外科治疗贲门周围胃肠间质瘤的远期预后分析  

Long-term prognosis of surgical treatment for peri-gastric cardial gastrointestinal stromal tumors

作　　者：况田 杨琳希 汪明[1] 曹晖[1] Kuang Tian;Yang Linxi;Wang Ming;Cao Hui(Department of General Surgery,the Affiliated Renji Hospital,Shanghai Jiaotong University School of Medicine,Shanghai200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院普通外科,上海200127

出　　处：《中华胃肠外科杂志》2024年第11期1141-1147,共7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：目的探讨外科手术治疗贲门周围胃肠间质瘤(GIST)的远期预后。方法采用回顾性队列研究的方法。总结分析1998年5月至2020年12月期间,上海交通大学医学院附属仁济医院接受根治性手术治疗的贲门周围GIST的病例资料。入组标准为行根治性手术治疗且病理学证实为原发性胃GIST、肿瘤累及贲门或肿瘤边缘至贲门齿状线最小距离<5 cm和具有相对完整的临床资料、辅助治疗情况以及随访信息;排除多发GIST或其他恶性肿瘤史以及术前或术中发现远处转移或局部侵犯。共计170例患者入组。其中男性98例(57.6%),中位年龄62(30~85)岁。肿瘤距贲门距离<2 cm者97例,2~5 cm者73例;腔内生长85例,腔外生长61例,腔内外生长24例;肿瘤直径≤2.0 cm、2.1~5.0 cm、5.1~10.0 cm和>10.0 cm者分别为11、90、60和9例;核分裂象计数(/50高倍视野)≤5个、5~10个和>10个者分别为129、21和20例;危险度分级为极低危、低危、中危和高危者分别为10、79、43和38例;128例符合“指南”诊疗规范;38例高危患者有21例伊马替尼治疗时间≥3年。主要观察指标为手术方式及总体生存率(OS)和无病生存率(DFS)。运用SPSS 28.0及R studio对数据进行整理分析。结果全组开放手术90例,其中全胃切除术5例,近端胃切除术49例,局部切除术36例;腹腔镜局部切除术80例。中位随访时间82.5(13~278)个月。全组1、3、5和10年OS分别为100.0%、98.2%、96.9%和89.6%,1年、3年、5年、10年DFS分别为99.4%、95.9%、92.0%和88.0%。在对肿瘤直径、核分裂象、辅助治疗情况、肿瘤距贲门距离和生长方向等因素行倾向性评分匹配后,DFS和OS在接受近端胃切除与局部切除术患者、以及接受开放局部切除与腹腔镜局部切除患者的比较中,其DFS和OS的差异均无统计学意义(均P>0.05)。结论外科手术治疗贲门周围GIST远期预后较好。贲门周围GIST行近端胃切除术和局部切除术,采用腹腔镜或�Objective To explore the long-term prognosis of surgical treatment for peri-gastric cardial gastrointestinal stromal tumors(GISTs).Methods In this retrospective cohort study,we analyzed selected data of patients with peri-gastric cardial GISTs who had undergone radical surgery in Renji Hospital,Shanghai Jiao Tong University School of Medicine,from May 1998 to December 2020.Inclusion criteria comprised radical surgery,pathologically confirmed primary gastric GIST;tumor involving the cardia or within 5 cm of the cardia dentate line;and relatively complete clinical data,including adjuvant therapy and follow-up information.Exclusion criteria comprised presence of multiple GISTs or a history of other malignancies and evidence of distant metastasis or local invasion either preoperatively or intraoperatively.The study cohort comprised 170 patients,including 98 men(57.6%),with a median age of 62 years(range:30–85 years).Tumors were located less than 2 cm from the dentate line in 97 patients and 2 to 5 cm from it in 73.Tumor growth patterns were intraluminal in 85 patients,extraluminal in 61,and both intraluminal and extraluminal in 24.Tumor diameters were≤2.0 cm in 11 patients,2.1–5.0 cm in 90,5.1–10.0 cm in 60,and>10.0 cm in nine.Mitosis counts(per 50 high-power fields)were≤5 in 129 patients,5–10 in 21,and>10 in 20.Risk stratification categorized patients as at extremely low risk in 10 patients,at low risk in 79,at intermediate risk in 43,and at high risk in 38.The guidelines for treatment were adhered to in 128 patients;21 of 38 high-risk patients had received imatinib for≥3 years.Primary outcomes included surgical procedure,overall survival(OS),and disease-free survival(DFS).Data were analyzed using SPSS 28.0 and R studio.Results Ninety of the patients had undergone open surgery,including five total gastrectomies,49 proximal gastrectomies,and 36 local resections.In addition,80 patients had undergone laparoscopic local resections.The median follow-up time was 82.5 months(range 13–278 months).The OS rate

关 键 词：胃肠间质瘤 贲门周围 外科治疗 预后 

分 类 号：R735[医药卫生—肿瘤]