原发性胃肠道间质瘤的多因素Cox模型分析

Cox model analysis for multiple factors in prognosis of patients with the primary gastrointestinal stromal tumors

目的分析胃肠道间质瘤（GIST）的临床特征、治疗效果及其影响因素。方法复习216例原发性GIST患者临床资料并加以随访进行Cox回归模型分析。结果全组1、2、3、4、5年生存率分别为94．4％（204／216）、90．2％（129／143）、88．3％（68／77）、87．5％（35／40）和85．0％（17／20）。年龄、肿瘤发生部位、是否完整切除、肿瘤是否破裂、术后是否辅助治疗、是否复发、肿瘤病理核分裂象、最大径等因素对GIST患者生存率的影响有显著性意义（P〈0．05）；并且随着影响因素变量值增大，死亡的风险值增高。其中完整切除对患者的预后起着决定性的作用。患者性别、CD117、是否活检、内窥镜下黏膜是否糜烂、手术切缘等对生存率影响无显著性意义（P〉0．05）。术后辅助治疗可明显提高患者生存率，尤其对于高风险度患者。结论GIST仍以外科治疗为主，其手术方式的选择更多取决于肿瘤的部位和大小，完整切除或扩大切除能提高生存率。患者年龄、肿瘤发生部位、是否完整切除、肿瘤是否破裂、是否辅助治疗、术后是否复发、肿瘤病理核分裂象、最大径等是影响预后的重要因素，有利于指导临床规范化治疗。

Objective To analyze the clinical characteristics, effects of adjuvant therapy and influential factors of gastrointestinal stromal tumors （GIST）. Methods A retrospective and multiple factor Cox model analysis on 216 cases of primary GIST diagnosed by surgery and pathology was conducted. Results The total survival rates of patients at one to five years were 94.4 % （204/216）, 90.2 % （129/143）, 88.3 % （68/77）, 87.5 % （35/40） and 85.0 % （17/20）, respectively. The statistically significant prognostic factors for survival rates of patients with GIST included age, location of tumor, local or total tumor resection, rupture of tumor, adjuvant treatment, recurrence, mitotic rate, and tumor size （P 〈 0.05）. Due to those influence factors, the greater of the values, the higher of the risk of death. Among those factors, whether having grass total resection played a decisive role in the prognosis of patients with GIST. Other factors, such as sex, CD,7, biopsies, endoscopic mucosal erosion, and operation cutting margin had no significant relevance with the survival rate of patients （P 〉0.05）. Postoperative adjuvant therapy could significantly improve the survival rate of patients with GIST, especially for patients with high risk. Conclusion Surgical treatment should be given priority to treatment of GIST, and the choice of the surgery strategies depends mainly on the location and size of tumors. The complete resection or extensive resection could improve survival rates. Age, location, total tumor resection, rupture of tumor, adjuvant treatment, recurrence, mitotic rate, and tumor size are important factors affecting prognosis and survival rate of patients with GIST, which could guide standardized clinical treatment.