伴有黏膜面破溃的胃间质瘤的危险因素及预后分析

Risk factor and prognosis analysis of gastric stromal tumor with mucosal surface rupture

目的:探讨伴有黏膜面破溃的胃间质瘤的危险因素及预后。方法:收集2015年6月至2021年2月于郑州大学第一附属医院接受内镜或外科手术完整切除的408例胃间质瘤患者的临床病理资料,根据患者术前胃镜结果判断胃间质瘤黏膜面是否破溃,将患者分为破溃组(n=179)和非破溃组(n=229),比较两组患者的临床病理特征及预后差异。采用Logistic回归分析胃间质瘤黏膜面破溃的危险因素,采用log-rank检验比较两组的无复发生存情况。结果:破溃组与非破溃组首发症状、肿瘤部位、肿瘤最大径、核分裂象计数、Ki-67指数、危险度分级、手术方式比较差异有统计学意义(P<0.05)。Logistic回归分析显示,肿瘤位于胃底贲门(OR=2.954,95%CI:1.253~6.960)、肿瘤最大径>5 cm(OR=4.732,95%CI:2.919~7.673)、核分裂象计数>5个/50 HPF(OR=1.721,95%CI:1.011~2.930)及Ki-67指数>5%(OR=1.733,95%CI:1.039~2.892)是胃间质瘤黏膜面破溃的危险因素。Log-rank检验显示,破溃组较非破溃组患者预后差(P=0.009)。结论:肿瘤部位、肿瘤最大径、核分裂象计数及Ki-67指数是胃间质瘤黏膜面破溃的危险因素。伴有黏膜面破溃的胃间质瘤患者预后较差。

Aim:To investigate the risk factor and prognosis of gastric stromal tumor with mucosal surface rupture.Methods:The clinicopathological data of 408 patients with gastric stromal tumors who underwent endoscopic or surgical resection at the First Affiliated Hospital of Zhengzhou University from June 2015 to February 2021 were collected.Judging whether the mucosal surface of gastric stromal tumors ruptured or not according to the preoperative gastroscopy,and divide the patients into rupture group(n=179)and non-rupture group(n=229).The clinicopathological features and prognosis between the 2 groups were compared.Logistic regression analysis was used to analyze the influencing factors of gastric stromal tumor with mucosal surface rupture,and log-rank test was used to compare the recurrence-free survival rate between the 2 groups.Results:There were significant differences in terms of initial symptom,tumor site,size,mitotic count,Ki-67 index,risk grade,and surgical method between rupture group and non-rupture group(P<0.05).Logistic regression analysis showed that tumor in gastric fundus or cardia(OR=2.954,95%CI:1.253-6.960),tumor size>5 cm(OR=4.732,95%CI:2.919-7.673),mitotic count>5/50 HPF(OR=1.721,95%CI:1.011-2.930),Ki-67 index>5%(OR=1.733,95%CI:1.039-2.892)were risk factors of gastric stromal tumor with mucosal surface rupture.Log-rank test showed that the prognosis of patients in rupture group was poor compared with the non-rupture group(P=0.009).Conclusion:Tumor site,size,mitotic count and Ki-67 index are risk factors of gastric stromal tumor with mucosal surface rupture.Gastric stromal tumor with mucosal surface rupture has poor prognosis.