屬醫(yī)院2011年8月-2015年9月以來經(jīng)過病理證實(shí)的胃腸間質(zhì)瘤病人133例,并應(yīng)用免疫組化的方法檢測GISTs患者中CD117、CD34和DOG-1等相關(guān)標(biāo)記物的表達(dá),采用SPSS19.0軟件分析上述免疫組織化學(xué)指標(biāo)與臨床病理因素(部位、腫瘤大小、核分裂象、組織學(xué)類型和危險(xiǎn)度)的相關(guān)性.結(jié)果:其中男性患者70例,女性患者63例,比例為1:0.9。發(fā)病時(shí)間為2天-數(shù)月不等�；颊甙l(fā)病年齡最小為41歲,年齡最大為86歲,中位發(fā)病年齡64歲,年齡與CD117、CD34、DOG-1之間并無統(tǒng)計(jì)學(xué)意義(P0.05)。本研究中間質(zhì)瘤位于胃的占80例(60.15%),其次是小腸37例(27.81%),結(jié)直腸為13例(9.77%),最后腹腔或系膜部位3例(2.25%)。其中鏡下組織細(xì)胞分型中梭形細(xì)胞為主型86例,上皮樣細(xì)胞為主型25例,混合型22例;免疫組化CD117陽性率96.24%(128/133)、CD34陽性率90.2%(120/133)、DOG-1陽性率90.2%(120/133)。133例患者隨訪17個(gè)月~69個(gè)月,失訪34例,腫瘤復(fù)發(fā)25例,其他死亡原因者14例,余60例患者一般情況良好。根據(jù)美國國立衛(wèi)生研究院(NIH)確定的GIST危險(xiǎn)度分級(jí)(2008年)進(jìn)行惡性度分級(jí)(表2)后,極低危26例(20%)、低危38例(29%)、中危27例(20%)和高危42例(31%)。133例患者隨訪17-69個(gè)月,失訪34例,腫瘤復(fù)發(fā)25例,其他死亡原因者14例,余60例患者一般情況良好。DOG-1蛋白的表達(dá)與腫瘤的組織學(xué)類型之間的關(guān)系有顯著性差異(P=0.005),CD34的表達(dá)與腫瘤的位置之間的關(guān)系有顯著性差異(P=0.026)。在生存率曲線中,CD117、CD34和DOG均無統(tǒng)計(jì)學(xué)意義(P0.05),但DOG-1陽性表達(dá)(P=0.096)患者有更長的生存時(shí)間。結(jié)論:CD117、CD34和DOG可以相互補(bǔ)充提高GIST患者診斷率。腫瘤的形態(tài)學(xué)特征對預(yù)測間質(zhì)瘤病人的生存時(shí)間有著很大的關(guān)聯(lián)性,對每一種情況都進(jìn)行深入分析對預(yù)測患者的生存期起著關(guān)鍵性作用,這可能為其以后的治療提供幫助。
[Abstract]:Aim: to evaluate the expression of CD117,CD34 and DOG-1 in gastrointestinal stromal tumors (GIST) in order to analyze the effects of these expressed proteins on tumor specific recognition and survival rate prediction in high risk patients. Methods: from August 2011 to September 2015 in the first affiliated Hospital of Southern Anhui Medical College, 133 cases of gastrointestinal stromal tumor confirmed by pathology were analyzed retrospectively. The immunohistochemical method was used to detect CD117, in patients with GISTs. The expression of CD34, DOG-1 and other related markers were analyzed by SPSS19.0 software. The correlation between the above immunohistochemical indexes and clinicopathological factors (location, tumor size, nuclear splitting image, histological type and risk) was analyzed. Results: among them, 70 cases were male and 63 cases were female, the proportion was 1. 9%. The onset time is 2 days-several months do not wait. The onset age was 41 years and 86 years respectively. The median age of onset was 64 years. There was no significant difference between the age and CD117,CD34,DOG-1 (P0.05). In this study, 80 cases (60.15%) were located in the stomach, 37 cases (27.81%) in the small intestine, 13 cases (9.77%) in the colorectal, and 3 cases (2.25%) in the final abdominal or mesenteric region. Among them, 86 cases were spindle type, 25 cases were epithelioid type and 22 cases were mixed type. The positive rates of CD117, CD34 and DOG-1 were 96.24% (128 / 133), 90.2% (120 / 133), 90.2% (120 / 133) and 90.2% (120 / 133) respectively. Other causes of death were found in 14 cases, and the remaining 60 cases were generally in good condition. According to the GIST risk rating (2008) determined by the National Institutes of Health (NIH), 26 cases (20%) were extremely low-risk and 38 cases (29%) were low-risk, according to the grade of malignancy (Table 2) determined by the National Institutes of Health (NIH). There were 27 cases (20%) at middle risk and 42 cases (31%) at high risk. 133 cases were followed up for 17 months, 34 cases lost follow-up, 25 cases suffered recurrence of tumor and 14 cases died of other causes of death. There was a significant difference between the expression of dog-1 protein and the histological type of the tumor (P < 0. 005), and a significant difference between the expression of CD34 and the location of the tumor (P < 0. 026), and there was a significant difference between the expression of DOG-1 protein and the histological type of the tumor (P < 0. 005). In the survival curve, there was no significant difference between CD117,CD34 and DOG (P0.05), but the patients with positive expression of DOG-1 (P0. 096) had longer survival time. Conclusion: CD117,CD34 and DOG can complement each other to improve the diagnostic rate of GIST. The morphological features of tumors have a great correlation in predicting the survival time of patients with stromal tumors. The in-depth analysis of each case plays a key role in predicting the survival time of the patients, which may be helpful for future treatment.
【學(xué)位授予單位】：皖南醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735

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