217例胃肠间质瘤临床分析  

Clinical analysis of 217 patients with gastrointestinal stromal tumor

作　　者：张鹏[1] 郑威强[1] 陶凯雄[1] 帅晓明[1] 韩高雄[1] 王国斌[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院普通外科,武汉430022

出　　处：《中华胃肠外科杂志》2012年第3期251-254,共4页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的探讨胃肠间质瘤（GIST）的临床特征、诊治及影响预后的因素。方法回顾性分析2005年1月至2010年9月华中科技大学同济医学院附属协和医院经手术治疗的217例GIST患者的临床病理资料。比较不同因素对患者预后的影响。结果217例患者中男性103例，女性114例，中位年龄55岁。除4例患者因广泛浸润未完整切除外，其余213例均行完整切除，其中35例行腹腔镜手术；48例术后EI服伊马替尼。178例（82．0％）患者获得术后随访，随访时间3。74个月。随访期间有16例（9．0％）发生术后复发和（或）转移，Logistic回归分析显示．肿瘤部位（OR=2．547，95％CI：1．466～4．424）和核分裂像（OR=6．556，95％CI：2．974。14．449）是影响根治术后复发和（或）转移的独立危险因素。随访患者中带瘤生存者5例，11例死于GIST，其中小肠GIST7例，肠道外GIST4例。Cox回归分析显示，核分裂像（RR=2．654，95％CI：1．094～6．438）与复发和（或）转移（RR=32．988，95％CI：3．879～280．529）是GIST患者的独立预后因素。结论肿瘤部位与核分裂像是影响GIST根治术后复发和（或）转移的独立因素，核分裂像与术后复发和（或）转移是影响GIST预后的独立因素。外科手术完整切除联合靶向治疗可使GIST患者获得满意疗效。Objective To study the clinical characteristics, diagnosis, treatment and prognostic factors of gastrointestinal stromal tumor（GIST）. Methods Clinicopathological data of 217 GIST patients from January 2005 to September 2010 in Wuhan Union Hospital were analyzed retrospectively and the prognostic factors were evaluated. Results There were 103 males and 114 females with a median age of 55 yeats old. Two hundred and thirteen patients underwent R0 resection and 4 R1 resection due to extensive invasion. Thirty-five patients underwent laparoscopic resection. Forty-eight patients received imatinib mesylate therapy after surgery. A total of 178 patients （82.0%） were followed up for 3 to 74 months. Sixteen patients （9.0%） developed recurrence or metastasis. Logistic regression analysis showed that tumor location （OR=2.547, 95% CI： 1.466-4.424） and mitotic count （OR=6.556, 95% CI： 2.974-14.449） were independent factors for post-operative recurrence or metastasis. Five patients survived with tumor, and 11 patients （6.2%） died of GIST including intestineal GIST （n=7） and extraintestinal GIST （n=4）. Cox regression analysis showed that the mitotic count （RR=2.654, 95% CI： 1.094-6.438） and post-operative recurrence or metastasis （RR=32.988, 95% CI：3.879-280.529） were independent prognostic factors. Conclusions Tumor location and mitotic count are independent risk factors for post-operaive recurrence or metastasis in GIST. Mitotic count and post-operative recurrence or metastasis are independent indicators of poor prognosis. Surgical radical resection combined with targeted therapy can acheive satisfactory outcomes in patients with GIST.

关 键 词：胃肠间质瘤 治疗 外科手术 伊马替尼 

分 类 号：R735[医药卫生—肿瘤]