【作者】 李勇； 范立侨； 辛海松； 赵群； 王力利； 王冬； 刘羽； 贾楠； 李兆星；

【Author】 LI Yong;FAN Li-qiao;XIN Hai-song;ZHAO Qun;WANG Li-li;WANG Dong;LIU Yu;JIA Nan;LI Zhao-xing;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】 目的探讨影响原发胃肠道间质瘤预后的相关风险因素。方法回顾性分析2003年9月~2013年6月于河北医科大学第四医院收治的389例胃肠道间质瘤患者的临床资料,对患者预后情况进行随访。评价预后情况采用复发转移率及术后生存率。采用单因素分析筛选出影响术后复发转移的相关因素,再纳入非条件logistic回归模型进行多因素分析。采用Log Rank检验筛选出影响术后生存率的相关因素,再纳入COX比例风险模型进行多因素分析,寻找影响术后生存率的独立因素。并对影响患者预后的因素进一步做Kaplan-Mei er生存分析。结果肿瘤的部位、直径、核分裂象、NIH分级、侵及周围脏器或组织、破裂情况、手术根治度、甲磺酸伊马替尼治疗和术后复发转移相关(P<0.05)。性别、年龄、既往肿瘤史、淋巴结清扫与术后复发转移不相关(P>0.05)。非条件logistic回归模型示:直径(P=0.000,OR=1.864,95%CI:1.320~2.631)、核分裂象(P=0.034,OR=1.567,95%CI:1.035~2.370)、NIH分级(P=0.000,OR=2.982,95%CI:1.917~4.637)、根治度(P=0.035,OR=3.268,95%CI:1.087~9.827)、甲磺酸伊马替尼治疗(P=0.008,OR=0.497,95%CI:0.296~0.835)是影响GIST术后复发转移的独立影响因素。肿瘤的部位、直径、核分裂象、NIH分级、侵及周围脏器或组织、破裂情况、手术根治度、甲磺酸伊马替尼治疗和术后生存相关(P<0.05)。性别、年龄、既往肿瘤史、淋巴结清扫和术后生存不相关(P>0.05)。COX风险回归模型示:核分裂象(P=0.013,OR=1.972,95%CI:1.151~3.379)、NIH分级(P=0.000,OR=2.478,95%CI:1.771~4.264)、根治度(P=0.000,OR=4.227,95%CI:2.314~7.720)、甲磺酸伊马替尼治疗(P=0.002,OR=0.475,95%CI:0.298~0.757)是影响GIST术后生存的独立影响因素。结论肿瘤部位、直径、核分裂象、NIH分级、侵及周围脏器或组织、破裂情况、手术根治度、甲磺酸伊马替尼治疗和预后相关,其中肿瘤直径、核分裂象、NIH分级、根治度、甲磺酸伊马替尼治疗是影响术后复发转移的独立因素,核分裂象、NIH分级、根治度、甲磺酸伊马替尼治疗是影响术后生存的独立因素。手术完整切除仍然是有效的治疗方法,中高危患者术后服用甲磺酸伊马替尼可以降低术后复发转移率,改善患者预后。更多还原

【Abstract】 Objective:to disscuss the prognostic factors of GIST.Method:The clinical date of 389 cases of GIST admitted between September 2003 and June 2013 in Fourth Hospital Of Hebei Medicial University was retrospectively analyzed.Univariate analysis and unconditional logistic regression analysis were used to evaluate the factors of recurrence or metastasis after surgery.Kaplan-meier survival rate curve and cox regression model were used to explore the factors of survival rate.Results:Tumor location,size,mitosis,risk classification,invading the surrounding tissue,tumor rupture,surgical procedure,imatinib treatment were analyzed respectively,the difference is statistical significance with recurrence or metastasis(P<0.05).No significant difference between the group of sex,age,tumor history,lymph node dissection or not(P>0.05).Unconditional logistic regression analysis showed that tumor size(P=0.000,OR=1.864,95%CI:1.320-2.631),mitosis(P=0.034,OR=1.567,95%CI:1.035~2.370),risk classification(P=0.000,OR=2.982,95%CI:1.917~4.637) surgical procedure(P=0.035,OR=3.268,95%CI:1.087~9.827),imatinib treatment(P=0.008,OR=0.497,95%CI:0.296~0.835) were independent factors of recurrence or metastasis.Tumor location,size,mitosis,risk classification,invading the surrounding tissue,tumor rupture,surgical procedure,imatinib treatment were analyzed respectively,the difference is statistical significance with survival rate(P<0.05).No significant difference between the group of sex,age,tumor history lymph node dissection or not(P>0.05).Cox regression analysis demonstrated mitosis(P=0.013,OR=1.972,95%CI:1.151~3.379),risk classification(P=0.000,OR=2.748,95%CI:1.771~4.264),surgical procedure(P=0.000,OR=4.227,95%CI:2.314~7.720) imatinibtreatment(P=0.002,OR=0.475,95%CI:0.298~0.757) were independent factors with survival rate.Conclusion:Tumor location,size,mitosis,risk classification,invading the surrounding tissue,tumor rupture,surgical procedure,imatinib treatment could influence on prognosis of gastrointestinal stromal tumor.Tumor size,mitosis,risk classification,surgical procedure,imatinib treatment were independent factors of recurrence or metastasis.Tumor mitosis,risk classification,surgical procedure,imatinib treatment were independent factors of survival rate.Surgical resection is the main method for the treatment of primary GIST.Taking imatinib after surgery could improve the prognosis for patients with gastrointestinal stromal tumors.更多还原