影响胃肠间质瘤患者预后的相关临床病理因素分析

Analysis of clinical and pathological factors affecting the prognosis of gastrointestinal stromal tumor patients

目的分析影响胃肠间质瘤(GIST)患者预后的相关临床病理因素,为GIST的临床治疗提供参考。方法选取2013年1月至2015年10月柳州市中医医院普通外科收治的300例GIST患者,所有患者均行手术治疗,且于术后行病理和免疫组化检测,对其临床病理资料进行回顾性分析及随访,采用Cox风险模型分析影响GIST患者术后3年生存情况的临床病理因素。结果GIST患者3年生存率有差异的指标包括肿瘤切除情况、切缘阳性情况、有无破裂、有无转移、核分裂数、Ki-67指数、NIH分级和术后甲磺酸伊马替尼服用与否及服用疗程(P<0.05);Cox风险模型结果显示,肿瘤切除不完整、切缘阳性、肿瘤破裂、肿瘤转移、核分裂数增多、Ki-67指数>5%、NIH分级高危险性、术后未进行靶向治疗皆为影响GIST患者预后的独立危险因素(P<0.05)。结论影响GIST患者预后的独立危险因素有切缘阳性、肿瘤破裂、肿瘤转移、核分裂数增多、Ki-67指数>5%、NIH分级高危险性、术后未进行靶向治疗,临床治疗应结合各临床病理因素综合考虑,以准确判断患者的预后。

Objective To analyze the related clinical and pathological factors affecting the prognosis of patients with gastrointestinal stromal tumors(GIST)and provide reference for the clinical treatment of GIST.Methods 300 patients with GIST after gastrointestinal surgery in our hospital were included in the study.All patients were examined by pathology and immunohistochemistry after surgery.The clinicopathological data were retrospectively analyzed and followed up.The clinical and pathological factors affecting the 3-year survival rate of GIST patients were analyzed.Results Logistic regression analysis showed that the 3-year survival rate of patients with GIST was different in terms of tumor resection,cutting edge,rupture and metastasis,nuclear fission number,ki-67 index(5%),NIH classification,whether or not to take imatinib mesylate after surgery,and the course of treatment(P<0.05).Cox risk model results showed that Incomplete resection,positive resection margins,tumor rupture,tumor metastasis,increased number of nuclear fission,Ki-67 index>5%,NIH classification of high risk,and no postoperative targeted therapy were all independent risk factors affecting the prognosis of GIST patients(P<0.05).Conclusions Prognosis of GIST patients included positive resection margins,tumor rupture,tumor metastasis,increased number of mitosis,Ki-67 index>5%,NIH classification of high risk and no postoperative targeted therapy.