CAJ | 학술논문

目的探讨分析胃肠道间质瘤(GIST)患者的临床和病理特征及影响预后的因素.方法回顾性分析北京协和医院2002年5月至2013年12月所有经手术治疗的GIST患者的临床及病理资料并进行随访,对其预后进行单因素及多因素分析.采用Kaplan-Meier法计算生存率,单因素预后分析采用Log-rank检验,多因素预后分析采用Cox比例风险模型.结果共收集558例GIST患者,其中男性284例,女性274例,多见于50 ～ 70岁年龄段;肿瘤原发部位最常见于胃(303例),其次为小肠(118例).R0切除517例,R1切除4例,R2或姑息切除37例.复发风险极低度102例,低度156例,中度67例,高度233例.全组病例中,495例成功随访,随访率88.7％.5年生存率为87.4％,中高度复发风险的患者中,术后服用靶向药物患者的预后明显好于未服用患者.单因素分析结果显示,年龄、肿瘤最大径、核分裂象、部位及肿瘤是否破裂是影响预后的因素;多因素分析结果显示,肿瘤最大径(P =0.01,RR=1.562,95％ CI:1.452～15.664)、肿瘤部位(P=0.01,RR=1.552,95％ CI:1.324～ 12.225)、肿瘤核分裂象(P＜0.01,RR=1.415,95％ CI:2.126～7.968)及肿瘤破裂(P =0.01,RR=1.578,95％ CI:1.543 ～ 15.892)是影响预后的独立因素.结论 R0切除联合靶向治疗是GIST的最佳治疗模式,肿瘤最大径、部位、核分裂象及肿瘤破裂是影响预后的独立因素.
목적 탐토분석위장도간질류(GIST)환자적림상화병리특정급영향예후적인소.방법 회고성분석북경협화의원2002년5월지2013년12월소유경수술치료적GIST환자적림상급병리자료병진행수방,대기예후진행단인소급다인소분석.채용Kaplan-Meier법계산생존솔,단인소예후분석채용Log-rank검험,다인소예후분석채용Cox비례풍험모형.결과 공수집558례GIST환자,기중남성284례,녀성274례,다견우50 ～ 70세년령단;종류원발부위최상견우위(303례),기차위소장(118례).R0절제517례,R1절제4례,R2혹고식절제37례.복발풍험겁저도102례,저도156례,중도67례,고도233례.전조병례중,495례성공수방,수방솔88.7％.5년생존솔위87.4％,중고도복발풍험적환자중,술후복용파향약물환자적예후명현호우미복용환자.단인소분석결과현시,년령、종류최대경、핵분렬상、부위급종류시부파렬시영향예후적인소;다인소분석결과현시,종류최대경(P =0.01,RR=1.562,95％ CI:1.452～15.664)、종류부위(P=0.01,RR=1.552,95％ CI:1.324～ 12.225)、종류핵분렬상(P＜0.01,RR=1.415,95％ CI:2.126～7.968)급종류파렬(P =0.01,RR=1.578,95％ CI:1.543 ～ 15.892)시영향예후적독립인소.결론 R0절제연합파향치료시GIST적최가치료모식,종류최대경、부위、핵분렬상급종류파렬시영향예후적독립인소.
Objective To investigate and analysis the clinical and pathological characteristic of gastrointestinal stromal tumor (GIST) patients,and to clarify the factors that effect on prognosis.Methods The clinical and pathological features and follow-up of GIST patients who received surgery in Peking Union Medical College Hospital from May 2002 to December 2013 were analyzed retrospectively.The prognosis was evaluated by univariate and multivariate analysis.Kaplan-Meier unvariate analysis and Log-rank test were used to compare the survival rates.Multivariate factors for survival were analyzed by Cox proportional hazards regression model.Results A total of 558 GIST patients were collected,including 284 males and 272 females.The high incidence was in the elderly and age of 50 to 70 years.Most of the primary tumors are located in stomach (303 cases),followed by the small intestine (118 cases).Surgical procedures included R0 resection in 517 cases,R1 resection in 4 cases,R2 or palliative resection in 37 cases.The recurrence risk was very low in 102 cases,low in 156 cases,moderate in 67 cases and high in 233 cases.Of all the patients,495 cases completed the follow-up,the follow-up rate was 88.7％.Five year survival rate was 87.4％.Patients who took targeted therapy with moderate and high risk of recurrence had a better prognosis compared with not taking the drug.Univariate analysis revealed that the factors impacting the prognosis were age,tumor size,tumor site and mitotic count.Multivariate analysis showed that tumor size (P =0.01,RR=1.562,95％ CI:1.452 to 15.664),location (P=0.01,RR =1.552,95％ CI:1.324 to 12.225),mitotic figures (P ＜ 0.01,RR =1.415,95％ CI:2.126 to 7.968) and tumor rupture (P =0.01,RR =1.578,95％ CI:1.543 to 15.892) were independent prognostic factors.Conclusion R0 resection combined with targeted therapy is the best treatment of GIST.Tumor size,location,mitosis count and tumor rupture are independent prognostic factors of GIST patients.