| Objective: To comparison of gastrointestinal stromal tumor(gastrointestinal stromal tumor,GIST)in 2008 the improved(National Institutes of health,NIH)grading standards and 2013 WHO used Miettinen grading standards differences in evaluation gist risk classification,and to explore the two in GIST malignancy potential evaluation of value.At the same time were observed after two grading standard evaluation of benign and malignant GIST cell type,cell atypia,tumor necrosis and other aspects of the differences.To the right of gastrointestinal stromal tumor risk classification standard and provide reference for clinical pathological diagnosis in choice.Methods: 1.To collect yi ji shan Hospital in 2004 may to October 2014 with complete clinicopathologic and follow-up data of 452 cases of gastrointestinal stromal tumor cases.All cases were confirmed by pathology and immunohistochemistry,and were treated with complete surgical resection.Before and after surgery did not take any radiotherapy and chemotherapy;2.Under the guidance of the two high capital pathology specialist for more patients with pathology by HE staining and immunohistochemistry of sections for interpretation,at the same time,to analyze each cases of GIST cell morphological characteristics,and record the result;finishing follow-up data;using modified NIH classification standard and Miettinen grading standards of 452 cases of GIST patients with dangerous degree classification assessment;3.Kaplan Meier survival analysis compare two grading standards in predicting tumor benign and malignant and malignant degree and prognosis of significance.Use SPSS19.0 software for the patients with follow-up data were statistically analyzed and classified data by chi square test,single factor analysis using Log-rank test,P < 0.05 was statistically significant.Results: 1.The group of 452 cases clinical data,243 cases were male,209 were female,male to female ratio of 1.28:1.The onset age of 28-86 years old,the average age is 59.2 years old,the median age was 57 years.The 40 year old patient diagnosed very rare.Tumors located in esophagus in 4 cases(1%),278 cases of stomach(66%),128 cases of small intestine(24%),12 cases of colon(3%),13 cases of rectal(4%),17 cases of gastrointestinal tract(2%).2.With modified NIH grading standard to evaluate the high risk group of 144 cases,medium risk group 66 cases,low risk group 97 cases,145 cases of extremely low risk group.High risk group in the total survival rate and disease-free survival rate(no recurrence,postoperative metastasis)was significantly lower than that in the medium risk group,low risk group and extremely low risk group(P<0.01).In the medium risk group the total survival rate and disease-free survival rate was significantly lower than that of low risk group and extremely low risk group(P<0.01).The low risk group,extremely low risk group,the total survival rate and disease-free survival rate had no significant difference(P>0.05).There was statistical significance in high-risk group of intestinal GIST and gastric GIST compared overall survival rate(P<0.05);the medium risk group,low risk group,low risk group of gastric GIST intestinal and GIST total survival rate comparison was statistically significant(P>0.05).3.According to miettinen8 grading standard group,the benign group 338 cases,the prognosis of group 1(145cases),the prognosis of group 2(97cases)and NIH group of extremely low risk group,low risk group were completely corresponding.Two groups of the total survival rate and disease-free survival rate had no significant difference(P>0.05).The prognosis of group 3A(96 cases),including 62 cases in the moderate group and NIH group;another 34 cases of NIH group and high risk group,clinical outcome should show the actual malignant,and occurred in the small intestine.Of uncertain malignant potential were only 4 cases(prognosis group(n=4),and NIH group risk group 4 cases of complete corresponding;110 cases of malignant group the number of cases,which prognosis group 3B(30 cases)and prognosis of group 5(6cases)and prognosis group 6A(50cases)and prognosis group 6B(24cases)respectively and the NIH standard risk group 110 cases were completely corresponding.Malignant disease free survival rate and overall survival rate was significantly lower than benign group(P<0.01).No 3A group survival and overall survival according to the incidence of the difference in the benign group(P < 0.05).4.On the cell morphology,452 cases of GIST patients with tumor,spindle cell / spindle cell predominant 366 cases(81%),epithelioid cells and epithelioid cells mainly in 33 cases(7.3%),and 53 cases of mixed cell type(11.7%).Evaluation of extremely low risk group 145 cases with modified NIH grading standards,including spindle cell / spindle cell type in 133 cases(91.7%),epithelioid cells / epithelioid cell type in 5 cases(3.4%),7 cases of mixed cell type(4.9%);97 cases of low risk group,in which the spindle cell / spindle cell type in 86 cases(88.7%),epithelioid cells / epithelioid cell type in 3 cases(3.1%),8 cases of mixed cell type(8.2%);66 cases of medium risk group,in which the spindle cell / spindle cell type in 51 cases(77.3%),epithelioid cells / epithelioid cell type in 6 cases(9.1%),mixed cell type in 9 cases(13.6%);144 cases of high-risk group,of which the spindle cell / spindle cell type in 96 cases(66.7%),epithelioid cells / epithelioid cell type in 19 cases(13.2%),29 cases of mixed cell type(20.1%);evaluation standard of grading,results show WHO,benign Group of 338 patients spindle cells,spindle cells mainly 288 cases(85.2%),epithelioid cells and epithelioid cells mainly in 19 cases(5.6%),31 cases of mixed cell type(9.2%);malignant potential undefined group in 4 cases and were spindle shaped cell type;the malignant group(n = 110)spindle cells,spindle cells mainly 74 cases(67.3%),epithelioid cells and epithelioid cells mainly in 14 cases(12.7%),22 cases of mixed cell type(20%).5.Cellular atypia,mild atypia 366 cases(80.9%),moderate atypia 73 cases(16.2%),severe atypia in 13 cases(2.9%),including cells and severe cases of atypical features appeared in the NIH grouping of high-risk group and who block the malignant group.The prognosis of benign group in WHO group 3a in some cases.6.Tumor necrosis,with modified NIH classification criteria for the evaluation of very low risk group and low risk group and risk group were no tumor necrosis and the high-risk group of patients of tumor necrosis accounted for 54.8%(79/144);WHO grading standards group of benign tumor necrosis accounted for 4.9%(16/338),which the prognosis of benign 3A group have occurred in 16 cases of tumor necrosis accounted for 48%(16/34),16 cases of gist was evaluated by the NIH grading standards are for the high-risk group.Malignant tumor necrosis group 57.3%(63/110).7.The gist of the immune group of labeling results CD117 positive cases for 426 cases(94.7%)and the number of CD34 positive cases for 321 cases(71.2%),Dog-1 positive cases for 441 Cases(97.6%),the number of S-100 protein positive cases for 28 cases(5.1%),the number of SMA positive cases 188 cases(40%),desmin positive STD cases number 11 cases(2.2%).Conclusion: 1.WHO grading standards can provide a reference to judge the risk of gist,but there are limitations,improved NIH grading standard by taking into account the risk degree of lesion and tumor rupture and other factors,a more comprehensive evaluation of GIST.Compared two kinds of classification standards,recommended the use of improved in 2008 after the NIH grading standard is more accurate;2.GIST risk estimation of low risk and low risk in clinical recommended in treatment of benign,risk assessment than direct diagnosis of benign more reasonable. |
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