【作者】 万德森； 伍小军； 梁小曼； 罗容珍； 潘志忠； 周志伟； 陈功； 李力人； 卢震海； 丁培荣；

【Author】 Wan De-Sen Wu Xiao-Jun Liang Xiao-Man Luo Rong-Zhen Pan Zhi-Zhong Chen Gong Lu Zhen-Hai Ding Pei-Rong Department of Abdominal Surgery, Cancer Center, Sun Yat-sen University. State Key Laboratory of Oncology in Southern China. Guangzhou 510060, China

【机构】 中山大学肿瘤防治中心腹部外科华南肿瘤学国家重点实验室；

【摘要】 目的:分析胃肠道间质瘤(gastrointestinal stro- mal tumor,GIST)外科治疗效果及其影响因素。方法:对我院1990年1月至2006年3月治疗的153例GIST临床资料和病理切片(含免疫组织化学检查)重新复核并加以随访,着重分析手术切除的效果以及影响手术疗效的因素。所有参数均采用SPSS 13．0统计软件处理,用卡方检验和Cox回归模型分析有关影响因素,应用Kaplan—Meier限乘法计算生存率。结果:本组中位生存时间为60．0月,术后1～、3～和5～年生存率分别为94．9％、73．3％和64．3％。完全切除术组患者生存率明显优于不完全切除术组(P=0．00),后者仅2例生存超过2年。完全切除术组中,肿瘤局部切除和肿瘤及所在器官切除患者生存率之间比较,差异无显著意(P>0．05), 但肿瘤局部切除或肿瘤及所在器官切除两组分别与扩大切除术者比较,差异却有显著性意义(P<0．05)。完全切除术患者的生存率与其性别、肿瘤部位和大小、肿瘤性质、核分裂及复发转移有关,但多因素的Cox同归分析显示,术后生存率仅与肿瘤大小、肿瘤性质和复发转移相关(P<0．05)。结论 GIST仍以外科治疗为主,原则上施行局部完全切除即可,广泛切除或扩大淋巴结清扫不能提高生存率。更多还原

【Abstract】 Objective: To analyze the surgical treatment effects for patients with gastrointestinal stromal tumors (GISTs) and its influential factors. Methods: In the retrospective study, the clinical data and the tissue slices including immunohistochemical staiming of 153 patients with GISTs from 1990 to March 2006 were rechecked, and all patients were followed up carefully. More attention was paid to the surgical treatment effects and the influential factors of survival after operation. SPSS 13.0 for windows software package was used for statistical analysis. The influential factors were analyzed with Chi-squared test and Cox Regression model, survival rates with Kaplan-Meier methods. Results: The overall survival rates at 1-, 2-, 3-4-and 5-year were 94.9%. 84.8%, 73.3%, 70.5% and 64.3%, respectively. The median survival duration for patients with tumor resected completely was 66.0 months, and the 2-year survival rate was 89.4%, and 5-year 70. 9% for these patients. But the median survival duration was 23.8 months for the patients with tumor resected partly, and only two of these patients survived over 2 years. Sex, tumor sites, preoperative metastasis, tumor size, pathology type, karyokinesis and recurrence-metastasis are related with survival rates for the patients with tumor resected completely in monovariate analysis, but only tumor size, pathology type, recurrence and metastasis were related with survival rates by the Cox Regression multi-variate analysis ( P<0.05 ). Conclusion: Surgery is still the main treatment for GISTs. Local complete resection is the principal treatment. The survival cannot be improved by extensive resection and lymph nodes clearance.更多还原