原发直肠胃肠间质瘤多中心临床诊治分析  

Diagnosis and treatment of primary rectal gastrointestinal stromal tumors

作　　者：张鹏[1] 汪明[2] 林国乐[3] 丰帆 叶颖江[5] 刘骞[6] 夏立建 赵岩[8] 熊治国[9] 胡俊波[10] 高志冬[5] 尹源[11] 张波[11] 曹晖[2] 陶凯雄[1] ZHANG Peng;WANG Ming;LIN Guo-le(Department of Gastrointestinal Surgery,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China;不详)

机构地区：[1]华中科技大学同济医学院附属协和医院,湖北武汉430022 [2]上海交通大学医学院附属仁济医院,上海200025 [3]中国医学科学院北京协和医院,北京100730 [4]空军军医大学第一附属医院,陕西西安710032 [5]北京大学人民医院,北京100044 [6]中国医学科学院肿瘤医院,北京100021 [7]山东第一医科大学第一附属医院,山东济南250014 [8]辽宁省肿瘤医院,辽宁沈阳110042 [9]湖北省肿瘤医院,湖北武汉430079 [10]华中科技大学同济医学院附属同济医院,湖北武汉430030 [11]四川大学华西医院,四川成都610041

出　　处：《中国实用外科杂志》2021年第5期543-549,共7页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金(No.81702386,No.81874184);湖北省卫生健康委员会青年人才项目(No.WJ2019Q030)。

摘　　要：目的分析原发直肠胃肠间质瘤(GIST)临床病理特征,探讨其外科诊治策略。方法回顾分析2000年1月至2019年12月国内11家医疗中心行手术治疗的340例原发直肠GIST病人临床病理及随访资料。统计资料包括病人基本信息、实验室检查、影像学检查、术前治疗、手术及术后情况、术后病理学检查结果及随访数据。应用倾向性评分匹配的最近邻匹配法减少组间基线水平差异;采用Kaplan-Meier法(Log-rank检验)计算生存率。结果340例病人中,男性211例(62.1%),女性129例(37.9%),中位确诊年龄54(16~84)岁;初诊时肿瘤中位直径为5.1 cm,肿瘤下缘距肛缘中位距离为5.0 cm。2000—2010年、2011—2013年、2014—2016年及2017—2019年期间局部切除术比例分别为31.3%、34.3%、42.6%、38.2%;术前治疗比例为6.0%、7.5%、33.7%、47.2%;基因检测比例为7.2%、9.0%、30.7%、32.6%;中高危病人辅助治疗比例为21.1%、24.2%、45.9%、47.1%。340例病人中126例(37.1%)行局部切除术,214例(62.9%)行根治性切除术;倾向评分匹配前,局部切除组病人肿瘤直径小(P<0.001),核分裂象少(P<0.001),肿瘤距肛缘距离近(P<0.001),术前治疗比例高(P=0.036);在手术时间、肛门保留率、术后并发症及术后住院时间方面优于行根治性切除术病人。倾向评分匹配后,两组分别纳入74例病人,两组病人性别、年龄、肿瘤距肛缘距离、肿瘤直径差、核分裂象及术后并发症差异无统计学意义(均P>0.05),局部切除组在手术时间、肛门保留率及术后住院时间方面优于行根治性切除病人。340例病人中位随访时间为52(1~215)个月,随访率(89.4%)。其中59例(17.4%)复发,3年、5年无复发生存率为88.4%、81.6%。倾向评分匹配前后局部切除组与根治性切除组病人预后差异均无统计学意义(P=0.856,P=0.065)。结论直肠GIST主要位于下段直肠,多发生于中老年男性;在保证完整切除前提下,局部切除术短期疗效优于�Objective To analyze the clinical and pathological features of rectal gastrointestinal stromal tumors(GIST)and the strategies of surgical treatment.Methods The clinicopathological and follow-up data of patients with rectal GIST who underwent surgical treatment in 11 medical centers in China from January 2000 to December 2019 were analyzed retrospectively.Basic information,laboratory examinations,imaging examinations,preoperative therapy,surgery,postoperative conditions,postoperative pathology and follow-up were included.The nearest neighbor matching of propensity score matching method(PSM)was conducted to reduce differences in baseline levels between groups.The Kaplan-Meier method was used to calculate the survival rate.Results A total of 340 patients with rectal GIST were enrolled,including 211 males(62.1%)and 129 females(37.9%),with a median age of 54 years;the median diameter of the tumor at the first diagnosis was 5.1 cm,and the median distance from inferior margin of the tumor to anal verge was 5.0 cm.During 2000 to 2010,2011 to 2013,2014 to 2016 and 2017 to 2019,the proportions of local excision were 31.3%,34.3%,42.6%,and 38.2%,respectively;the proportions of preoperative therapy were 6.0%,7.5%,33.7%,and 47.2%,respectively;the proportions of genetic testing were 7.2%,9.0%,30.7%,and 32.6%,respectively;the proportions of adjuvant treatment for patients with intermediate-and high-risk were 21.1%,24.2%,45.9%,and 47.1%,respectively.One hundred and twenty-six cases(37.1%)underwent local excision and 214 cases(62.9%)underwent radical resection.Before PSM,patients underwent local excision had smaller tumor size(P<0.001),fewer mitotic count(P<0.001),closer distance to anal verge(P<0.001),and higher rate of preoperative therapy(P=0.036);the operation time,anus preservation rate,postoperative complications and postoperative hospital stay of local excision group were better than those of radical resection group.After PSM,148 patients were included.The gender,age,distance from the tumor to the anal verge,tumor size,mito

关 键 词：胃肠间质瘤 直肠 手术 靶向治疗 预后 

分 类 号：R6[医药卫生—外科学]