胃肠道间质瘤术后伊马替尼辅助治疗停药后复发的危险因素分析

Risk factors related to gastrointestinal stromal tumor recurrence after discontinuing postoperative adjuvant imatinib treatment

目的 探讨影响胃肠道间质瘤患者术后伊马替尼（imatinib mesylate,IM）辅助治疗停药后复发的危险因素.方法 回顾性分析2006年1月至2014年1月在上海交通大学医学院附属仁济医院手术并在术后接受IM辅助治疗的138例中、高危原发胃肠道间质瘤患者的临床病理资料.结果 所有病例的预期停药后5年无复发生存率为54.5％.多因素分析显示肿瘤Ki67指数（P=0.005）、肿瘤局部侵犯（P=0.026）与胃肠道间质瘤术后IM辅助治疗停药后复发有关.根据两项危险因素在COX回归分析中所占不同权重建立综合评分模型,其预测IM辅助治疗后复发风险的准确性优于NIH分级（AUC：0.714比0.631）;基于综合评分模型建立了复发低危组和高危组患者的预期停药后5年无复发生存率为81.3％和31.1％ （P＜0.05）.结论 对于NIH分级中、高危的患者,如果合并有肿瘤局部侵犯,或虽然没有肿瘤局部侵犯但Ki67指数＞8％的患者,应尽量延长IM的辅助治疗时间.

Objective To study the risk factors related to recurrence of gastrointestinal stromal tumor （GIST） after discontinuing postoperative adjuvant imatinib mesylate （IM） treatment.Methods We retrospectively analyzed our clinical database of 138 GIST patients who received radical resection and subsequent IM adjuvant treatment at the Renji Hospital,Shanghai Jiaotong University School of Medicine between January 2006 and January 2014.Results For the entire Multivariate analysis study group,the overall 5-year recurrent free survival （RFS） rate was 54.5%.There were two tumor characteristics which were independent prognostic factors of GIST treated by postoperative IM：Ki67 index （P =0.005）,and serosal invasion （P =0.026）.The accuracy of comprehensive evaluation based on the two weighted variables was better than NIH staging criteria（AUC：0.714 vs.0.631）.Furthermore,two risk groups were created according to the risk model with 5-year RFS of 81.3% and 31.1% as low-risk and high-risk groups,respectively （P 〈0.05）.Conclusions For patients with intermediate or high risk in NIH classification,if there was tumor serosal invasion,or if there was no local invasion but Ki67 index 〉 8%,extended continuous IM adjuvant treatment should be recommended after the primary tumor was radically resected.