CAJ | 학술논문

目的探讨胃肠间质瘤(GIST)手术患者的预后影响因素.方法回顾性分析2003年1月至2012年11月青岛大学医学院附属医院收治的247例GIST术后患者的临床病理资料,采用Log-rank检验和Cox比例风险模型分别对其预后影响因素进行单因素和多因素分析.结果随访1～113(中位26)个月,26例出现复发或(和)转移,18例死亡,1、3、5年生存率分别为94％、91％和83％.单因素预后分析显示,年龄、肿瘤部位、肿瘤大小、核分裂像及肿瘤是否破裂与患者预后有关(均P＜0.01).对于中、高风险患者,术后服用伊马替尼者5年总体生存率明显高于未服用者(85.7％比81.0％,P＜0.05).多因素预后分析显示,肿瘤大小(P=0.030,RR=2.248,95％CI:1.081～4.677)、核分裂像(P=0.041,RR=2.220,95％CI:1.032～4.776)和肿瘤是否破裂(P=0.004,RR=5.183,95％ CI:1.677～16.017)是影响术后患者预后的独立因素.结论肿瘤大小、核分裂像及肿瘤是否破裂是GIST术后患者预后的独立影响因素;伊马替尼可改善GIST术后中、高风险患者总体生存.
목적 탐토위장간질류(GIST)수술환자적예후영향인소.방법 회고성분석2003년1월지2012년11월청도대학의학원부속의원수치적247례GIST술후환자적림상병리자료,채용Log-rank검험화Cox비례풍험모형분별대기예후영향인소진행단인소화다인소분석.결과 수방1～113(중위26)개월,26례출현복발혹(화)전이,18례사망,1、3、5년생존솔분별위94％、91％화83％.단인소예후분석현시,년령、종류부위、종류대소、핵분렬상급종류시부파렬여환자예후유관(균P＜0.01).대우중、고풍험환자,술후복용이마체니자5년총체생존솔명현고우미복용자(85.7％비81.0％,P＜0.05).다인소예후분석현시,종류대소(P=0.030,RR=2.248,95％CI:1.081～4.677)、핵분렬상(P=0.041,RR=2.220,95％CI:1.032～4.776)화종류시부파렬(P=0.004,RR=5.183,95％ CI:1.677～16.017)시영향술후환자예후적독립인소.결론 종류대소、핵분렬상급종류시부파렬시GIST술후환자예후적독립영향인소;이마체니가개선GIST술후중、고풍험환자총체생존.
Objective To study the clinicopathologic features and prognostic factors of gastrointestinal stromal tumor (GIST).Methods Clinicopathologic data of 247 patients with GIST from January 2003 to November 2012 in the Affiliated Hospital of Qingdao University Medical College,and the prognostic factors were evaluated retrospectively by univariate and multivariate analysis with Log-rank test and Cox proportional hazard model.Results Patients were followed up with a median time of 26 months(1 to 113 months).Twenty-six patients developed recurrence or metastasis,and 18 died of GIST.The 1-,3-,5-year survival rates were 94％,91％ and 83％ respectively.Univariate analysis showed that age,tumor location,tumor size,mitotic count and tumor rupture were predictive factors of survival after resection of primary GIST(all P＜0.01).For patients at intermediate and high risk to relapse,imatinib group had a higher 5-year overall survival rate than non-imatinib group (85.7％ vs.81.0％,P＜0.05).Multivariate analysis revealed that tumor size(RR=2.248,95％CI:1.081-4.677,P=0.030),mitotic count (RR=2.220,95％CI:1.032-4.776,P=0.041) and tumor rupture(RR=5.183,95％CI:1.677-16.017,P=0.004) were independent prognostic factors.Conclusions Tumor size,mitotic count and tumor rupture affect the prognosis after resection of primary GIST independently.Imatinib adjuvant therapy can improve overall survival of patients at intermediate and high risk to relapse after surgery.