南方医科大学学报

南方医科大学学报 ›› 2013, Vol. 33 ›› Issue (06): 918-.

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三种风险分级标准在中国胃肠间质瘤患者中的应用价值

陈韬，刘浩，胡彦锋，余江，牟廷裕，李国新   

  • 出版日期:2013-06-20 发布日期:2013-06-20

Value of three risk-stratification criteria in Chinese patients with gastrointestinal stromal tumors

  • Online:2013-06-20 Published:2013-06-20

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摘要： 目的目前国际常用的胃肠间质瘤（gastrointestinal stromal tumor, GIST）风险分级标准有三种：Fletcher、Miettinen 和
NIH2008，本文拟探讨三种分级对中国GIST风险程度评估中的应用价值。方法回顾性分析2008年1月~2010年12月我院收治
并具有完整病理及随访资料的144例原发GIST患者的临床及随访资料，采用Fletcher、NIH2008分级分别对其进行风险评估，
采用Miettinen分级对119例GIST进行风险评估，使用Kaplan-Meier生存分析比较Miettinen和Fletcher分级，建立Logistic回归
模型分析比较Miettinen和NIH2008分级的准确度。结果（1）Fletcher分级中中危组的非胃（小肠、直肠等）GIST和胃GIST的无
瘤生存时间之间相比差异有统计学意义（P=0.001），Miettinen分级极低、低、中、高危各组中，不同部位GIST的无瘤生存时间相
比差异无统计学意义（P>0.05）；（2）Miettinen 分级的Logistic 回归模型：y=1.350-3.807X1-4.664X2-2.554X3；NIH2008 分级的
Logistic 回归模型：y=0.875-3.332X1-3.944X2-2.028X3；Logistic 回归模型的判对率比较：Miettinen 分级（89.4）>NIH2008 分级
（85.2）。结论Fletcher分级相对简易，有一定的使用价值，但是对不同部位的GIST的预后评估容易误判；Miettinen分级在中国
GIST的风险评估中可能可以成为NIH2008分级一种潜在的补充手段。

Abstract: Objective To evaluate the application value of three risk-stratification criteria in domestic GIST risk assessment.
Methods The clinical data of 144 patients with GIST who were admitted to our hospital from January 2008 to December 2010
were analyzed retrospectively. 144 cases of GISTs were evaluated for their biologic potential by the risk-stratification criteria of
Fletcher, NIH2008, and among those, 119 cases of GISTs were evaluated by the risk-stratification criteria of Miettinen. Fletcher
and Miettinen criteria were compared by Kaplan-Meier survival analysis. The Logistic regression model was established to
analyze the comparison of Miettinen and NIH2008 criteria. Results (1) According to Fletcher criteria in the intermediate risk
GISTs, the recurrence-free survival (RFS) of non gastric(small intestinal, rectal and so on) GISTs and gastric GISTs were
statistically different (P=0.001). According to Miettinen criteria, in the risk subgroup of GISTs，the recurrence-free survival of
different location of GISTs had no statistical difference(P>0.05); (2)Logistic regression model judgment rate: Miettinen criteria
(89.4)>NIH2008 criteria (85.2). Conclusion Fletcher criteria is simple and easy to use, but may misjudge the prognosis of the
GIST in different part; Miettinen criteria may be a potential supplementary way of NIH2008 criteria in domestic GIST risk
assessment.