The Clinicopathologic Features and Outcome of Patients with Gastrointestinal Stromal Tumors in Colorectal Region

大腸直腸之胃腸道間質瘤之臨床病理表現及預後分析：單一醫療機構之分析

楊雪儷(Hsueh-Li Yang) ； 張世慶(Shih-Ching Chang) ； 藍苑慈(Yuan-Tzu Lan) ； 王煥昇(Huann-Sheng Wang) ； 楊純豪(Shung-Haur Yang) ； 姜正愷(Jeng-Kae Jiang) ； 陳維熊(Wei-Shone Chen) ； 林資琛(Tzu-Chen Lin) ； 林楨國(Jen-Kou Lin)

《中華民國大腸直腸外科醫學會雜誌》 22卷4期 (2011/12) Pp. 115-121

https://doi.org/10.6312/SCRSTW.2011.22(4).10005

摘要

目的　大腸直腸之胃腸道間質瘤是一種罕見的大腸直腸腫瘤。它的發生主要是因為c－kit突變所造成的。這篇文章主要是要探討大腸直腸之胃腸道間質瘤，其臨床病理表現及預後。方法　這是一個單一醫學中心，由單一外科團隊執行的研究。從1997年開始所有住院接受大腸腫瘤根除性切除手術的病人皆會接受評估是否符合於此一研究。診斷符合胃腸道間質瘤，也就是病理免疫染色CD117呈陽性的病人，予以收錄至此一研究，並探討其臨床病理表現及預後。結果　從1997年到2008年間，一共有4205位病患接受大腸腫瘤根除性切除手術。其中有19位（0.44%）診斷有胃腸道間質瘤。這19位病患平均年齡是61.3±16.2歲（範圍：23－81歲）。其中十四位（74%）是男性。有十四位病患（74%）腫瘤位於直腸。腫瘤平均直徑是4.0±3.3公分。最大的腫瘤有13×7×6公分。有十一個腫瘤顯示了高度分裂。十五名患者接受了根除性切除手術。九名患者接受了imatinib治療，這些患者包括腫瘤細胞屬於高度分裂，或腫瘤大小大於5公分，或腹腔內有腫瘤散播。平均追蹤時間是40.2±29.8個月（範圍：3－111個月）。在十一名腫瘤屬於高度分裂（≧ 5／50HPF）的患者中，有七名患者在56個月內復發。對於腫瘤屬於低度分裂的患者，存活率高達87.5%，比腫瘤屬於高度分裂的患者存活率高（54.6%）。另外，腫瘤屬於高風險的患者有比較高的風險產生腫瘤復發（66.7%）。結論　大腸直腸之胃腸道間質瘤若腫瘤大於5公分（復發率：100%）或是腫瘤分裂數大於5／50HPF（復發率：63.5%），即使接受根除性手術切除，仍然會有較高的腫瘤復發率。

關鍵字

胃腸道間質瘤 ； 大腸直腸癌

並列摘要

Background: Gastrointestinal stromal tumor (GIST), originated from c-kit mutation, is a rare tumor in colorectal region. This study was to describe the clinicopathologic features and outcome of patients with colorectal GIST.Methods: We prospectively recorded the clinical data of colorectal tumors receiving operations in Taipei-Veterans General Hospital since 1997. The patients with the diagnosis of GIST were reviewed for the clinical courses and pathological results. The diagnosis of GIST was confirmed by positive staining of CD117 in immunohistochemistry.Results: From Dec. 1997 to Oct. 2008, 19 of the 4205 patients (0.44%) were diagnosed to have GIST. The mean age was 61.3 ± 16.2 year-old (range: 23-81 year-old). Fourteen (74%) were male. Fourteen (74%) tumors located at rectum. The mean diameter of tumor was 4.0 ± 3.3 cm. The largest size of the tumor was 13 × 7 × 6 cm. Eleven tumors showed high grade mitosis. Fifteen patients received radical resection. Nine patients received imatinib treatment for high grade mitosis, large tumor size (＞ 5 cm in diameter) and intraabdominal seeding. The average follow-up period was 40.2 ± 29.8 months (range: 3-111 months). Eleven patients had high mitosis (≧ 5/50 HPF), 7 of them had recurrent disease in 56 months (median = 29.9 ± 21.7 months). For patients with low mitosis tumor, survival rate was 87.5%, better than those with high mitosis (54.6%). High risk patients had higher risk of tumor recurrence (66.7%).Conclusion: Patients with GIST who had large tumor size (tumor size ＞ 5 cm, recurrent rate 100%) or high mitosis (mitosis ≧ 5/50 HPF, recurrent rate 63.5%) in pathological analysis had higher incidence of tumor recurrence, even after radical surgical resection.

並列關鍵字

GIST ； Colorectal cancer