胃肠道间质瘤大小与预后

Prognostic significance of primary tumor size in gastrointestinal stromal tumor

目的探讨胃肠道间质瘤(GIST)原发肿瘤大小与预后的关系。方法对该院1990年1月至2006年3月132例能完全切除的GIST患者的临床资料和病理切片(含免疫组织化学检查)重新复核并进行随访,分析原发肿瘤大小与预后的关系。结果患者中位生存时间为66.0个月,术后2年和5年生存率分别为89.4%和70.9%。原发灶肿瘤完全切除术患者的生存率与其性别、肿瘤部位和大小、肿瘤性质、核分裂及复发转移有关;但多因素的Cox回归分析显示,术后生存率仅与肿瘤大小、肿瘤性质和复发转移相关(P<0.05)。以2cm为界比较生存率有统计学意义(P<0.05),以5cm为界比较生存率无统计学意义(P>0.05)。结论GIST仍以外科治疗为主,GIST原发灶大小是影响预后的独立高危因素,直径≥2cm的患者应加强随诊。

Objective To analyze the surgical treatment effects for patients with gastrointestinal stromal tumors （GIST） and the prognostic significance of primary tumor size in GIST. Methods In the retrospective study, the clinical data and the tissue slices including immunohistochemical staining of 132 patients with GISTs from January 1990 to March 2006 were rechecked, and all patients were followed up carefully. More attention was paid to the surgical treatment effects and the influential factors of survival after operation. SPSS 12.0 for windows software package was used for statistical analysis. The influential factors were analyzed with Chi-squared test and Cox Regression model, survival rates with Kaplan-Meier methods. Results The median survival duration for patients with tumor reseeted completely was 66.0 months. The overall survival rates at 2 and 5 years were 89.4 % and 70.9 %, respectively. Sex, tumor sites, preoperative metastasis, tumor size, pathology type, karyokinesis and recurrence-metastasis are related with survival rates for patients with tumor reseeted completely in monovariate analysis, but only tumor size, pathology type, recurrence and metastasis were related with survival rates by the Cox Regression multivariate analysis （P〈O.05）. The difference between the survival rates of two groups divided by 2cm was statistically significant（P〈O.05）, but the groups divided by 2em was not statistically significant （P 〉 0.05）.＂ Conclusions Surgery is still the main treatment for GISTs. Tumor size was a significant independent prognostic factor in patients with GISTs. We should take intensive follow-up for patients with tumor size more than 2cm.