非胃来源低复发风险胃肠间质瘤的远期预后及影响因素的全国多中心回顾性研究  

Prognosis and its influencing factors in patients with non-gastric gastrointestinal stromal tumors at low risk of recurrence:a retrospective multicenter study in China

作　　者：杨琳希 杨伟历[2] 吴欣[3] 张鹏[4] 张波[5] 马君俊[6] 张信华[7] 钱浩然[8] 周烨[9] 陈韬[10] 徐皓[11] 顾国利 高志冬[13] 翟刚[14] 孙小峰[15] 靖昌庆[16] 邱海波[17] 高晓东[18] 曹晖[1] 汪明[1] Yang Linxi;Yang Weili;Wu Xin;Zhang Peng;Zhang Bo;Ma Junjun;Zhang Xinhua;Qian Haoran;Zhou Ye;Chen Tao;Xu Hao;Gu Guoli;Gao Zhidong;Zhai Gang;Sun Xiaofeng;Jing Changqing;Qiu Haibo;Gao Xiaodong;Cao Hui;Wang Ming(Department of Gastrointestinal Surgery,Renji Hospital,Shanghai Jiaotong University,School of Medicine,Shanghai 200127,China;Department of Gastrointestinal Surgery,the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310003,China;Department of General Surgery,Chinese PLA General Hospital,Beijing 100853,China;Department of Gastrointestinal Surgery,Union Hospital of Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China;Department of Gastrointestinal Surgery,West China Hospital of Sichuan University,Chengdu 610041,China;Department of General Surgery,Ruijin Hospital,Shanghai Jiaotong University,School of Medicine,Shanghai 200020,China;Department of Gastrointestinal Surgery,the First Affiliated Hospital,Sun Yat-sen University,Guangzhou 510080,China;Department of General Surgery,Sir Run Run Shaw Hospital,Zhejiang University,School of Medicine,Hangzhou 310009,China;Department of Gastric Surgery,Fudan University Shanghai Cancer Center,Shanghai 200032,China;Department of Gastrointestinal Hernia Surgery,Ganzhou Hospital,Nanfang Hospital of Southern Medical University,Ganzhou 341000,China;Department of General Surgery,the First Affiliated Hospital with Nanjing Medical University,Nanjing 210029,China;Department of General Surgery,Air Force Medical Center,PLA,Beijing 100142,China;Department of Gastrointestinal Surgery,Peking University,People's Hospital,Beijing 100044,China;Department of Hepatobiliary,Pancreatic and Gastric Surgery,Shanxi Cancer Hospital,Taiyuan 650118,China;Department of Medical Oncology,Jiangsu Cancer Hospital,Nanjing 210009,China;Department of Gastrointestinal Surgery,Shandong Provincial Hospital,Jinan250021,China;Department of Gastric Surgery,Sun Yat-sen University Cancer Center,Guangzhou 510060,China;Department of General Surgery,Zhongshan Hos

机构地区：[1]上海交通大学医学院附属仁济医院胃肠外科,上海200127 [2]浙江大学医学院附属第一医院胃肠外科,杭州310003 [3]解放军总医院普通外科,北京100853 [4]华中科技大学同济医学院附属协和医院胃肠外科,武汉430022 [5]四川大学华西医院胃肠外科,成都610041 [6]上海交通大学医学院附属瑞金医院普通外科,上海200020 [7]中山大学附属第一医院胃肠外科,广州510080 [8]浙江大学医学院附属邵逸夫医院普通外科,杭州310009 [9]复旦大学附属肿瘤医院胃外科,上海200032 [10]南方医科大学南方医院赣州医院胃肠疝外科,赣州341000 [11]南京医科大学第一附属医院普通外科,南京210029 [12]解放军空军特色医学中心普通外科,北京100142 [13]北京大学人民医院胃肠外科,北京100044 [14]山西省肿瘤医院肝胆胰胃外科,太原650118 [15]江苏省肿瘤医院肿瘤内科,南京210009 [16]山东省立医院胃肠外科,济南250021 [17]中山大学肿瘤防治中心胃外科,广州510060 [18]复旦大学附属中山医院普通外科,上海200032

出　　处：《中华胃肠外科杂志》2024年第11期1123-1132,共10页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金(82072669);北京白求恩公益基金(WCJZL202109)。

摘　　要：目的探讨非胃来源低复发风险胃肠间质瘤(GIST)患者的预后及相关影响因素。方法采用回顾性队列研究方法。收集2000年1月至2023年6月期间,在国内18家医疗中心就诊的、非胃来源的低复发风险(即危险度分级为极低危或低危)GIST患者临床病理及预后资料,排除既往恶性肿瘤病史、伴发同时性第二原发恶性肿瘤、存在多发性GIST以及术前接受伊马替尼治疗者。共1571例GIST患者纳入研究,全组370例(23.6%)为极低危GIST,1201例(76.4%)为低危GIST。男性799例(50.9%),女性772例(49.1%),中位年龄57(16~93)岁。随访截止时间为2024年7月。分析其预后及相关影响因素。建立肿瘤长径及Ki67的ROC曲线,以95%CI评估灵敏度、特异度、曲线下面积(AUC)和最佳临界值。倾向评分匹配按1∶1最近邻匹配法匹配,匹配容差0.02。结果中位随访63(12~267)个月,1571例患者的5年和10年的总生存率(OS)分别为99.5%和98.0%,5年和10年的无病生存率(DFS)分别为96.3%和94.4%。术后随访期间,3.8%(60/1571)患者疾病出现复发转移,其中极低危GIST出现复发转移比例为0.8%(3/370);低危GIST者为4.7%(57/1201),低危GIST复发转移中十二指肠GIST复发转移比例为5.5%(25/457),小肠GIST为3.9%(25/645),直肠GIST为9.2%(6/65),结肠为1/10。60例复发转移患者中,56.7%(34/60)腹腔转移,53.3%(32/60)肝脏转移,3.3%(2/60)骨转移。随访期间,因疾病复发转移死亡的患者共13例(0.8%)。对肿瘤长径及Ki67绘制ROC曲线,采用约登指数提示,当肿瘤长径的最佳截断值为3.5 cm时,两组之间DFS差异具有统计学意义(AUC=0.731,95%CI:0.670~0.793,灵敏度77.7%,特异度64.1%);当Ki67的最佳截断值为5%时,两组之间DFS差异具有统计学意义(AUC=0.693,95%CI:0.624~0.762,灵敏度60.7%,特异度65.3%)。多因素分析结果显示:肿瘤长径≥3.5 cm、Ki67≥5%以及R 1切除是原发性非胃来源低复发风险GIST患者DFS的独立危险因素(均P<0.05);年龄>57岁、Ki67≥5%以Objective To investigate the prognosis and the factors that influence it in patients with non-gastric gastrointestinal stromal tumors(GISTs)who are at low risk of recurrence.Methods This was a retrospective cohort study.Clinicopathologic and prognostic data from patients with non-gastric GISTs and at low risk of recurrence(i.e.,very low-risk or low-risk according to the 2008 version of the Modified NIH Risk Classification),who attended 18 medical centers in China between January 2000 and June 2023,were collected.We excluded patients with a history of prior malignancy,concurrent primary malignancy,multiple GISTs,and those who had received preoperative imatinib.The study cohort comprised 1,571 patients with GISTs,370(23.6%)of whom were at very low-risk and 1,201(76.4%)at low-risk of recurrence.The cohort included 799(50.9%)men and 772(49.1%)women of median age 57(16–93)years.Patients were followed up to July 2024.The prognosis and its influencing factors were analyzed.Receiver operating characteristic curves for tumor diameter and Ki67 were established,and the sensitivity,specificity,area under the curve(AUC)and optimal cut-off value with 95%confidence intervals were calculated.Propensity score matching was implemented using the 1:1 nearest neighbor matching method with a matching tolerance of 0.02.Results With a median follow-up of 63(12–267)months,the 5-and 10-year overall survival(OS)rates of the 1,571 patients were 99.5%and 98.0%,respectively,and the 5-and 10-year disease-free survival(DFS)rates were 96.3%and 94.4%,respectively.During postoperative follow-up,3.8%(60/1,571)patients had disease recurrence or metastasis,comprising 0.8%(3/370)in the very low-risk group and 4.7%(57/1,201)in the low-risk group.In the low-risk group,recurrence or metastasis occurred in 5.5%(25/457)of patients with duodenal GISTs,3.9%(25/645)of those with small intestinal GISTs,9.2%(6/65)of those with rectal GISTs,and 10.0%(1/10)of those with colonic GISTs.Among the 60 patients with metastases,56.7%(34/60)of the metastases were loc

关 键 词：胃肠间质瘤 非胃来源 低复发风险 外科治疗 伊马替尼 辅助治疗 

分 类 号：R735[医药卫生—肿瘤]