高危胃肠间质瘤108例治疗与预后分析

Treatment and prognosis of 108 patients with high.risk gastrointestinal stromal tumor

目的探讨高危胃肠间质瘤（GIST）的治疗方法及预后影响因素。方法回顾性分析2002年1月至2016年2月间在新疆医科大学附属肿瘤医院胃肠外科接受手术治疗的108例高危GIST患者的临床病理及随访资料。根据术后是否接受辅助治疗将患者分为两组，一组为术后接受甲磺酸伊马替尼辅助治疗（辅助治疗组，69例）；另一组为术后仅观察随访，发现复发转移再开始进行靶向药物治疗（随访观察组，39例）。比较两组患者术后生存及复发情况，并采用Cox回归模型进行预后危险因素分析。结果全组病例均获随访，术后中位随访时间48（1～161）月。随访期间57例（52．8％）患者出现复发和（或）转移，其中辅助治疗组和随访观察组术后复发转移率分别为34．8％（24／69）和84．6％（33／39），差异有统计学意义（P=0．000）。28例（25．9％）死亡，全组1年、3年、5年、10年总生存率分别为99．8％、87．7％、76．0％和42．7％，其中辅助治疗组和随访观察组5年生存率分别为79．3％和72．3％，差异无统计学意义（P=0．648）。单因素预后分析显示，核分裂数、手术根治度及术中肿瘤破裂与患者预后有关（均P〈0．05）。多因素预后分析显示，核分裂象（P=0．013．RR=2．400，95％CI：1．206—4．779）和手术根治度（P=0．003，RR=3．968，95％CI：1．609—9．784）是影响高危GIST患者的独立预后因素。结论应用根治性手术联合靶向治疗的综合治疗模式，并予以密切的随访，可使高危GIST患者获得长期生存。

Objective To investigate the treatment methods and prognostic factors of high-risk gastrointestinal stromal tumor （GIST）. Methods Clinieopathological date and follow-up data of 108 patients with high-risk GIST from January 2002 to February 2016 treated at our department were retrospectively reviewed. The patients were divided into two groups according to whether they received adjuvant therapy after surgery. A group of patients received imatinib adjuvant therapy （adjuvant therapy group, 69 cases）. Another group of patients were not treated with imatinib until they were found to have disease progression （follow-up observation group, 39 cases）. The survival rate and recurrence rate were compared between two groups, and the risk factors of prognosis were analyzed by Cox regression model. Results All the cases were followed up with a median time of 48 months （1 to 161 months）. Recurrence and/or metastasis occurred in 57 （52.8%） patients during follow-up. The postoperative recurrence and/or metastasis rate was 34.8% （24/69） and 84.6%（33/39） respectively in the adjuvant therapy group and the follow-up observation group, the difference was statistically significant （P= 0.000）. Twenty-eight （25.9%） patients died. The 1-, 3-,5-, 10-year survival rates of the 108 patients undergoing follow-up were estimated to be 99.8%, 87.7% , 76.0% and 42.7% respectively. The 5-year survival rates were 79.3% and 72.3% in the adjuvant therapy group and the follow-up observation group, the difference was not statistically significant （P= 0.648）. Univariate analysis showed that mitotic count, radical degree and tumor rupture were predictive factors of survival after resection of primary high-risk GIST （all P〈 0.05）. Multivariate analysis using Cox regression model revealed that the mitotic count （P = 0.013, RR = 2.400, 95%CI： 1.206 to 4.779） and radical degree（P = 0.003, RR=3.968, 95%CI： 1.609 to 9.784） were independent prognostic factors. Conclusion Comprehensive treatment of radical surgery combined with targeted therapy and close followed up can lead to better long-term survival of high-risk patients with GIST.