中国胃肠间质瘤患者伊马替尼服药依从性的多中心横断面调查  

Adherence to adjuvant with therapy imatinib in patients with gastrointestinal stromal tumor:a national multi⁃center cross⁃sectional study

作　　者：张鹏[1] 张军[2] 张波[3] 杨文昶 胡俊波[4] 孙小峰[5] 翟刚[6] 钱浩然[7] 李勇[8] 徐皓 丰帆 吴星烨[2] 刘合利[11] 刘洪俊 邱海波[13] 伍小军[14] 周岩冰[15] 沈坤堂[16] 寇有为[17] 符洋[18] 揭志刚[19] 邹小明[20] 曹晖[21] 高志冬[22] 陶凯雄[1] Zhang Peng;Zhang Jun;Zhang Bo;Yang Wenchang;Hu Junbo;Sun Xiaofeng;Zhai Gang;Qian Haoran;Li Yong;Xu Hao;Feng Fan;Wu Xingye;Liu Heli;Liu Hongjun;Qiu Haibo;Wu Xiaojun;Zhou Yanbing;Shen Kuntang;Kou Youwei;Fu Yang;Jie Zhigang;Zou Xiaoming;Cao Hui;Gao Zhidong;Tao Kaixiong(Department of Gastrointestinal Surgery,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China;Department of Gastrointestinal Surgery,the First Affiliated Hospital,Chongqing Medical University,Chongqing 400016,China;Department of Gastrointestinal Surgery,West China Hospital,Sichuan University,Chengdu 610041,China;Department of Gastrointestinal Surgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China;Department of Medical Oncology,Jiangsu Institute of Cancer Research,Jiangsu Provincial Cancer Hospital,the Affiliated Cancer Hospital,Nanjing Medical University,Nanjing 210009,China;The First Department of General Surgery,Tumor Hospital of Shanxi Province,Taiyuan 030013,China;Department of General Surgery,Institute of Minimal Invasive Surgery,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Hangzhou 310016,China;The Third Department of Surgery,the Fourth Hospital,Hebei Medical University,Shijiazhuang 050011,China;Department of Gastric Surgery,the First Affiliated Hospital,Nanjing Medical University,Nanjing 210029,China;Department of Digestive Surgery,the First Affiliated Hospital,Air Force Medical University,Xi′an 710032,China;Department of Gastrointestinal Surgery,Xiangya Hospital,Central South University,Changsha 410008,China;Department of Gastrointestinal Surgery,Shandong Provincial Hospital,Shandong First Medical University,Jinan 250021,China;Department of Gastric Surgery,Cancer Center,Sun Yat-sen University,Guangzhou 510060,China;Department of Colorectal Surgery,Cancer Center,Sun Yat-sen University,Guangzhou 510060,China;Department of Gastrointestinal Surgery,the Affiliated Hospital,Qingdao University,Qingdao 266003,China;Department

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 [2]重庆医科大学附属第一医院胃肠外科,400016 [3]四川大学华西医院胃肠外科,成都610041 [4]华中科技大学同济医学院附属同济医院胃肠外科,武汉430030 [5]江苏省肿瘤医院,江苏省肿瘤防治研究所,南京医科大学附属肿瘤医院肿瘤内科,210009 [6]山西省肿瘤医院普通外一科,太原030013 [7]浙江大学医学院附属邵逸夫医院普通外科,杭州310016 [8]河北医科大学第四医院外三科,石家庄050011 [9]南京医科大学第一附属医院胃外科,210029 [10]空军军医大学第一附属医院消化外科,西安710032 [11]中南大学湘雅医院胃肠外科,长沙410008 [12]山东第一医科大学附属省立医院胃肠外科,济南250021 [13]中山大学肿瘤防治中心胃外科,广州510060 [14]中山大学肿瘤防治中心结直肠外科,广州510060 [15]青岛大学附属医院胃肠外科,266003 [16]复旦大学附属中山医院普通外科,上海200032 [17]中国医科大学附属盛京医院胃肠外科,沈阳110004 [18]郑州大学第一附属医院胃肠外科,450052 [19]南昌大学第一附属医院普通外科,330006 [20]哈尔滨医科大学附属第二医院普通外科,150086 [21]上海交通大学医学院附属仁济医院胃肠外科,200127 [22]北京大学人民医院胃肠外科,100044

出　　处：《中华胃肠外科杂志》2021年第9期775-782,共8页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金(81702386、81874184);“白求恩·肿瘤基础研究计划”项目(BCF⁃NH⁃ZL⁃20201119⁃002)。

摘　　要：目的分析国内胃肠间质瘤(GIST)患者伊马替尼服药依从性现状及其影响因素。方法采用横断面调查方法进行问卷调查。调查时间为2020年10月1日至11月31日;调查对象为在具有GIST诊疗资质的公立三级甲等综合医院和肿瘤专科医院诊治,且正在服用伊马替尼的GIST患者,排除未得到病理确诊者和未曾服用伊马替尼者,或既往服用伊马替尼但当前已停药者。使用“问卷星”网络平台设计中国GIST患者伊马替尼服药依从性调查问卷,通过微信方式向调查对象发送问卷链接,问卷内容包括患者基本信息、用药情况及Morisky服药依从性量表。结果共回收2162份来自全国31个省、自治区、直辖市的GIST患者调查问卷,其中有效问卷2005份,有效率92.7%。调查对象中男性1104例,女性901例,中位年龄56(22~91)岁。生活状态:单位在职工作609例(30.4%),退休729例(36.4%),灵活就业及无业667例(33.3%);文化程度:大学本科及以上477例(23.8%),高中658例(32.8%),小学或初中782例(39.0%),未受过教育88例(4.4%);婚姻状况:1789例(89.2%)已婚、179例(8.9%)离异或丧偶,37例(1.8%)未婚。初诊GIST时肿瘤发生转移者294例(14.7%),其中肝脏转移203例,腹膜转移52例,其他部位39例。1869例(93.2%)接受了手术治疗,其中1642例(81.9%)行完整切除术。患者服用伊马替尼中位时间为25(1~200)个月,服用伊马替尼的主要不良反应包括眶周水肿1701例(84.8%),白细胞减少1031例(51.4%),乏力948例(47.3%),恶心呕吐781例(39.0%),皮疹709例(35.4%)和双下肢水肿670例(33.4%)。Morisky服药依从性量表评分显示,伊马替尼服药依从性差392例(19.6%),依从性中等1023例(51.0%),依从性好590例(29.4%)。单因素分析显示,患者性别、年龄、居住城市、工作状态、经济收入、居住地、文化程度、婚姻、服药时间及药物不良反应均与患者伊马替尼服药依从性有关(均P<0.05);多因素分析结果显示,女性(OR=1.264,P=0.Objective To analyze the current adherence to imatinib in patients with gastrointestinal stromal tumors(GIST)in China and its influencing factors.Methods A cross⁃sectional survey was conducted.Study period:from October 1,2020 to November 31,2020.Study subjects:GIST patients taking imatinib who were diagnosed and treated in public tertiary level A general hospitals or oncology hospitals;those who had not been pathologically diagnosed,those who never received imatinib,or those who had taken imatinib in the past but stopped afterwards were excluded.The Questionnaire Star online surgery platform was used to design a questionnaire about the adherence to adjuvant imatinib therapy of Chinese GIST patients.The link of questionnaire was sent through WeChat.The questionnaire contained basic information of patients,medication status and Morisky Medication Adherence Scale.Results A total of 2162 questionnaires from 31 provinces,autonomous regions,and municipalities were collected,of which 2005 were valid questionnaires,with an effective rate of 92.7%.The survey subjects included 1104 males and 901 females,with a median age of 56(22⁃91)years old.Working status:609 cases(30.4%)in the work unit,729 cases(36.4%)of retirement,667 cases of flexible employment or unemployment(33.3%).Education level:477 cases(23.8%)with bachelor degree or above,658 cases(32.8%)of high school,782 cases(39.0%)of elementary or junior high school,88 cases(4.4%)without education.Marital status:1789 cases(89.2%)were married,179 cases(8.9%)divorced or widowed,37 cases(1.8%)unmarried.Two hundred and ninety⁃four patients(14.7%)had metastasis when they were first diagnosed,including 203 liver metastases,52 peritoneal metastases,and 39 other metastases.One thousand eight hundred and sixty⁃nine patients underwent surgical treatment,of whom 1642(81.9%)achieved complete resection.The median time of taking imatinib was 25(1⁃200)months.Common adverse reactions of imatinib included 1701 cases(84.8%)of periorbital edema,1031 cases(51.4%)of leukopenia,948 ca

关 键 词：胃肠间质瘤 伊马替尼 依从性 问卷调查 复发 

分 类 号：R735[医药卫生—肿瘤]