539例胃肠道间质瘤的临床分析
Clinical analysis of gastrointestinal stromal tumor: a report of 539 cases
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摘要:
目的 探讨原发胃肠道间质瘤(GIST)的临床病理特点及影响预后的因素。方法 回顾性分析2002年1月至2012年12月第三军医大学西南医院收治的539例原发GIST患者的临床资料。根据肿瘤可否行完整切除且不严重影响相关脏器功能的原则，同时结合患者情况和肿瘤位置选择治疗方式。根据患者术后改良NIH危险度分级情况施行术后辅助治疗。本组患者采用门诊复查、电话及书信方式进行随访。随访时间截至2013年2月。采用Kaplan-Meier法绘制生存曲线，单因素分析临床病理因素与GIST患者预后关系采用Log-rank检验，多因素分析采用COX回归模型。结果 539例患者发病年龄集中在40～70岁，占总例数的76.25%(411/539)；肿瘤发生部位：胃316例、小肠100例、食管37例、腹腔37例、结直肠26例、盆腔23例。467例患者行手术切除治疗，72例患者行非手术治疗。术后病理检查结果：CD117阳性率为91.65%(428/467)，CD34阳性率为86.30%(403/467)，α-平滑肌肌动蛋白阳性率为36.18%(106/293)，S100阳性率为9.78%(18/184)。396例手术治疗的GIST患者获得术后随访，中位随访时间为29个月(2～94个月)，患者1、3、5年总体生存率分别为97.4%、78.7%、60.0%。单因素分析结果显示：肿瘤直径、手术根治性、改良NIH危险度分级和肿瘤细胞核分裂象是影响原发GIST患者术后生存的因素(χ2=69.846，69.776，7.368，49.041，P<0.05)。多因素分析结果显示：手术根治性和改良NIH危险度分级是影响原发GIST患者预后的独立危险因素(RR=2.493，2.330，P<0.05)。结论 GIST以40～70岁患者居多，肿瘤主要发生于胃，手术根治性和改良NIH危险度分级是影响GIST患者预后的独立危险因素。
Abstract:Objective To investigate the clinicopathological characters of primary gastrointestinal stromal tumor (GIST), and to analyze the influencing factors on the prognosis of patients. Methods The clinical data of 539 patients with primary GIST who were admitted to the Southwest Hospital of Third Military Medical University from January 2002 to December 2012 were retrospectively analyzed. The treatment methods were selected based on the principle of complete resection of tumor without severely influencing the function of related organs, and in combination with the condition of patients and the position of GIST. The method of adjuvant therapy was selected according to the modified National Institite of Health (NIH) risk stratifications. All the patients were followed up till February 2013 via outpatient re examination, letter or telephone. The survival rate was calculated using the KaplanMeier method. The univariate and multivariate analysis of the relationship between clinicopathological factors and the prognosis of GIST patients were done using the Log－rank test and COX regression model, respectively. Results The age of GIST onset was concentrated between 40 and 70 years, which accounted for 76.25%(411/539). The tumor sites included stomach (316 cases), small intestine (100 cases), esophagus (37 cases), abdomen (37 cases), colon and rectum (26 cases) and pelvic cavity (23 cases). Four hundred and sixtyseven patients received surgical treatment, and 72 received non surgical treatment. The positive rates of CD117, CD34, α smooth muscle actin, S100 were 91.65%(428/467), 86.30%(403/467), 36.18%(106/293) and 9.78%(18/184), respectively. A total of 396 patients were followed up with a median time of 29 months (range, 2~94 months). The 1, 3, 5year overall survival rates were 97.4%, 78.7%, 60.0%. The results of univariate analysis showed that tumor diameter, radical resection, modified NIH risk stratification and mitotic index were correlated with the survival rates of GIST patients (χ2=69.846, 9.776, 67.368, 49.041, P<0.05). The results of multivariate analysis showed that radical resection and modified NIH risk stratification were the independent prognostic factor for patients with GIST (RR=2.493, 2.330, P<0.05). Conclusion Radical resection and modified NIH risk stratification are the independent prognostic factors for patients with GIST, and operation is the main treatment method for GIST.
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