中国实用外科杂志

中国实用外科杂志

• 论著 • 上一篇    下一篇

中度复发风险胃胃肠间质瘤预后因素分析

王    力a，高晓东a，方    勇a，薛安慰a，侯英勇b，李    鹤a，凌佳倩a，束    平a，沈坤堂a，秦    净a，孙益红a，秦新裕a   

  1. 复旦大学附属中山医院a.普外科  b.病理科，上海200032
  • 出版日期:2017-01-01 发布日期:2017-01-03

  • Online:2017-01-01 Published:2017-01-03

摘要：

目的    探讨中度复发风险胃胃肠间质瘤的临床和病理学特点，研究甲磺酸伊马替尼(格列卫)术后辅助治疗对其预后的影响。方法    回顾性分析2003年1月至2013年12月在复旦大学附属中山医院手术并经病理学检查诊断为中度复发风险胃胃肠间质瘤的123例病人临床和随访资料。结果    123例中，男64例，女59例。中位年龄58岁。部分（39.0%，48例）病人在体检时发现，无明显症状，出现症状者以腹痛、腹胀为主（30.1%，37例），其次为出血、贫血。中位随访58（24~150）个月，27例术后行甲磺酸伊马替尼辅助治疗者，1例出现肝转移；96例未服用甲磺酸伊马替尼者，5例出现复发或转移。6例复发转移病人，按照“WHO良恶性评估”标准，3例属恶性，3例属良性；按照“形态学良恶性评估”标准，5例属恶性，1例属交界性。服用甲磺酸伊马替尼组1、3、5年的无病生存（DFS）率分别为100.0%，95.8%，95.8%，未服用甲磺酸伊马替尼组1、3、5年的DFS分别为98.9%，97.9%，94.4%，两组DFS差异无统计学意义（P=0.760）。“WHO良恶性评估”，82例良性GIST与41例恶性GIST间DFS差异无统计学意义（P=0.450）。“形态学良恶性评估”，42例恶性间质瘤与81例非恶性间质瘤间DFS差异具有统计学意义（P=0.017）。结论    中度复发风险胃GIST经手术R0切除后，术后复发率较低，甲磺酸伊马替尼的辅助治疗对DFS未见明显影响，当然这需要大样本量前瞻性随机对照研究进行证实；形态学指标在临床决策上有参考意义。

关键词: 胃肠间质瘤, 中度复发风险, 甲磺酸伊马替尼, 无病存活率

Abstract:

Analysis of prognostic factors of intermediate risk gastrointestinal stromal tumors        WANG Li*, GAO Xiao-dong, FANG Yong, et al. *Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Corresponding author: SHEN Kun-tang, E-mail: shen.kuntang@zs-hospital.sh.cn
Abstract    Objective    To investigate the clinical and pathological characteristics and the effect of imatinib (IM)adjuvant therapy on the prognosis of intermediate risk gastrointestinal stromal tumors(GIST). Methods    The clinical data and follow-up data of 123 patients with intermediate risk GIST confirmed by pathology in Zhongshan Hospital Affiliated to Fudan University between January 2003 and December 2013 were analyzed retrospectively. Results    There were 64 male and 59 female patients with a median age of 58 months (24-150). The major clinical symptoms were abdominal pain, abdominal distension (30.1%，37 cases), followed by hemorrhage, anemia (16.3%，20 cases). One of 27 patients who received adjuvant IM experienced liver metastasis while 5 of 96 patients without had recurrence or metastases. Among 6 patients, according to WHO evaluation criteria, 3 cases were malignant, 3 cases were benign; according to the morphological criteria, 5 cases were malignant, 1 cases were borderline. Disease-free survival rates of 1-, 3-, and 5-years were 100.0%，95.8%，95.8% in patients taking IM, respectively. DFS rates of 1-, 3-, and 5-years were 98.9%，97.9%，94.4% in patients without taking IM, respectively. There was no obvious statistical difference in the DFS rates between the two groups (P=0.760). WHO benign and malignant evaluation, 82 cases of benign GIST and 41 cases of malignant GIST, there was no significant difference in DFS between the two groups (P=0.450). According to the pathological morphological index, GIST was divided into malignant and non-malignant, and there was a significant statistical difference between the two groups(P=0.017). Conclusions    Adjuvant use of IM without selection didn’t benefit patients classified as NIH intermediate risk GIST after R0 surgery. However, the pathologically morphological index identifies those with relatively high potential of malignancy and requiring adjuvant IM.

Key words: gastrointestinal stromal tumors, intermediate risk, imatinib mesylate（IM）, disease-free survival（DFS）