CAJ | 학술논문

目的探讨围手术期应用伊马替尼对可切除原发中高危胃肠间质瘤(GIST)患者R0 切除率及预后的影响.方法回顾性分析2001年12月至2012年2月在北京大学肿瘤医院诊断为可切除中高危GIST、并进行手术切除加围手术期伊马替尼治疗的48例患者的临床资料,根据伊马替尼治疗方式分为新辅助治疗组(术前加术后伊马替尼治疗,15例)及辅助治疗组(术后伊马替尼治疗,33例).比较两组患者R0切除率、术后并发症发生率、无病生存率及总体生存率.结果新辅助治疗组的肿瘤最大径(11.2 cm)和平均径(9.1 cm)均明显大于辅助治疗组(7.7 cm和6.2 cm,P=0.005和P=0.014).新辅助治疗组术前治疗疾病控制率为93.3％(14/15).新辅助治疗组和辅助治疗组患者R0切除率分别为86.7％(13/15)和84.8％ (28/33) (P=1.000),手术并发症发生率分别为13.3％(2/15)和9.1％(3/33) (P=0.642).两组患者术后3年无病生存率分别为55％和41％,5年总体生存率分别为83％和75％,差异均无统计学意义(P=0.935,P=0.766).结论对于可切除的原发中高危GIST,围手术期应用伊马替尼的治疗模式具有潜在优势.
목적 탐토위수술기응용이마체니대가절제원발중고위위장간질류(GIST)환자R0 절제솔급예후적영향.방법 회고성분석2001년12월지2012년2월재북경대학종류의원진단위가절제중고위GIST、병진행수술절제가위수술기이마체니치료적48례환자적림상자료,근거이마체니치료방식분위신보조치료조(술전가술후이마체니치료,15례)급보조치료조(술후이마체니치료,33례).비교량조환자R0절제솔、술후병발증발생솔、무병생존솔급총체생존솔.결과 신보조치료조적종류최대경(11.2 cm)화평균경(9.1 cm)균명현대우보조치료조(7.7 cm화6.2 cm,P=0.005화P=0.014).신보조치료조술전치료질병공제솔위93.3％(14/15).신보조치료조화보조치료조환자R0절제솔분별위86.7％(13/15)화84.8％ (28/33) (P=1.000),수술병발증발생솔분별위13.3％(2/15)화9.1％(3/33) (P=0.642).량조환자술후3년무병생존솔분별위55％화41％,5년총체생존솔분별위83％화75％,차이균무통계학의의(P=0.935,P=0.766).결론 대우가절제적원발중고위GIST,위수술기응용이마체니적치료모식구유잠재우세.
Objective To evaluate the effect of perioperative imatinib mesylate (IM) therapy for patients with initial resectable primary local advanced gastrointestinal stromal tumor(GIST) at intermediate or high risk on R0 resection rate and the prognosis.Methods Forty-eight above GIST patients between December 2001 and February 2012 were divided into 2 groups:neoadjuvant group (15 cases,pre-and post-operation IM therapy) and adjuvant group (33 cases,post-operative IM therapy).R0 resection rate,complication rate,disease-free survival (DFS) and overall survival (OS) were analyzed and compared between the two groups.Results The maximal tumor diameter and average tumor diameter were larger in neoadjuvant group as compared to adjuvant group (11.2 cm vs.7.7 cm,P=0.005 ; 9.1 cm vs.6.2 cm,P=0.014).The response rate of preoperative IM therapy was 93.3％(14/15).The R0 resection rate was 86.7％ and 84.8％(P=1.000),and the complication rate was 13.3％ and 9.1％(P=0.642) in neoadjuvant and adjuvant group respectively.The 3-year DFS was 55％ and 41％(P=0.935),and 5-year OS was 83％ and 75％(P=0.766) in neoadjuvant and adjuvant group respectively.Conclusions Resectable primary local advanced GIST at intermediate or high risk with larger tumor diameter receiving perioperative IM therapy can achieve the same R0 resection rate,complication rate,DFS and OS as the GIST with smaller diameter receiving operation first.Perioperative IM therapy has potential advantage.