【作者】 李勇； 赵群； 吴海丰； 范立侨； 王力利； 焦志凯； 张志栋； 刘庆伟；

【Author】 LI Yong;ZHAO Qun;WU Hai-feng;FAN Li-qiao;WANG Li-li;JIAO Zhi-kai;ZHANG Zhi-dong;LIU Qing-wei;Department of General Surgery,the Fourth Affiliated Hospital,Hebei Medical University;

【机构】 河北医科大学第四医院外三科；

【摘要】 目的:探讨转移复发胃肠道间质瘤治疗及预后相关因素方法:回顾分析2003年6月至2013年6月在河北医科大学第四医院门诊及住院病人经病理及免疫组化检查确诊复发转移的胃肠道间质瘤142例的临床及随访资料。结果:全组患者初次行手术139例,未行手术的3例。其中94例患者服用格列卫,包括进展(含死亡)的12例,稳定(SD)22例,缓解(包括部分缓解(CR)和完全缓解(DR))60例,客观有效率(CR+DR)63.83%,总获益率87.23%。1-3-5-7-10年无瘤生存率(PFS)分别是45.8%,18.3%,2.8%,1.4%,0.00%。1-3-5-7-10生存率分别为:89.3%,66.9%,53.8%,53.8%,53.8%。单因素分析显示:肿瘤原发部位(P=0.008)肿瘤直径(P=0.014)。核分裂像数(P=0.030)。局部复发与远处转移(P=0.049),远处转移部位(P=0.021)以及转移复发后不同治疗中手术联合靶向药物伊马替尼治疗(P=0.000)与患者的预后有关。多因素分析显示:核分裂像数(P=0.005)、转移复发后的治疗(P=0.000)是影响转移复发间质瘤预后的独立因素。结论:肿瘤直径越小、肿瘤原发部位位于小肠、核分裂像数越少、局部复发,单纯肝脏转移及转移复发后手术联合靶向药物伊马替尼治疗者预后较好。手术联合靶向药物的综合治疗是目前治疗转移复发间质瘤的最佳方式。更多还原

【Abstract】 Objective To investigate treatment and prognostic factors metastasis and recurrence of gastrointestinal stromal tumor.Methods:The clinicopathological data of 142 patients with metastasis and recurrence of GIST.which are diagnosed by pathology and immunohistochemistry,admitted to the Fourth Hospital of Hebei Medical University between June 2003 and June 2013 were retrospectively analyzed and the prognostic factors were evaluated.Results:All patients of 139 cases of primary surgical treatment,3 patients did not undergo surgery.94 patients taking Gleevec,including progress(including death) of the 12 cases,stable(SD) 22 cases,60 cases of remission(including partial remission(CR) and complete response(DR)),objective response rate(CR + DR) was 63.83%,and the total benefit rate was87.23%.1-3-5-7-10-year disease-free survival(PFS) were 45.8%,18.3%,2.8%,1.4%,0.00%.1-3-5-7-10 survival rates were:89.3%,66.9%,53.8%,53.8%,53.8%.Univariate analysis revealed that:primary tumor site(P = 0.008) tumor size(P = 0.014),mitotic count(P = 0.030).,local recurrence and distant metastasis(P = 0.049),distant metastases(P = 0.021) and the different treatment of metastatic recurrence after surgery combined with targeted drug imatinib(P = 0.000)was associated with prognosis.Multivariate analysis revealed that:mitotic count(P = 0.005),the treatment of metastasis and recurrence(P = 0.000) were independent factors affecting the stromal tumor recurrence and metastasis prognosis.Conclusions:They that the smaller tumor size,primary tumor site located in the small intestine,the fewer mitotic count,local recurrence,simple liver metastasis and surgical therapy combined with targeted drug will are better prognosis.Surgical therapy combined with targeted drug treatment model is the best way that the treatment of metastatic recurrence of GIST.更多还原