119例巨大胃肠间质瘤的临床特征及预后分析  

Clinical characteristics and prognosis analysis of 119 cases with giant gastrointestinal stromal tumor

作　　者：张鹏[1] 曾祥宇[1] 高金波[1] 刘炜圳 帅晓明[1] 刘科[1] 刘兴华[1] 蔡明[1] 蔡开琳[1] 王国斌[1] 陶凯雄[1] 

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

出　　处：《中华胃肠外科杂志》2016年第11期1290-1295,共6页Chinese Journal of Gastrointestinal Surgery

基　　金：中国卫计委公益性行业基金（201402015）;国家自然科学基金（81572413）

摘　　要：目的探讨巨大胃肠间质瘤（GIST）的临床特点及预后影响因素。方法回顾性分析华中科技大学同济医学院附属协和医院2005年1月至2015年7月间经手术治疗的235例高危GIsT患者的临床资料，其中肿瘤直径≥10cm者119例（巨大GIST组），肿瘤直径〈10cm者116例（普通高危组），比较两组患者的临床特征及预后，同时总结巨大GIST组患者的临床特点，并采用Cox回归模型对影响巨大GIST患者预后的资料进行多因素分析。结果本组巨大GIST患者占同期高危GIST的50．6％（119／235）。巨大GIST组119例患者中男63例，女56例，中位年龄53（20—82）岁；肿瘤原发部位为胃43例（36．1％），小肠39例（32．8％），结直肠5例（4．2％），胃肠道外（肠系膜、腹膜后及腹盆腔等）32例（26．9％）。与普通高危组相比，巨大GIST组患者的发病年龄更为年轻[≤50岁比例：44．5％（53／119）比31．9％（37／116），P=0．046]，肿瘤发生于胃肠道外者的比例相对较高[26．9％（32／119）比9．5％（11／116），P=0．000]。巨大GIST组凡切除115例（96．6％），R1切除3例（2．5％），R2切除1例（0．9％），有32例（26．9％）行扩大切除术（即同时行淋巴结清扫或联合脏器切除）。术后巨大GIST组与普通高危组服用靶向药物（伊马替尼400mg／d）患者比例[32．8％（39／116）比39．6％（46／116）]差异无统计学意义（P=0．232）。巨大GIST组有8例发生复发转移。巨大GIST组和普通高危组5年总体生存率分别为79．4％和85．1％（P=0．788），5年无复发生存率分别为72．8％和84．2％（P=0．932），差异均无统计学意义。多因素预后分析结果显示，性别（P=0．047，RR=0．383。95％CI：0．149—0．987）、核分裂像（P=0．001，RR=0．216，95％CI：0．087～0．538）及是否服用靶向药物（P=0．019，RR=5．719，95％CI：1．324～24．695）是影响巨大GObjective To investigate the clinical characteristics, diagnosis and treatment as well as prognostic factors of the giant gastrointestinal stromal tumor （GIST）. Methods Clinical data of 235 patients with high risk GIST treated in the Union Hospital, Tongi Medical College, Huazhong University of Science and Technology between January 2005 and July 2015 were retrospectively analyzed. Patients were divided into giant GIST group （diameter equal to or larger than 10 cm, 119 cases） and high risk group （diameter less than 10 cm, 116 cases） according to tumor size. Clinical characteristics and prognosis of two groups were compared and the clinical features of giant GIST were summarized. Multivariate analysis was performed to evaluate the prognostic factors of giant GIST with Cox regression model. Results Of the 119 patients with giant GIST, which accounted for 50.6% （119/ 235） of all the high risk patients, there were 63 male and 56 female patients with a median age of 53 （20-82） years. Primary giant GIST of 43 （36.1%） located in the stomach, of 39 （32.8%） in the small intestine, 5（4.2%） in the colon and rectum, and of 32 （26.9%） outside the gastrointestinal tract （mesentery, retroperitoneum, abdominal cavity, etc） and pelvic. Compared to high risk group, age of onset was younger [ratio of ≤ 50 years, 44.5% （53/119） vs. 31.9% （37/116）, P = 0.046] and incidence of outside the gastrointestinal tract was significantly higher [ 26.9% （32/119） vs. 9.5% （11/116）, P=0.000] in giant GIST group. All the giant GIST patients underwent surgical resection, including 115 cases（96.6%） of R0 resection, 3 cases（2.5%） of R1 resection and 1 case（0.9%） of R2 resection, besides, 32 cases （26.9%） underwent expanded resection （namely, underwent lymphadenectomy or combined organ resection simultaneously）. Thirty-nine giant GIST cases （32.8%）accepted imatinib 400 mg/d for targeted therapy after operations, which was not significantly different with high risk group

关 键 词：胃肠间质瘤 巨大 高危 外科手术 伊马替尼 预后 

分 类 号：R735[医药卫生—肿瘤]