胃肠间质瘤的外科治疗及预后分析

Surgical treatment and prognosis of gastrointestinal stromal tumor

目的探讨胃肠间质瘤（GIST）~科治疗效果及其影响因素。方法对中山大学肿瘤防治中心1990年1月至2010年2月间收治的首次进行外科治疗且能够完全切除的277例GIST患者临床资料进行回顾性分析，对其病理切片重新复核并加以随访。结果277例患者中男性176例，女性101例，年龄20～81（中位年龄57）岁；肿瘤位于结直肠28例，小肠76例，胃173例。均予以肿瘤完整切除，其中局部切除98例，肿瘤及所在器官切除64例。扩大切除术115例：3种切除方式患者术后5年生存率分别为83．5％、71．9％和61．9％，差异无统计学意义（P〉0．05）。Cox模型分析显示，肿瘤大小和复发转移是影响GIST患者预后的独立因素（P〈0．05）。结论胃肠道GIST仍以外科治疗为主．原则上施行肿瘤完全切除即可．广泛切除或扩大淋巴结清扫并不能提高生存率。

Objective To investigate the outcome of surgical treatment for gastrointestinal stromal tumor （GIST） and the associated factors. Methods A total of 277 patients with GIST underwent primary surgical treatment from January 1990 to February 2010 at the Cancer Center of Sun Yat-sen University. The clinical data were retrospectively reviewed and the pathological examination was reviewed. Follow-up was performed. Results There were 176 males and 101 females. The age ranged from 20 to 81 years old （median,57）. Location of the tumor included colorectum （n=28）, small bowel （n=76）, stomach（n=173）. All the patients had en bloc resection, including local excision in 98 patients, organ resection in 64, and extended resection in 115. The 5-year survival rates were 83.5%, 71.9%, and 61.9% in the three different procedures, respectively, and the difference was not statistically significant （P〉0.05）. Cox model showed that the tumor size, recurrence and metastasis were independent risk factors associated with the prognosis in GIST patients （P〈0.05）. Conclusions Surgery remains the major approach for gastrointestinal GIST. Complete resection is the principal treatment. Extensive resection or extended lymph nodes dissection is not associated with improved survival.