中高度复发风险胃肠间质瘤术后伊马替尼辅助治疗的疗效观察

Therapeutic efficacy of post-operational imatinib adjuvant therapy in patients with gastrointestinal stromal tumor at intermediate and high risk of recurrence

目的 探讨伊马替尼（IM）对中高度复发风险胃肠道间质瘤（GIST）患者的术后辅助治疗疗效及其优化措施.方法 回顾性分析2004年1月至2012年9月间接受R0手术切除的连续225例中高危原发GIST患者（中危62例,高危163例）的临床及随访资料,比较接受IM辅助治疗及未接受IM辅助治疗两组患者的术后复发情况.结果 在中危GIST患者中,服药组与未服药组相比,5年无复发生存率（RFS）分别为83.3%和88.6%,两组生存曲线差异无统计学意义（P=0.647）;高危GIST患者中,服药组与未服药组术后1年的RFS分别为93.5%和81.2%,差异有统计学意义（P=0.037）,而术后5年RFS分别为56.1%和50.2%,两组生存曲线比较差异无统计学意义（P=0.112）;此外,在高危GIST患者中,核分裂象＞10/HPF或有局部浸润的服药组和未服药组患者比较,服药组术后1年的复发率均显著低于未服药组,P值分别为0.022和0.036,而核分裂相≤10/HPF且无局部浸润的服药和未服药组患者术后1年的复发率差异无统计学意义（P=0.789）.结论 GIST术后IM辅助治疗可有效延缓肿瘤复发,但不能预防IM停药后的肿瘤复发,对于核分裂象＞10/HPF或伴有局部浸润的高危GIST患者,应尽量延长术后IM的辅助治疗时间.

Objective To explore the optimized methods and efficacy of post-operational ima- tinib adjuvant therapy in patients with gastrointestinal stromal tumor （GIST） at intermediate and high risk of recurrence. Methods A total of 225 patient s records with intermediate and high risk GIST who underwent R0 surgical treatment in our center from January 2004 to September 2012 were examined retrospectively. 62 cases among which presented with intermediate risk of recurrence and 163 cases were presented with high risk of recurrence. The recurrence rate was used to comparethe recurrence rate between patients with and without post-operational imatinib adjuvant therapy. Results In GIST patients with intermediate risk of recurrence, there was no significant difference regarding to the five- year recurrence free survival（RFS） between patients with and without adjuvant therapy, with 83. 3G vs 88. 6~ in 5-year recurrence free survival（RFS） rate respectively （P = 0. 647）. Significant difference was found in one-year RFS between the patients with and without adjuvant therapy who presented GIST of high risk（93.5~ vs 81.2~ P = 0. 037）while there was no significant difference in 5-year RFS （56. 1 ~//00 vs 50. 2~ P = 0. 112）. Meanwhile, GISTs with local infiltration or mitosis〉10/HPF could reach lower one-year recurrence rate, especially for those with post-operational imatinib adjuvant ther- apy （P = 0. 022 and P = 0. 036）, however, there was no significant difference in patients without local infiltration and mitosis10/HPF （P = 0. 789）. Conchtsion The post-operational Imatinib adjuvant therapy can effectively reduce the recurrence of GIST during the supplementation period , however, it fails to prevent it after treatment. For those high risk of patients with GIST, tumors with local infiltration or high count of mitosis in them are more likely to recurrence. It may be rational for those pa- tients to undertake longer post-operational adjuvant treatment.