Abstract:

Prognosis of duodenal stromal tumor: A multi-institutional retrospective analysis        HU Yu-long*, LI Le-ping, DAI Yong, et al.*Department of General Surgery, Affiliated Hospital of Medical College of Qingdao University, Qingdao 266003, China
Corresponding author: ZHOU Yan-bing, E-mail:zhouyanbing999@aliyun.com
Abstract    Objective    To investigate the clinicopathological features and prognosis of patients with duodenal stromal tumor after surgery Methods    The clinicopathological data of duodenal stromal tumor patients underwent different surgical procedure from July 2003 to November 2014 in 23 grade A tertiary hospitals in Shandong province were reviewed retrospectively. Pathology results were rechecked. Patients were followed up. The prognostic factors were evaluated by univariate and multivariate analysis with Log-rank test and Cox proportional hazard model. Results    A total of 203 duodenal stromal tumor cases were enrolled. There were 101 males and 102 females. The median age was 55 years old. The 1-, 3-,5- and 10-year actuarial survival was 95.0%, 88.0%, 82.0% and 82.0% respectively. The 1-, 3-, 5- and 10-year actuarial recurrence-free survival was 93.0%, 87.0%, 81.0% and 75.0% respectively. For patients with high risk of recurrence after surgery, the 5-year overall survival rate was significantly higher than those without medication (89% vs. 62%, P<0.05). Multivariate analysis revealed that tumor size (P<0.05, RR=5.510，95%CI 1.170-5.719）,mitotic count (P<0.05, RR=6.849,95%CI 1.264-5.124) and the tumor rupture (P<0.05, RR=7.349，95%CI 1.608-18.196) were independent prognostic factors. Conclusion    Tumor size, mitotic count and the tumor rupture affect prognosis of patients after resection of primary duodenal stromal tumor independently. Surgical methods were not associated with 5-year overall survival. Adjuvant imatinib therapy can improve overall survival of patients with high risk of recurrence after surgery.

Key words: gastrointestinal stromal tumor, duodenal tumor, surgical approach, prognosis, imatinib

摘要：

目的    探讨十二指肠间质瘤手术病人的临床病理学特征、预后及其影响因素。方法    回顾性分析2003年7月至2014年11月山东省23家三级甲等医院十二指肠间质瘤手术病人的临床病理学资料，对所有病例进行病理学复核及随访，对其预后因素进行单因素和多因素分析。结果    共收集203例十二指肠间质瘤病例，男101例，女102例。中位年龄55岁。术后1、3、5和10年总体存活率分别为95.0%、88.0%、82.0%和82.0%，术后1、3、5和10年无复发存活率分别为93.0%、87.0%、81.0%和75.0%。高复发风险病人术后服用伊马替尼，其5年总体存活率明显高于未服药者（89% vs. 62%，P＜0.05）。预后因素分析结果显示，肿瘤直径（RR=5.510，95%CI 1.170～5.719，P＜0.05）、核分裂像（RR=6.849，95%CI 1.264～5.124，P＜0.05）和肿瘤是否破裂（RR=7.349，95%CI 1.608～18.196，P＜0.05）是十二指肠间质瘤病人的独立预后因素。结论    肿瘤直径、核分裂像和肿瘤是否破裂是十二指肠间质瘤术后病人预后的独立影响因素；不同手术方式5年总体存活率无明显差异，伊马替尼可改善术后高复发风险病人的预后。

关键词: 胃肠间质瘤, 十二指肠肿瘤, 手术方式, 预后, 伊马替尼