高危胃肠间质瘤的临床病理特征及预后分析

Pathological characteristics and prognosis of high risk gastrointestinal stromal tumors

目的分析高危胃肠间质瘤(GIST)临床特征及预后影响因素。方法回顾性分析2009年8月至2016年2月乐山市人民医院收治的241例高危GIST患者临床资料,分析其临床特征及预后影响因素。结果男女比例为1.13:1,年龄构成以中老年为主,40岁以上人群构成比达90.87%(219/241)。原发部位以胃和小肠为主,胃50例(20.75%),小肠121例(50.21%)。首发症状以消化道症状为主,临床表现不典型。R0切除232例(96.27%),术后复发转移率为25.31%(61/241),1、3、5年无复发生存率分别为97.23%、86.56%和75.86%,无复发生存时间为(53.12±13.08)个月。肿瘤最大径(RR=4.780,95% CI:3.716~6.052)、核分裂像(RR=5.411,95% CI:2.195~7.119)是影响高危GIST 5年无复发生存率的独立危险因素,服用靶向药物是保护因素(RR=0.504,95% CI:0.288~0.883),差异有统计学意义(P<0.001)。结论高危GIST临床特征不明显,预后受核分裂像、肿瘤最大径和服用靶向药物影响。

Objective To investigate the clinical characteristics and prognosis of high-risk gastrointestinal stromal tumors (GIST).Methods The clinical data of two hundred and forty-one high-risk GIST patients admitted to Leshan People’s Hospital from August 2009 to February 2016 were analyzed retrospectively.Results The proportion of men and women was 1.13:1.The age composition was mainly middle-aged and old people,and the proportion of people over 40 years old was 90.87% (219/241).The primary sites were stomach and small intestine,with 50 cases (20.75%) in stomach and 121 cases (50.21%) in small intestine.The first symptoms were mainly gastrointestinal symptoms,and the clinical manifestations were not typical.232 patients (96.27%) underwent R0 resection and the recurrence and metastasis rate was 25.31% (61/241).The recurrence free survival rates of 1-,3-,5-year were 97.23%,86.56% and 75.86%,respectively.The recurrence free survival time was (53.12±13.08) months.The tumor maximum diameter (RR=4.780,95% CI:3.716-6.052),mitotic image (RR=5.411,95% CI:2.195-7.119) were independent risk factors for 5-year recurrence free survival of high-risk GIST,while taking targeted drugs was the protective factor (RR=0.504,95% CI:0.288-0.883),the differences were statistically significant (P<0.001).Conclusion The clinical features of high-risk GIST are not obvious,and the prognosis is affected by mitotic image,the maximum diameter of the tumor and taking targeted drugs.