胃肠道间质瘤术后复发转移的临床特点及治疗

Postoperative recurrent-metastatic gastrointestinal stromal tumors： a study of 56 patients

目的 探讨胃肠道间质瘤（gastrointestinal stromal tumors,GIST）首次术后复发转移的特点、治疗及预后因素.方法 回顾性分析天津医科大学附属肿瘤医院和唐山市协和医院1997年1月至2007年12月首次手术后出现复发转移而就诊于两院的56例GIST病例的临床特点和治疗方法,并对其预后进行评价.结果 本组56例发现复发转移的中位时间为17.3个月.单纯手术治疗19例,单纯靶向治疗8例,手术联合靶向治疗14例,3年生存率分别为65%、66%、89%.再次手术切除后的复发率为76%.单因素分析显示,预后与手术、靶向治疗及年龄有关（P＜0.05）;多因素分析显示,手术和靶向治疗是预后的独立影响因素（P＜0.05）.结论 对于复发转移的GIST患者,手术联合靶向治疗能获得最佳的预后.

Objective To investigate the clinical characteristics, treatment and prognostic factors of postoperative recurrent-metastatic gastrointestinal stromal tumors （GIST）. Methods The clinical data of 56 patients with postoperative recurrent-metastatic GIST between January 1997 and December 2007 were analyzed retrospectively , and the prognostic factors were evalutated. Results Initial recurrence-metastasis was diagnosed after a median of 17.3 months from primary resection. Of the 56 cases, 19 cases received resection, 8 cases received imatinib targeted therapy,14 cases were treated by imatinib targeted therapy and surgery, the 3 year survival rates were 65% ,66% ,89% respectively. The rate of recurrence-metastasis after reoperation is 76%. Univariate analysis revealed that surgery, targeted therapy and age were related to the survival rates, multivariate analysis demonstrated that surgery and targeted therapy were the independent prognostic factors for survival. Conclusions For recurrent-metastatic GIST, a multimodal approach including surgery and targeted therapy improves survival.