CAJ | 학술논문

目的：探讨山东省胃肠间质瘤（GIST）手术患者的临床病理学特征、预后及其影响因素。方法回顾性收集2001年1月至2013年6月山东省4家大学的教学医院GIST手术患者的临床病理学资料，对所有病例进行病理学复核及随访，对其预后影响因素进行单因素和多因素分析。结果共收集1039例GIST病例，其中男509例，女530例，年龄18～87（中位数58）岁。术后随访时间1～150（中位数34）月，期间93例因肿瘤进展死亡，1、3、5年生存率分别为94．6％、91．7％和87．8％。 R0手术患者5年总体生存率高于R1手术患者（88．8％比69．0％，P＜0．01）。中度复发风险患者术后是否服用伊马替尼，其5年总体生存率的差异无统计学意义（94．4％比89．2％，P＞0．05）；高复发风险患者术后服用伊马替尼，其5年总体生存率明显高于未服药者（76．8％比67．7％，P＜0．05）。预后因素分析结果显示，肿瘤大小（P＜0．01，RR＝1．988，95％CI：1．497～2．641）、核分裂象（P＜0．01，RR＝2．326，95％CI：1．686～3．208）和肿瘤是否破裂（P＜0．01，RR＝3．032，95％CI：1．732～5．308）是GIST手术患者的独立预后因素。结论肿瘤大小、核分裂象和肿瘤是否破裂是GIST术后患者预后的独立影响因素；R0手术是原发局限性GIST首选治疗方式；伊马替尼可改善术后高复发风险患者的预后。
목적：탐토산동성위장간질류（GIST）수술환자적림상병이학특정、예후급기영향인소。방법회고성수집2001년1월지2013년6월산동성4가대학적교학의원GIST수술환자적림상병이학자료，대소유병례진행병이학복핵급수방，대기예후영향인소진행단인소화다인소분석。결과공수집1039례GIST병례，기중남509례，녀530례，년령18～87（중위수58）세。술후수방시간1～150（중위수34）월，기간93례인종류진전사망，1、3、5년생존솔분별위94．6％、91．7％화87．8％。 R0수술환자5년총체생존솔고우R1수술환자（88．8％비69．0％，P＜0．01）。중도복발풍험환자술후시부복용이마체니，기5년총체생존솔적차이무통계학의의（94．4％비89．2％，P＞0．05）；고복발풍험환자술후복용이마체니，기5년총체생존솔명현고우미복약자（76．8％비67．7％，P＜0．05）。예후인소분석결과현시，종류대소（P＜0．01，RR＝1．988，95％CI：1．497～2．641）、핵분렬상（P＜0．01，RR＝2．326，95％CI：1．686～3．208）화종류시부파렬（P＜0．01，RR＝3．032，95％CI：1．732～5．308）시GIST수술환자적독립예후인소。결론종류대소、핵분렬상화종류시부파렬시GIST술후환자예후적독립영향인소；R0수술시원발국한성GIST수선치료방식；이마체니가개선술후고복발풍험환자적예후。
Objective To investigate the clinicopathological features and prognosis of patients with gastrointestinal stromal tumor (GIST) after surgery in Shandong Province. Methods Clinicopathological data of GIST patients undergoing surgery from January 2001 to June 2013 in four university teaching hospitals in Shandong Province were reviewed. Pathology results were rechecked. Patients were followed up. The prognostic factors were evaluated by univariate and multivariate analys es with Log-rank test and Cox proportional hazard model. Results A total of 1039 GIST cases were enrolled, including 509 males and 530 females, with age from 18 to 87 years (median, 58). Ninety-three patients died of GIST during follow-up. The 1-, 3-, 5-year survival rates were 94.6%, 91.7% and 87.8%, respectively. Patients undergoing R0 resection had a higher 5-year overall survival rate than those undergoing R1 resection (88.8% vs 69.0%, P<0.05). For patients with intermediate risk of recurrence after surgery, the 5-year overall survival rate was 94.4% and 89.2% respectively in imatinib and non-imatinib intervention groups (P>0.05). For patients with high risk of recurrence after surgery, the 5-year overall survival rate was 76.8% and 67.7% respectively (P<0.05). Multivariate analysis revealed that tumor size (P<0.01, RR=1.988, 95%CI:1.497-2.641), mitotic count (P<0.01,RR=2.326, 95%CI:1.686-3.208) and tumor rupture (P<0.01, RR=3.032, 95%CI:1.732-5.308) were independent prognostic factors. Conclusions Tumor size, mitotic count and tumor rupture affect the prognosis of patients after resection of primary GIST independently. The standard treatment of localized GIST is R0 resection. Adjuvant imatinib therapy can improve overall survival of patients with high risk of recurrence after surgery. The efficacy of imatinib for patients with intermediate risk of recurrence remains to be verified.