山东省胃肠间质瘤多中心回顾性调查

A multicentre retrospective cohort study of patients with gastrointestinal stromal tumors in Shandong Province

目的探讨山东省胃肠间质瘤（GIST）手术患者的临床病理学特征、预后及其影响因素。方法回顾性收集2001年1月至2013年6月山东省4家大学的教学医院GIST手术患者的临床病理学资料，对所有病例进行病理学复核及随访，对其预后影响因素进行单因素和多因素分析。结果共收集1039例GIST病例，其中男509例，女530例，年龄18。87（中位数58）岁。术后随访时间1—150（中位数34）月，期间93例因肿瘤进展死亡，1、3、5年生存率分别为94．6％、91．7％和87．8％。R0手术患者5年总体生存率高于R1手术患者（88．8％比69．0％，P〈0．叭）。中度复发风险患者术后是否服用伊马替尼，其5年总体生存率的差异无统计学意义（94．4％比89．2％，P〉0．05）；高复发风险患者术后服用伊马替尼，其5年总体生存率明显高于未服药者（76．8％比67．7％，P〈0．05）。预后因素分析结果显示，肿瘤大小（P〈0．01，RR=1．988，95％CI：1．497—2．641）、核分裂象（P〈0．01，RR=2．326，95％CI：1．686—3．208）和肿瘤是否破裂（P〈0．01，RR=3．032，95％CI：1．732～5．308）是GIST手术患者的独立预后因素。结论肿瘤大小、核分裂象和肿瘤是否破裂是GIST术后患者预后的独立影响因素；Ro手术是原发局限性GIST首选治疗方式；伊马替尼可改善术后高复发风险患者的预后。

Objective To investigate the clinicopathological features and prognosis of patients with gastrointestinal stromal tumor （GIST） after surgery in Shandong Province. Methods Clinicopathological data of GIST patients undergoing surgery from January 2001 to June 2013 in four university teaching hospitals in Shandong Province were reviewed. Pathology results were rechecked. Patients were followed up. The prognostic factors were evaluated by univariate and multivariate analyses with Log-rank test and Cox proportional hazard model. Results A total of 1039 GIST cases were enrolled, including 509 males and 530 females, with age from 18 to 87 years （median, 58）. Ninety- three patients died of GIST during follow-up. The 1-, 3-, 5-year survival rates were 94.6%, 91.7% and 87.8%, respectively. Patients undergoing R0 resection had a higher 5-year overall survival rate than those undergoing R1 resection（88.8% vs 69.0%, P〈0.05）. For patients with intermediate risk of recurrence after surgery, the 5-year overall survival rate was 94.4% and 89.2% respectively in imatinib and non-imatinib intervention groups （P〉0.05）. For patients with high risk of recurrence after surgery, the 5-year overall survival rate was 76.8% and 67.7% respectively （P〈0.05）. Multivariate analysis revealed that tumor size （P〈0.01, RR=1.988, 95%CI：1.497-2.641）, mitotic count （P〈O.O1,RR= 2.326, 95%CI： 1.686-3.208） and tumor rupture （P〈O.01, RR=3.032, 95%CI： 1.732-5.308） were independent prognostic factors. Conclusions Tumor size, mitotic count and tumor rupture affect the prognosis of patients after resection of primary GIST independently. The standard treatment of loc^dized GIST is R0 resection. Adjuvant imatinib therapy can improve overall survival of patients with high risk of recurrence after surgery. The efficacy of imatinib for patients with intermediate risk of recurrence remains to be verified.