胃肠道间质瘤67例

Diagnosis, treatment and prognosis of gastrointestinal stromal tumors: an analysis of 67 cases

目的:探讨胃肠道间质瘤(gastrointestinal stromal tumors,GIST)的临床诊断、治疗方式及预后因素.方法:回顾性分析华中科技大学同济医学院附属协和医院普外科2002-01/2008-10收治的GIST患者67例的临床病理及随访资料,采用Kaplan-meier法比较不同因素对生存率的影响,并用Cox多因素回归分析评价其预后.结果:间质瘤67例,位于胃31例、小肠23例、直肠7例、胃肠道外6例.免疫组织化学检测CD117分子阳性率为97.0%,CD34分子阳性率为85.1%.所有随访患者53例其1年、3年、5年生存率分别为96.2%、81.1%、70.5%.单因素分析显示美国国立卫生研究院(national institute of health,NIH)2008年关于GIST的危险度分级与生存率有密切关系(P<0.05).高风险组中甲磺酸伊马替尼辅助治疗者较单纯手术治疗者疗效显著提高(P<0.05).多因素分析显示危险分级和甲磺酸伊马替尼治疗是影响预后的因素.结论:GIST的NIH危险度分级和甲磺酸伊马替尼辅助治疗与患者术后生存率密切相关.肿瘤手术后复发主要发生于高风险组,高风险组患者给予甲磺酸伊马替尼治疗可获得更大收益.

AIM： To investigate the clinical characteristics of and prognostic factors for gastrointestinal stromal tumors （GIST）.METHODS： The clinicopathological data for 67 patients with gastrointestinal tumors treated between January 2002 and October 2008 at our hospital were analyzed retrospectively. All these patients were treated by surgery. Kaplan-Meier survival analysis and Cox regression model were used to evaluate the prognostic factors for GIST. RESULTS： Of all the 67 cases, 31 tumors were located in the stomach, 23 in the small intestine, 7 in the rectum, and 6 were out of the gastroin-testinal tract. The positive rates of CD117 and CD34 expression were 97.0% and 85.1%, respectively. The 1-, 3-and 5-year survival rates in 53 patients undergoing followup were 96.2%, 81.1% and 70.5%, respectively. Univariate analysis revealed that the risk classification of GIST published by National Institute of Health （NIH） in 2008 was associated with the survival rate in GIST patients. In the high-risk group, adjuvant imatinib mesylate therapy after surgery improved the prognosis signif icantly. Multivariate analysis using Cox hazard proportional model revealed that the risk classification and admin-istration of imatinib mesylate could affect the prognosis of GIST patients. CONCLUSION： The NIH risk classification for GIST and imatnib mesylate treatment are related to the survival rate of GIST patients. Surgical resection is still the main therapy for GIST though targeted therapy will play a more important role in future. As postoperative recurrence mainly occurs in the high-risk group, these GIST patients will get more benefit from adjuvant Gleevec treatment.