143例胃肠道间质瘤的外科诊治及预后分析

Surgical Treatment of 143 Cases of Gastrointestinal Stromal Tumors

目的:探讨胃肠道间质瘤的临床病理特征及外科诊治情况,分析影响预后相关因素。方法:回顾性分析经手术治疗的143例患者的临床资料。结果:发生于胃42.7%,小肠35.0%,腹痛不适44.1%,消化道出血或贫血28.0%。131例手术完整切除,免疫组化表型CD117阳性率为98.5%。中位生存时间为64.0个月,1、3、5年生存率分别为89.7%,72.4%和53.4%。手术切除的完整性和危险程度分级是影响预后的独立因素(P<0.05)。结论:胃肠道间质瘤术前确诊率较低,手术完整切除是主要治疗手段,伊马替尼治疗晚期患者有一定疗效。影响患者预后的独立因素是肿瘤危险程度分级、手术切除的完整性和伊马替尼治疗。

Objective To explore the clinicopathological characteristics, demonstrate the condition of diagnosis and treatment and analyze the risk factors of prognosis of gastrointestinal stromal tumors （GIST）. Methods The clinical data of 143 operated cases of GTST were enrolled into retrospective analysis. Results The stomach and intestine were the two most common locations with the constituent ratios of 42.7% and 35.0% respectively. The common and first clinical symptoms were abdominal pain or discomfort （44.1%）, and gastrointestinal （GI） tract bleeding and anemia （28%）. The tumors were completely removed in 131 cases. The immunohistochemical analysis revealed that the positive rate of CD117 was 98.5%. The median survival time was 65.0 months. The overall 1, 3, and 5 year survival rates were 91.8%, 73.3% and 52.1% respectively. Using multivariate analysis, it was found that tumor completely resected and malignant risk of tumor were two independent prognostic factors （P 0.05）. Conclusion The primary treatment of GIST is complete surgical resection. Patients with advanced GISTs achieved clinical benefit with imatinib. Tumor completely resected risk of malignancy and imatinib treatment are independent prognostic factors.