中国实用外科杂志

中国实用外科杂志 ›› 2025, Vol. 45 ›› Issue (05): 576-581.DOI: 10.19538/j.cjps.issn1005-2208.2025.05.18

• 论著 • 上一篇    下一篇

专病与非专病诊疗医师诊治中高危胃肠间质瘤预后对比研究

丁嘉宁，陈志亮，田红坤，蒋    祈，杜雨强，曾祥宇，刘炜圳，马先雄，张    鹏，陶凯雄   

  1. 华中科技大学同济医学院附属协和医院胃肠外科 湖北省微创外科医学临床研究中心，湖北武汉 430022
  • 出版日期:2025-05-01 发布日期:2025-05-28

  • Online:2025-05-01 Published:2025-05-28

摘要： 目的    对比专病与非专病诊疗组医师诊治的中高危胃肠间质瘤（GIST）病人预后的差异。方法  回顾性分析2013年1月至2023年12月华中科技大学同济医学院附属协和医院胃肠外科诊治的643例中高危GIST病人临床病理及预后资料。将累计诊治新发GIST>100例的主诊医师定义为专病诊疗医师，累积诊治新发GIST≤100例的主诊医师定义为非专病诊疗医师，并对应将两类主诊医师诊治的病人分为专病诊疗组（270例）和非专病诊疗组（373例）。比较两组病人基线及预后资料的差异。采用Kaplan-Meier法绘制生存曲线（Log-rank test），Cox回归分析模型进行多因素分析。结果    与非专病诊疗组相比，专病诊疗组病人年龄≤60岁比例更高（65.2% vs. 54.7%，P=0.008），肿瘤直径＞5 cm的GIST行腹腔镜手术比例更高（62.7% vs. 46.7%，P<0.001），肿瘤核分裂象＞10个/50 HPF的比例更低（17.4% vs. 26.6%，P=0.024），术后并发症Clavien-Dindo分级＞Ⅲ级发生率更低（4.4% vs. 9.9%，P=0.010），行基因检测比例更高（88.5% vs. 34.3%，P<0.001），行伊马替尼（IM）术后辅助治疗比例更高（91.9% vs. 48.5%，P<0.001），接受IM血药浓度监测比例更高（51.7% vs. 29.0%，P<0.001），行IM剂量调整的比例更高（22.6% vs. 1.3%，P<0.001），有效随访率更高（92.2% vs. 87.1%，P=0.040），遵医嘱服药的比例更高（63.3% vs. 28.2%，P<0.001），差异有统计学意义。多因素Cox分析结果显示，进行辅助治疗（HR=0.534，95%CI 0.306-0.931，
P=0.027）和专病诊疗医师诊治（HR=0.320，95%CI 0.161-0.638，P=0.001）是影响病人总体生存率的独立保护因素。专病诊疗组病人3年无复发生存率（94.4% vs. 88.4%，P=0.010）、3年总体生存率（97.8% vs. 90.6%，P<0.001）和5年总体生存率（96.7% vs. 86.6%，P<0.001）显著高于非专病诊疗组，差异有统计学意义；两组5年无复发生存率差异无统计学意义（89.6% vs. 85.8%，P>0.05）。结论    GIST专病诊疗在全程化管理方面更为精准规范，可进一步提升GIST病人长期预后。

关键词: 胃肠间质瘤, 中高危, 专病诊疗, 诊治, 预后

Abstract: To investigate the prognosis differences between the patients moderate-high risk gastrointestinal stromal tumors (GIST) treated by the surgeons from the specialized treatment group and the non-specialized treatment group. Methods    The clinicopathological and prognostic data of 643 patients with moderate-high risk GIST diagnosed and treated at Union Hospital of Tongji Medical College of Huazhong University of Science and Technology between January 2013 and December 2023 were retrospectively collected. The attending doctors who cumulatively treated more than 100 cases of new-onset GIST were defined as the specialized treatment group, and the attending doctors who cumulatively treated less than 100 cases of new-onset GIST were defined as the non-specialized treatment group. The baseline and prognostic data between patients from the two groups was compared. Survival analysis was performed by Kaplan-Meier method (Log-rank test). Multivariate analysis was performed using the Cox regression analysis model. Results    Compared with the non-specialized treatment group, the proportion of patients ≤60 years old in the specialized treatment group was higher (65.2% vs. 54.7%, P=0.008), the proportion of laparoscopic surgery for GIST with tumor diameter >5 cm in the specialized treatment group was higher (62.7% vs. 46.7%, P<0.001), the proportion of tumor mitotic figures greater than 10 /50HPF in the specialized treatment group was lower (17.4% vs. 26.6%, P=0.024), the incidence of postoperative complications of grade Ⅲ and above in the specialized treatment group was lower (4.4% vs. 9.9%, P=0.010), the proportion of patients receiving genetic testing in the specialized treatment group was higher(88.5% vs. 34.3%, P<0.001), the proportion of patients receiving imatinib (IM) adjuvant therapy after surgery in the specialized treatment group was higher (91.9% vs. 48.5%, P<0.001), the proportion of patients receiving IM concentration monitoring in the specialized treatment group was higher (51.7% vs. 29.0%, P<0.001), the proportion of patients receiving IM dose adjustment in the specialized treatment group was higher (7.8%vs.1.3%, P<0.001), the effective follow-up rate of patients in the specialized treatment group was higher (92.2% vs. 87.1%, P=0.040), and the proportion of patients taking medication as prescribed by the doctor in the specialized treatment group was higher (63.3% vs. 28.2%, P<0.001), with statistically significant differences. Multivariate analysis showed that adjuvant treatment (HR=0.534, 95%CI 0.306-0.931, P=0.027) and specialized treatment (HR=0.320, 95%CI 0.161-0.638, P=0.001) were independent protective factors affecting the overall survival rate of patients. The 3-year recurrence free survival rate (94.4% vs. 88.4%, P=0.010), the 3-year overall survival rate (97.8% vs. 90.6%, P<0.001), and the 5-year overall survival rate (96.7% vs. 86.6%, P<0.001) were significantly higher in the specialized treatment group, while The 5-year recurrence free survival rate showed no significant difference (89.6% vs. 85.8%, P>0.05). Conclusion  The specialized treatment group is more precise and standardized in the overall management of GIST , which can further improve the prognosis of GIST patients.

Key words: gastrointestinal stromal tumor, moderate-high risk, specialized treatment group, diagnosis and treatment, prognosis