高危胃肠道间质瘤的临床特点及预后分析

Clinical characteristics and prognostic analysis of 307 patient with high-risk gastrointestinal stromal tumors

目的探讨高危胃肠道间质瘤（gastrointestinal stromal tumors, GIST）患者的临床特征及预后影响因素。方法回顾性分析2005年1月至2016年12月间华中科技大学同济医学院附属协和医院收治的307例高危可切除原发GIST患者的临床病理资料。结果307例高危GIST患者中肿瘤原发部位：胃88例（28．7％），小肠141例（45．9％），结直肠27例（8．8％），胃肠道外（肠系膜、腹膜后、腹盆腔等）51例（16．6％）；R。切除299例（97．4％），R．切除6例（2．0％），R。切除2例（0．7％）；术后未接受辅助治疗者239例，术后服用伊马替尼400mg／d辅助治疗者68例，中位治疗时间23个月（3～84个月）。本组患者1、3、5年生存率分别为95％、85％、76％，1、3、5年无复发生存率分别为92％、83％、71％。单因素及多因素预后分析结果示，不同性别、肿瘤原发部位（胃与非胃）、肿瘤大小、肿瘤破裂、是否伴有局部浸润患者的无复发生存曲线相比差异均无统计学意义（均P〉0．05），核分裂象〉5／50HPF患者的术后无复发生存率较核分裂象〈5／HPF患者的低（P=0．004）。结论有效的外科手术切除是高危GIST首选的治疗方式；核分裂象是影响GIST预后的主要危险因素。

Objective To investigate the clinical characteristics, diagnosis and treatment as well as prognostic factors of high-risk gastrointestinal stromal tumors （GIST）. Methods Clinical data of 307 patients with high risk GIST treated in the Union Hospital from Jan 2005 to Dec 2016 were retrospectively analyzed. Results There were 172 males and 135 females with median age of 51 （20 -84） years. Tumors located in the stomach in 88 （28.7%） cases, in the small intestine in 141 （45.9%）, in the colon and rectum in 27 （8.8%） and outside the gastrointestinal tract （mesentery, retroperitoneum, abdominal cavity, and pelvic） in 51 （16. 6% ）. All underwent surgical resection, including R0 resection of 299 cases （97.4%）, Rl resection of 6 cases （2.0%） and R2 resection of 2 case （0.7%）. 68 cases （ 22. 1% ） received postoperative imatinib 400 mg/d for 3 to 84 months. The 1-, 3-, 5-year overall survival rates of high-risk GIST were 95% , 86% , 76% , the 1-, 3-, 5-year recurrence-free survival rates were 92% , 83%, 71%. By multivariate analysis the 5-year RFS were related only to mitotic count while, there was no significant difference in the RFS in patients gender,tumor site,tumor size. Conclusions Complete surgical excision is the effective treatment for high-risk GIST. Mitotic count is the most important prognostic factor.