伊马替尼辅助治疗时间对中高度复发风险胃肠间质瘤患者无复发生存的影响

Influence of imatinib as adjuvant therapy on relapsefree survival in patients with gastrointestinal stromal tumors at moderate to high risk of recurrence

目的:探讨伊马替尼辅助治疗时间对中高度复发风险胃肠间质瘤(gastrointestinal stromal tumor,GIST)患者无复发生存的影响以及不良反应.方法:回顾性分析2003-03/2009-01我院收治的中高度复发风险GIST患者65例的临床资料.评价近期疗效、复发情况,并依据伊马替尼辅助治疗的时间进行分组,比较各组间复发情况、无复发生存以及不良反应之间的差异.结果:完全缓解(complete remission,CR)5例(7.69%),部分缓解(partial remission,PR)44例(67.69%),疾病稳定(stable disease,SD)13例(20.0%),疾病进展(progressive disease,PD)3例(4.62%),客观有效率(overall response rate,ORR)为75.38%(49/65),疾病控制率(disease control rates,DCR)为95.38%(62/65).65例患者中共有12例患者(18.46%)出现肿瘤复发;随着伊马替尼治疗时间的延长,患者1、2、3、4、5年无复发生存率均呈逐渐升高的趋势,治疗时间≥4年的1、2、3、4年无复发生存率均为100%,5年可达95.24%.治疗时间≥3年组5年无复发生存率(92.11%)显著高于<3年组(59.26%),差异有统计学意义(P=0.026);治疗>3年组5年无复发生存率(95.65%)有高于治疗3年组(92.59%)的趋势,但差异无统计学意义(P=0.168).伊马替尼治疗期间不良发硬以血液毒性、消化系反应、皮肤黏膜水肿、乏力等为主,多为0-2级,经相关对症治疗后好转.治疗时间≥3年组乏力的发生率显著高于<3年组,差异有统计学意义(P<0.05).结论:对于中高度复发风险的GIST患者,延长术后伊马替尼辅助治疗的时间至3年以上可以在一定程度上提高无复发生存时间,不良反应除乏力发生率明显升高外,其余均未发现明显升高的现象.

AIM： To explore the influence of imatinib as adjuvant therapy on relapse-free survival in patients with gastrointestinal stromal tumors（GISTs） at moderate to high risk of recurrence. METHODS： Sixty-five patients with GISTs at moderate to high risk of recurrence who were treated at our hospital from March 2006 to January 2009 were retrospectively analyzed.The short term curative effect and relapse were evaluated. The patients were divided into different groups according to imatinib treatment time, and the differences in relapse, relapse-free survival and adverse reactions were compared between different groups.RESULTS： Complete remission was achieved in5（7.69%） cases, partial remission in 44（67.69%） cases, stable disease in 13（20.0%） cases, and progressive disease in 3（4.62%） cases. The overall response rate was 75.38%（49/65）, and disease control rate was 95.38%（62/65）. Twelve（18.46%） patients developed tumor recurrence. With the increase in imatinib treatment time, the relapsefree survival rates of patients at 1, 2, 3, 4 and 5 years showed a rising trend. The relapse-free survival rates at 1, 2, 3 and 4 years were all 100%, and it was 95.24% at 5 years. The 5-year relapsefree survival rate（92.11%） in the treatment ≥ 3 years group was significantly higher than that in the ＆lt; 3 years group（59.26%）（P = 0.026）; the 5-year relapse-free survival rate（95.65%） in the ≥ 3 years group was higher than that in the 3 years group（92.59%）, but there was no significant difference（P = 0.168）. Imatinib toxicities mainly included blood toxicity, digestive tract toxicity, skin and mucosal edema, and debilitation, and most of these toxicities were mild（grades 0-2） and improved after symptomatic treatment. The incidence of debilitation in the ≥ 3 years group was significantly higher than that in the ＆lt; 3 years group（P ＆lt; 0.05）. CONCLUSION： For patients with GISTs at moderate to high risk of recurrence, prolonged postoperative imatinib adjuvant treatment to more than 3 years can improve relapse-free survival time to some extent. Except for the significantly increased incidence of debilitation, the incidence of other adverse reactions showed no significant rise.