CAJ | 학술논문

目的探讨原发可切除高危胃肠间质瘤(GIST)的临床特征及预后影响因素.方法回顾性分析新疆医科大学附属肿瘤医院2002年1月至2010年1 1月间收治的45例原发可切除高危GIST患者的临床病理和术后随访资料.结果 45例患者中男性18例,女性27例,中位年龄48岁.肿瘤位于胃19例,小肠9例,直肠7例,肠系膜4例,腹膜后6例.肿瘤完整切除35例(77.8％),术前或术中肿瘤破裂10例(22.2％).Ro切除33例(73.3％),R1切除5例(11.1％),R2切除7例(15.6％).术后均使用甲磺酸伊马替尼辅助治疗,中位用药时间24(10～99)月.药物不良反应发生率为100％,以水肿(86.7％,39/45)和白细胞减少(60.0％,27/45)最为常见.所有患者术后均接受了随访,中位随访时间29(11～114)月.术后复发转移率为37.8％(17/45),1、3和5年总生存率分别为100％、86.7％和74.4％.单因素和多因素预后分析显示,手术切除程度是高危GIST患者的独立预后因素(P=0.016,HR=8.698,95％CI:1.487～50.888).结论 R0切除是提高原发可切除高危GIST疗效的重要手段.
목적 탐토원발가절제고위위장간질류(GIST)적림상특정급예후영향인소.방법 회고성분석신강의과대학부속종류의원2002년1월지2010년1 1월간수치적45례원발가절제고위GIST환자적림상병리화술후수방자료.결과 45례환자중남성18례,녀성27례,중위년령48세.종류위우위19례,소장9례,직장7례,장계막4례,복막후6례.종류완정절제35례(77.8％),술전혹술중종류파렬10례(22.2％).Ro절제33례(73.3％),R1절제5례(11.1％),R2절제7례(15.6％).술후균사용갑광산이마체니보조치료,중위용약시간24(10～99)월.약물불량반응발생솔위100％,이수종(86.7％,39/45)화백세포감소(60.0％,27/45)최위상견.소유환자술후균접수료수방,중위수방시간29(11～114)월.술후복발전이솔위37.8％(17/45),1、3화5년총생존솔분별위100％、86.7％화74.4％.단인소화다인소예후분석현시,수술절제정도시고위GIST환자적독립예후인소(P=0.016,HR=8.698,95％CI:1.487～50.888).결론 R0절제시제고원발가절제고위GIST료효적중요수단.
Objective To investigate the clinical characteristics and prognosis factors of primary resectable high-risk gastrointestinal stromal tumors (GIST).Methods The clinicopathological and follow-up data of 45 patients with primary resectable high-risk gastrointestinal stromal tumors between January 2002 and November 2010 were retrospectively reviewed.Results Forty-five patients included 18 males and 27 females with a median age of 48 years(range,28-77 years).Of 45 tumors,19(42.2％) located in the stomach,9(20.0％) in the small intestine,7(15.6％) in the rectum,4 (8.9％) in the mesentery,and 6(13.3％) in the retroperitoneum.All the patients received surgical resection and 35 (77.8％) underwent complete resection,10(22.2％) underwent resection of ruptured tumors (before or during operation),33 (73.3 ％) underwent R0 resection,5 (11.1％) underwent R1 resection,and 7(15.6％) underwent R2 resection.All the patients received targeted therapy of imatinib after surgery.The median duration of imatinib was 24(10-99) months.The main side effect was noticed in all the patients,mainly including edema in 39(86.7％) patients and leukopenia in 27(60.0％) patients.The relapse rate was 37.8％(17/45).The 1-,3-,and 5-year survival rates were 100％,86.7％ and 74.4％,respectively.Univariate and multivariate analysis revealed that the degree of resection was independently associated with the prognosis of high-risk GIST patients.Conclusions Surgery is effective treatment for the GIST.Efforts to obtain R0 resection are important to improve the efficacy of primary resectable high-risk GIST.