靶向药物联合手术治疗复发转移胃肠间质瘤患者的疗效分析

Efficacy analysis of targeted therapy combined with surgery in the treatment of recurrent and metastatic gastrointestinal stromal tumor

目的探讨靶向联合手术治疗复发转移胃肠间质瘤（GIST）患者的疗效。方法回顾性分析2000年1月至2015年12月间，复旦大学附属中山医院收治的318例复发转移GIST患者的临床资料。按照治疗方案的不同，分为单纯手术组（接受单纯手术治疗，44例）、靶向治疗组（单纯接受靶向药物治疗，108例）、靶向联合手术组（同时接受手术和伊马替尼靶向药物治疗，139例）及其他治疗组（接受化疗及中药等其他治疗，27例），比较不同治疗组患者无进展生存时间（PFS）和总体生存时间（OS）。结果4组患者之间年龄、性别及原发部位等基线资料的差异无统计学差异（均P〉0．05），但4组间复发转移部位的差异有统计学意义（P=0．000）。单纯手术组患者的中位PFS为16（95％CI：4．9-27．0）月，靶向治疗组为44（95％CI：30．9～57．1）月，靶向联合手术组为35（95％CI：26．5-43．5）月；靶向治疗组和靶向联合手术组较单纯手术组PFS明显延长（P=0．000）。靶向联合手术组与靶向治疗组PFS的差异无统计学意义（P=0．251）。单纯手术组患者的中位OS为24（95％CI：9．0～39．0）月。靶向治疗组为69（95％CI：40．8—97．2）月，靶向联合手术组为92（95％CI：78．0—106．0）月，其他治疗组为12（95％CI：9．5～14．5）月，靶向治疗组和靶向联合手术组较单纯手术组和其他治疗组OS明显延长（P=0．000）；且靶向联合手术组的中位OS明显长于靶向治疗组（P=0．028）。结论靶向治疗联合手术能显著延长复发转移GIST患者的生存时间。

Objective To investigate the efficacy of targeted therapy combined with surgery in the treatment of recurrent and metastatic gastrointestinal stromal tumor （GIST）. Methods Chnicopathological and followed-up data of 318 patients with recurrent and metastatic GIST admitted in Zhongshan Hospital between January 2000 and December 2015 were analyzed retrospectively. According to different treatment methods, the patients were divided into four groups： surgery group （operation alone, 44 cases）, target therapy group （imatinib alone, 108 cases）, target therapy combined with surgery group （imatinib plus operation, 139 cases）, other therapy group （chemotherapy, Chinese medicine and others, 27 cases）. The progression-free survival （PFS） and overall survival （OS） of four groups were compared. Results The baseline informations, such as age, gender, primary site, et al, were not significantly different （all P 〉 0.05）, but the recurrent and metastatic site was significantly different among 4 groups （P = 0.000）. The medial PFS of surgery group, target therapy group, target therapy combined with surgery was 16 （95%CI： 4.9 to 27.0） months, 44 （95%CI ： 30.9 to 57.1） months, 35 （95%CI： 26.5 to 43.5） months, respectively, and the latter 2 groups had significantly longer PFS than surgery group （P = 0.000）, while no significant difference was found between target therapy group and target combined with surgery group （P = 0.251）. The median OS of surgery group, target therapy group, target therapy combined with surgery, and other therapy group was 24 （95% CI：9.0 to 39.0） months, 69（95% CI：40.8 to 97.2） months, 92（95% CI： 78.0 to 106.0） months, 12 （95%CI：9.5 to 14.5） months. Target therapy group and target therapy combined with surgery group had significantly longer OS than surgery and other therapy groups （P = 0.000）, while the target therapy combined with surgery group had significantly longer OS than target therapy group （P = 0.028）. Conclusion Target therapy combined with surgery can prolong the survival of recurrent and metastatie GIST patients.