手术切除程度对高危胃肠间质瘤预后的影响

Influence of surgical resection extent on prognosis of high-risk gastrointestinal stromal tumors

目的探讨原发高危胃肠间质瘤(GIST)的临床特征及手术切除程度对其预后影响因素。方法回顾性分析该院2005年1月至2013年1月收治的48例原发可切除高危GIST患者的临床和术后随访资料,分析3种不同手术切除方式对高危GIST预后的影响。结果 R0切除34例(70.83%),R1切除6例(11.50%),R2切除8例(16.67%)。术后均使用甲磺酸伊马替尼辅助治疗,平均用药时间(26.5±13.6)个月。药物不良反应发生率为100%,以水肿和白细胞减少最为常见。3种切除方式术后5年生存率分别为97.06%、66.67%、25.00%。单因素和多因素预后分析显示,手术切除程度及肿瘤是否破裂是高危GIST患者的独立预后因素。结论完整手术切除,防止肿瘤破裂,是提高高危GIST患者术后生存率的关键。

Objective To investigate the clinical characteristics,surgical resection extent and prognosis influencing factors of pri-mary high-risk gastrointestinal stromal tumors（GIST）.Methods The clinicopathological and follow-up data of 48 patients with pri-mary resectable high-risk GIST in this hospital from January 2005 to January 2013 were retrospectively analyzed.The influence of three kinds of different surgical resection methods on the prognosis of GIST was analyzed.Results 34 cases were treated by R0 re-section（70.83%）,6 cases by R1 resection（11.50%）and 8 cases by R2 resection（16.67%）.All cases were given the postoperative adjuvant therapy of imatinib mesylate.The average medication time was（26.5±13.6）months.The occurrence rate of adverse drug reactions was 100%,and the main symptoms were swelling and leukopenia.The 5-year survival rates in 3 kinds of resection modes were 97.06%,66.67% and 25.00% respectively.The univariate and multivariate prognostic analysis showed that the surgical re-section extent and the tumor rupture were the independent prognostic factors in the high-risk GIST patients.Conclusion The intact operative resection and preventing the tumor rupture are the keys to increase the postoperative survival rate of GIST patients.