【摘要】 目的 探讨术前血清丙氨酸氨基转移酶（alanine aminotransferase, ALT）与天门冬氨酸氨基转移酶（aspartate aminotransferase, AST）比值(LSR)对老年胃肠道间质瘤(gastrointestinal stromal tumor, GIST)肝转移患者预后的影响。方法 选取2010年1月～2016年5月在湖北省汉川市人民医院治疗的189例老年GIST肝转移患者的临床资料进行回顾性分析。分析其临床病理特征及与生存预后的关系。根据ROC曲线得到LSR最佳截点为1.39，根据此截点将患者分为LSR<1.39组(n=132)和LSR≥1.39组(n=57)，比较各组患者的生存率，用Kaplan-Meier法进行生存分析，并进行COX单因素和多因素分析。结果 所有患者随访期为8～68个月，中位数21.3个月。所有患者1年、3年和5年生存率（OS）分别为89.95%,71.43%和50.26%。LSR<1.39组1年、3年和5年OS分别为93.18%,77.27%和56.82%,LSR≥1.39组1年，3年和5年OS分别为82.46%,57.89%和35.09%。两组间1年、3年和5年OS差异均有统计学意义(χ~2=5.065,7.325,7.520，均P <0.05)。LSR<1.39组与LSR≥1.39组患者的肿瘤大小、核分裂数、淋巴结转移及NIH危险度分级差异均有统计学意义(χ~2=5.011～15.452，均P <0.05)，性别及肿瘤位置差异无统计学意义(χ~2=0.268, 0.611,均P>0.05)。COX单因素分析结果显示，肿瘤位置(OR=1.514,95%CI:1.081～2.121,P=0.016)，肿瘤大小(OR=2.201,95%CI:1.373～3.530,P=0.001)，核分裂数(OR=1.505,95%CI:1.117～2.028,P=0.007)，淋巴结转移(OR=1.744,95%CI:1.338～2.272,P=0.000),NIH危险度分级(OR=2.678,95%CI:2.146～3.342,P=0.000)和LSR(OR=2.344,95%CI:1.839～2.989,P=0.000)是老年GIST肝转移患者预后的影响因素；COX多因素分析结果显示，肿瘤大小(OR=1.610,95%CI:1.209～2.143,P=0.001)，淋巴结转移(OR=1.564,95%CI:1.181～2.069,P=0.002),NIH危险度分级(OR=2.565,95%CI:2.072～3.176,P=0.000)和LSR(OR=2.206,95%CI:1720～2.829,P=0.000)是老年GIST肝转移患者预后的独立影响因素(P<0.05)。结论 术前LSR是老年GIST肝转移患者预后的独立危险因素。更多还原

【Abstract】 Objective To investigate the effect of preoperative serum alanine aminotransferase(ALT) and aspartate aminotransferase(AST) ratio(LSR) on liver metastasis prognosis in elderly gastrointestinal stroma(GIST) patients. Methods The clinical data of 189 elderly patients with GIST liver metastasis treated from January 2010 to May 2016 in Hanchuan City People’s Hospital of Hubei Province were selected for retrospective analysis. Clinicopathological characteristics and their relationship with survival prognosis were analyzed. The best LSR from ROC curve was 1.39, which divided patients into LSR <1.39(n=132) and LSR ≥ 1.39(n=57). Survival rate was compared in each groups. Survival analysis was performed by KaplanMeier and COX single and multifactor analysis. Results All patient follow-up period was 8～68 months, with a median of 21.3 months. All patients were 1-year OS 89.95%(170/189), 3-year OS 71.43%(135/189), and 5-year OS 50.26%(95/189). In LSR<1.39 group 1-year, 3-year and 5-year OS were 93.18%, 77.27% and 56.82% respectively. In LSR ≥ 1.39 group 1-year, 3-year and 5-year OS were 82.46%, 57.89% and 35.09%, respectively. The 1-year, 3-year and 5-year OS differences between the two groups had statistical significance(t=5.065, 7.325, 7.520, all P<0.05). Tumor size, nuclear division, lymph node metastasis, and NIH risk classification had statistical significance in LSR<1.39 and LSR ≥ 1.39(χ~2=5.011 ～15.452, all P<0.05),gender and tumor location differences had no statistical significance(χ~2=0.268, 0.611, all P>0.05). The results of COX singlefactor analysis showed that tumor location(OR=1.514,95%CI:1.081～2.121,P=0.016), tumor size(OR=2.201,95%CI:1.373～3.530,P=0.001), nuclear division number(OR=1.505,95%CI:1.117～2.028,P=0.007), lymph node metastasis(OR=1.744, 95%CI:1.338～2.272, P=0.000), NIH risk classification(OR=2.678, 95%CI:2.146～3.342, P=0.000) and LSR(OR=2.344, 95%CI:1.839～2.989, P=0.000) were the infuencing factors affecting the prognosis of elderly patients with GIST liver metastasis(all P<0.05). The results of COX multi-factor analysis showed that tumor size(OR=1.610, 95%CI:1.209～2.143, P=0.001), lymph node metastasis(OR=1.564, 95%CI:1.181～2.069, P=0.002), NIH risk classification(OR=2.565, 95%CI: 2.072～3.176, P=0.000) and LSR(OR=2.206, 95%CI:1720～2.829, P=0.000) were the independent influencing factors for the prognosis in elderly patients with GIST liver metastasis(all P<0.05). Conclusion LSR is an independent risk factor for elderly patients with GIST liver metastasis, and suggests that their liver function should be improved to improve their prognosis and prolong survival.更多还原