| 摘要: |
| ［摘要］ 目的 分析影响中高危险度胃肠间质瘤（GIST）患者术后生存与复发的因素。方法 回顾性分析2012年1月至2021年12月南昌大学第一附属医院胃肠外科收治的370例GIST患者的临床资料。根据改良美国国立卫生研究院（NIH）危险度分级标准，高危险度GIST患者255例，中危险度GIST患者115例。比较腹腔镜手术患者和开腹手术患者，以及R0切除术后患者和R1切除术后患者的无复发生存期（RFS）、总体生存期（OS）。采用Cox回归分析探讨影响中高危险度GIST患者术后生存与复发的因素。结果 免疫组化结果显示，CD117阳性率为99.46%（368/370），CD34阳性率为77.03%（285/370）。原发部位以胃（48.92%，181/370）和小肠（37.30%，138/370）最常见。腹腔镜手术患者的RFS显著优于开腹手术患者（P<0.05），但两组OS差异无统计学意义（P>0.05）。R0切除术后患者的RFS显著优于R1切除术后患者（P<0.05），但两组OS差异无统计学意义（P>0.05）。多因素Cox回归分析结果显示，危险度分级、GIST细胞形态、靶向药物治疗是影响患者OS的独立因素（P<0.05）；年龄、危险度分级、手术根治程度、Ki-67指数、核分裂数、GIST细胞形态和靶向药物治疗是影响中高危险度GIST患者RFS的独立因素（P<0.05）。对于302例接受靶向药物治疗的中高危险度GIST患者，靶向治疗时长>3年者的RFS显著优于服药时长<1年者及服药时长1～3年者，差异有统计学意义（P=0.023），但三组OS差异无统计学意义（P>0.05）。结论 危险度分级、GIST细胞形态、接受靶向药物治疗是影响中高危险度GIST患者预后的因素。延长靶向药物治疗时间有利于患者获得更好的预后。 |
| 关键词: 胃肠间质瘤 中高危险度 预后 影响因素 |
| DOI：10.3969/j.issn.1674-3806.2022.11.10 |
| 分类号:R 735 |
| 基金项目: |
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| Analysis on the influencing factors of postoperative survival and recurrence in patients with intermediate and high-risk gastrointestinal stromal tumors |
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JU Hou-qiong, ZHONG Chong-han, LIU Dong-ning, et al.
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Department of Gastrointestinal Surgery, the First Affiliated Hospital of Nanchang University, Jiangxi 330006, China
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| Abstract: |
| ［Abstract］ Objective To analyse the factors affecting postoperative survival and recurrence in patients with intermediate and high-risk gastrointestinal stromal tumors(GIST). Methods The clinical data of 370 GIST patients admitted to Department of Gastrointestinal Surgery, the First Affiliated Hospital of Nanchang University from January 2012 to December 2021 were retrospectively analyzed. According to the modified National Institutes of Health(NIH) risk classification criteria, there were 255 high-risk GIST patients and 115 intermediate-risk GIST patients. The recurrence-free survival(RFS) and overall survival(OS) of patients undergoing laparoscopic surgery and laparotomy, as well as patients after R0 resection and R1 resection were compared. Cox regression was used to analyze the factors affecting postoperative survival and recurrence in patients with intermediate and high-risk GIST. Results The immunohistochemical results showed that the positive rate of CD117 was 99.46%(368/370), and the positive rate of CD34 was 77.03%(285/370). The most common primary sites were stomach(48.92%, 181/370) and small intestine(37.30%, 138/370). The RFS of the laparoscopic surgery patients was significantly better than that of the laparotomy patients(P<0.05), but there was no significant difference in OS between the two groups(P>0.05). The RFS of the patients after R0 resection was significantly better than that of the patients after R1 resection(P<0.05), but there was no significant difference in OS between the two groups(P>0.05). The results of multivariate Cox regression analysis showed that risk classification, GIST cell morphology, and targeted drug therapy were independent factors affecting OS of the patients(P<0.05); age, risk classification, degree of radical surgery, Ki-67 index, mitoses, GIST cell morphology and targeted drug therapy were independent factors for RFS in intermediate and high-risk GIST patients(P<0.05). For 302 intermediate and high-risk GIST patients who received targeted drug therapy, the RFS of the patients with targeted therapy duration >3 years was significantly better than that of the patients with duration of medication <1 year and that of the patients with duration of medication from 1 to 3 years, and the differences were statistically significant(P= 0.023). However, there was no significant difference in OS among the three groups(P>0.05). Conclusion Risk classification, GIST cell morphology, and receiving targeted drug therapy are factors that affect the prognosis of patients with intermediate and high-risk GIST. Prolonging the time of targeted drug therapy is beneficial for better prognosis of the patients. |
| Key words: Gastrointestinal stromal tumor(GIST) Intermediate and high risk Prognosis Influencing factor |
