CAJ | 학술논문

目的：分析不同治疗方法治疗小肠胃肠间质瘤（GIST）的疗效及其预后。方法回顾性分析2004-2013年间北京解放军总医院收治的63例小肠GIST患者的临床资料。根据是否完整切除肿瘤及术后是否服用伊马替尼进行分组，获手术R0切除的55例患者分为R0切除加服药组（13例）和R0切除未服药组（42例），肿瘤未获R0切除的8例患者分为非R0切除加服药组（7例）和非R0切除未服药组（1例），比较不同治疗方法患者的的生存情况。结果全组病例术后中位随访时间为24（3～120）月，1、3、5年总体生存率分别为97％、94％和80％。R0切除加服药组、R0切除未服药组、非R0切除加服药组患者中位疾病无进展生存期分别为24、24和23月；术后1年疾病无进展生存率（PFS）分别为100％、97％和83％，3年PFS分别为100％、45％和83％，5年PFS分别为100％、28％和42％，R0切除加服药组PFS明显高于其他治疗组（均P＜0．05）；而非R0切除亦未服药的1例患者于术后6月死亡。获R0切除的55例患者16例肿瘤复发，术后1、3、5年复发率分别为2％、43％和58％。其中局部复发8例，肝脏复发3例，广泛复发5例；分别予以单纯伊马替尼治疗、手术加伊马替尼治疗以及伊马替尼加介入治疗，中位生存时间分别为65.5月、92.5月和48月；主动放弃治疗的1例17月后死亡。结论手术完整切除肿瘤并术后服用伊马替尼可有效改善患者预后，提高无疾病进展生存率。
목적：분석불동치료방법치료소장위장간질류（GIST）적료효급기예후。방법회고성분석2004-2013년간북경해방군총의원수치적63례소장GIST환자적림상자료。근거시부완정절제종류급술후시부복용이마체니진행분조，획수술R0절제적55례환자분위R0절제가복약조（13례）화R0절제미복약조（42례），종류미획R0절제적8례환자분위비R0절제가복약조（7례）화비R0절제미복약조（1례），비교불동치료방법환자적적생존정황。결과전조병례술후중위수방시간위24（3～120）월，1、3、5년총체생존솔분별위97％、94％화80％。R0절제가복약조、R0절제미복약조、비R0절제가복약조환자중위질병무진전생존기분별위24、24화23월；술후1년질병무진전생존솔（PFS）분별위100％、97％화83％，3년PFS분별위100％、45％화83％，5년PFS분별위100％、28％화42％，R0절제가복약조PFS명현고우기타치료조（균P＜0．05）；이비R0절제역미복약적1례환자우술후6월사망。획R0절제적55례환자16례종류복발，술후1、3、5년복발솔분별위2％、43％화58％。기중국부복발8례，간장복발3례，엄범복발5례；분별여이단순이마체니치료、수술가이마체니치료이급이마체니가개입치료，중위생존시간분별위65.5월、92.5월화48월；주동방기치료적1례17월후사망。결론수술완정절제종류병술후복용이마체니가유효개선환자예후，제고무질병진전생존솔。
Objective To analyze the efficacy and prognosis of different treatments on small intestinal gastrointestinal stromal tumors (SIGIST). Methods Clinical data of 63 patients with SIGIST who were admitted to the Chinese PLA General Hospital from January 2004 to December 2013 were analyzed retrospectively. According to resection procedure and postoperative use of imatinib, patients were divided into R0 resection plus imatinib group (13 cases), R0 resection without imatinib group (42 cases), non-R0 resection plus imatinib group (7 cases), non-R0 resection without imatinib group (1 case). Survival was compared among groups. Result All the patients were followed up with a median length of 24 months(3 to 120 months), and the over survival (OS) rates at 1-year, 3-year, 5-year were 97%, 94% and 80%. In R0 resection plus imatinib group, R0 resection without imatinib group, and non-R0 resection plus imatinib group, the progression free survival (PFS) time was 24, 24 and 23 months; the 1-year PFS were 100%, 97% and 83%; the 3-year PFS were 100%, 45% and 83%; the 5-year PFS were 100%, 28% and 42%. R0 resection plus imatinib group had significantly higher PFS (all P<0.05). The case of non-R0 resection without imatinib died 6 months after operation. Among 55 patients undergoing R0 resection, recurrence was found in 16 patients, whose recurrence rates of 1-year, 3-yeart and 5-year were 2%,43% and 58%. Local recurrence was found in 8 cases, hepatic recurrence in 3 cases and widespread recurrence in 5 cases , who received simple imatinib , operation plus imatinib and imatinib intervention, with median survival time of 66.5 months, 92.5 months and 48 months respectively. One patient initiatively abandoned treatment and died 17 months later. Conclusion The total resection and postoperative imatinib administration can improve the prognosis and raise the progression free survival of patients with small intestinal stromal tumors.