中华胃肠外科杂志
中華胃腸外科雜誌
중화위장외과잡지
CHINESE JOURNAL OF GASTROINTESTINAL SURGERY
2014年
4期
335-339
,共5页
伍小军%姜武%张荣欣%丁培荣%陈功%卢震海%李力人%方淯靖%王福龙%孔令亨%林俊忠%潘志忠%万德森
伍小軍%薑武%張榮訢%丁培榮%陳功%盧震海%李力人%方淯靖%王福龍%孔令亨%林俊忠%潘誌忠%萬德森
오소군%강무%장영흔%정배영%진공%로진해%리력인%방육정%왕복룡%공령형%림준충%반지충%만덕삼
胃肠间质瘤,直肠%外科手术%伊马替尼%预后
胃腸間質瘤,直腸%外科手術%伊馬替尼%預後
위장간질류,직장%외과수술%이마체니%예후
Gastrointestinal stromal tumors,rectal%Surgical procedures%Imatinib%Prognosis
目的：探讨直肠胃肠间质瘤（GIST）的临床特征和治疗及其预后因素。方法对中山大学肿瘤防治中心1990年1月至2012年10月收治的61例直肠GIST患者的临床资料和随访资料进行回顾性分析，并对病理标本进行复核；应用Kaplan-Meier法计算生存率，分别应用Log-rank检验和Cox回归模型对影响预后的因素进行单因素和多因素分析。结果61例直肠GIST患者中，男42例，女19例，中位年龄59岁。18例（29．5％）为术前活检确诊为GIST；46例首次病理诊断为GIST，另15例（24．6％，15/61；其中14例原诊断为平滑肌瘤或肉瘤，1例诊为神经鞘膜瘤）经复核病理标本后修正为GIST。肿瘤位于腹膜反折以上12例（19．7％），反折以下49例（80．3％）。经手术治疗52例，其中扩大切除术（同时作淋巴结清扫或联合脏器切除）21例，局部切除术（肿瘤剔除或直肠壁部分切除）31例。11例术前予以伊马替尼400 mg/d新辅助治疗，41例患者术后或活检诊断后以伊马替尼治疗，其中25例为术后复发姑息治疗。中位随访时间为55（6～391）月，52例手术者1、2、3和5年生存率分别为98.0％、95．6％、86．0％和73．7％；扩大切除术组5年生存率为82．6％，局部切除术组则为77．3％，两组差异无统计学意义（P＝0．947）；单因素分析结果显示，生存率仅与复发转移相关（P＝0．038）。多因素Cox回归分析显示，各项因素均与术后生存率无关（均P＞0．05）。但术后复发及远处转移患者口服伊马替尼治疗者的3年生存率优于未服药者（82．7％比71．4％）。结论直肠GIST多见于直肠下段。外科手术仍是治疗的核心，原则上施行局部完全切除即可，广泛切除或扩大淋巴结清扫不能提高生存率。伊马替尼有助于改善复发转移患者的预后。
目的：探討直腸胃腸間質瘤（GIST）的臨床特徵和治療及其預後因素。方法對中山大學腫瘤防治中心1990年1月至2012年10月收治的61例直腸GIST患者的臨床資料和隨訪資料進行迴顧性分析，併對病理標本進行複覈；應用Kaplan-Meier法計算生存率，分彆應用Log-rank檢驗和Cox迴歸模型對影響預後的因素進行單因素和多因素分析。結果61例直腸GIST患者中，男42例，女19例，中位年齡59歲。18例（29．5％）為術前活檢確診為GIST；46例首次病理診斷為GIST，另15例（24．6％，15/61；其中14例原診斷為平滑肌瘤或肉瘤，1例診為神經鞘膜瘤）經複覈病理標本後脩正為GIST。腫瘤位于腹膜反摺以上12例（19．7％），反摺以下49例（80．3％）。經手術治療52例，其中擴大切除術（同時作淋巴結清掃或聯閤髒器切除）21例，跼部切除術（腫瘤剔除或直腸壁部分切除）31例。11例術前予以伊馬替尼400 mg/d新輔助治療，41例患者術後或活檢診斷後以伊馬替尼治療，其中25例為術後複髮姑息治療。中位隨訪時間為55（6～391）月，52例手術者1、2、3和5年生存率分彆為98.0％、95．6％、86．0％和73．7％；擴大切除術組5年生存率為82．6％，跼部切除術組則為77．3％，兩組差異無統計學意義（P＝0．947）；單因素分析結果顯示，生存率僅與複髮轉移相關（P＝0．038）。多因素Cox迴歸分析顯示，各項因素均與術後生存率無關（均P＞0．05）。但術後複髮及遠處轉移患者口服伊馬替尼治療者的3年生存率優于未服藥者（82．7％比71．4％）。結論直腸GIST多見于直腸下段。外科手術仍是治療的覈心，原則上施行跼部完全切除即可，廣汎切除或擴大淋巴結清掃不能提高生存率。伊馬替尼有助于改善複髮轉移患者的預後。
목적：탐토직장위장간질류（GIST）적림상특정화치료급기예후인소。방법대중산대학종류방치중심1990년1월지2012년10월수치적61례직장GIST환자적림상자료화수방자료진행회고성분석，병대병리표본진행복핵；응용Kaplan-Meier법계산생존솔，분별응용Log-rank검험화Cox회귀모형대영향예후적인소진행단인소화다인소분석。결과61례직장GIST환자중，남42례，녀19례，중위년령59세。18례（29．5％）위술전활검학진위GIST；46례수차병리진단위GIST，령15례（24．6％，15/61；기중14례원진단위평활기류혹육류，1례진위신경초막류）경복핵병리표본후수정위GIST。종류위우복막반절이상12례（19．7％），반절이하49례（80．3％）。경수술치료52례，기중확대절제술（동시작림파결청소혹연합장기절제）21례，국부절제술（종류척제혹직장벽부분절제）31례。11례술전여이이마체니400 mg/d신보조치료，41례환자술후혹활검진단후이이마체니치료，기중25례위술후복발고식치료。중위수방시간위55（6～391）월，52례수술자1、2、3화5년생존솔분별위98.0％、95．6％、86．0％화73．7％；확대절제술조5년생존솔위82．6％，국부절제술조칙위77．3％，량조차이무통계학의의（P＝0．947）；단인소분석결과현시，생존솔부여복발전이상관（P＝0．038）。다인소Cox회귀분석현시，각항인소균여술후생존솔무관（균P＞0．05）。단술후복발급원처전이환자구복이마체니치료자적3년생존솔우우미복약자（82．7％비71．4％）。결론직장GIST다견우직장하단。외과수술잉시치료적핵심，원칙상시행국부완전절제즉가，엄범절제혹확대림파결청소불능제고생존솔。이마체니유조우개선복발전이환자적예후。
Objective To explore the clinicopathological characteristics, efficacy, and prognostic factors for patients with rectal gastrointestinal stromal tumor (GIST). Methods Clinicopathological and follow-up data of 61 patients with rectal GIST in our department from January 1990 to Oc tober 2012 were analyzed retrospectively and pathology specimens were reviewed. Kaplan-Meier method was used to calculate the survival. Univariate analysis and multivariate analysis were performed to investigate the influencing factors of prognosis with Log-rank test and Cox regression model. Results There were 42 male and 19 female patients with a median age of 59 years old. Eighteen cases (29.5%) were confirmed preoperatively as GIST by biopsy and 46 cases were diagnosed as GIST by first pathological examination. Fifteen cases (24.6%) were revised as GIST after re-examination of specimes among whom 14 cases had been diagnosed as leiomyoma or sarcoma, and 1 as neurolemmoma. Tumor location was above peritoneal reflection in 12 cases (19.7%) and below peritoneal reflection in 49 (80.3%). Fifty-two patients underwent surgery, including 21 extended resections(lymph nodes clearance and combined organs resection simultaneously) and 31 local resections (tumor rejection or partial resection of rectal wall). Eleven patients received preoperative imatinib(400 mg/d). Forty-one cases received imatinib therapy after operation or biopsy diagnosis, including 25 cases who received palliative treatment for postoperative recurrence. Median follow-up time was 55 (6 to 391) months and follow-up longer than 2 years was carried out in 46 patients. Overall survival rates of 1-, 2-, 3-, 5-year were 98%, 95.6%, 86.0%and 73.7%respectively. There were no significant differences between local resection group (96.4%, 92%, 83.3%and 77.3%) and extended resection group (100%, 94.7%, 89.50%and 82.6%) (χ2=0.004, P=0.947). Univariate analysis showed that survival was only associated with recurrence and metastasis (χ2=4.292, P=0.038). Multivariate Cox analysis showed postoperative survival was not associated with any factors (all P>0.05). The 3-year survival rate of patients with postoperative recurrence or metastasis receiving imatinib therapy was better as compared to those who did not received imatinib (82.7%vs. 71.4%). Conclusions Rectal GIST are more common in the lower rectum. Surgery is the main treatment for rectal GIST. Local complete resection is the mainstay treatment. Extensive resection and lymph node clearance may not improve survival. Imatinib can improve the prognosis of patients with recurrence or metastasis.
