40例直肠胃肠间质瘤的预后分析

Prognostic analysis of 40 cases with rectal gastrointestinal stromal tumor

目的探讨直肠胃肠间质瘤（GIST）的预后特点。方法对新疆医科大学附属中医医院和天津市人民医院1979年6月至2010年6月间收治的40例直肠GIST患者的临床和随访资料进行回顾性分析。结果40例直肠GIST中男性23例，女性17例，年龄28～81（中位数54．5）岁。术后随访1～300（中位52．5）个月，复发和转移18例，其中单纯局部复发7例，单纯远处转移6例，局部复发并远处转移5例。术后1、3及5年生存率分别为82．5％、60．0％及42．5％。单因素预后分析显示。患者术后生存率与肿瘤大小（P〈0．01）、肿瘤Fletcher分级（P〈0．01）、核分裂像（P〈0．01）及术后远处转移（P〈0．05）有关；多因素预后分析显示，肿瘤大小（P〈0．05）、核分裂像（P〈0．01）和术后远处转移fP〈0．01）是直肠GIST的独立预后因素。结论直肠GIST治疗仍以手术切除为主，肿瘤原发灶大小、核分裂像和术后远处转移是影响预后的独立因素。

[Abstract] Objective To analyze the prognosis of rectal gastrointestinal stromal tumors （GIST）. Methods Records of 40 patients diagnosed as rectal GIST at the Affiliated Chinese Traditional Medical Hospital of Xinjiang Medical University and the People＇s Hospital of Tianjin City between June 1979 and June 2010 were reviewed. Clinical features, treatment modalities and outcomes were analyzed. Results There were 23 males and 17 females with a median age of 54.5 years old （range, 28-81 years old）. During the follow-up （median 52.5 months, range 1-300 months）, 18 patients developed recurrence including 7 local recurrence, 6 metastasis and 5 local recurrence complicated with metastasis. The overall survival rates at 1, 3 and 5 years were 82.5%, 60.0%, and 42.5% respectively. On univariate analysis, tumor size （P〈0.01）, Fletcher classification （P〈0.01）, mitotic index （P〈0.01）, and post- operative distant metastasis were associated with survival. Multivariate analysis showed that tumor size （P〈0.05）, mitotic rate （P〈0.01）, and postoperative distant metastasis （P〈0.01） were independent prognostic factors associated with survival. Conclusions Surgery is the main treatment for rectal GIST. Tumor size, mitotic rate and metastasis are independent prognostic factors in patients with rectal GIST.