摘要
目的分析山东省胃胃肠间质瘤（GIST）的临床病理特点及预后影响因素，以了解山东省胃GIST的诊治现状。方法收集山东省内23家三级甲等医院2001年1月至2014年12月期间手术切除并经病理证实、且完成临床病理学资料复核的1 165例胃GIST病例资料及随访信息，建立数据库，进行回顾性分析。依照美国国立卫生研究院（NIH）于2008年推荐的GIST危险度分级标准对全组病例进行危险度分级。采用Kaplan-Meier法计算患者生存率，分别采用Log-rank检验和Cox风险回归模型进行单因素和多因素预后分析。结果1 165例胃GIST患者中男性557例，女性608例，中位发病年龄60（15~89）岁。肿瘤位于胃底贲门623例（53.5%），胃体346例（29.7%），胃窦196例（16.8%）。行内镜下切除106例，局部切除术589例，胃大部切除术399例，全胃切除术72例。危险度分极：极低危256例（22.0%），低危435例（37.3%），中危251例（21.5%），高危223例（19.1%）。1 116例患者（95.8%）获得随访，随访时间1~60（中位数40）月。随访期间共有337例患者出现复发，中位复发时间为34月（1~60月）。全组患者1、3和5年生存率分别为98.6%、86.1%和73.4%，其中极低危、低危、中危和高危患者5年生存率分别为93.1%、85.8%、63.0%和42.3%，差异有统计学意义（P= 0.000）。多因素预后分析结果显示，肿瘤原发部位（RR= 0.580，95%CI：0.402~0.835）、肿瘤大小（RR= 0.450，95%CI：0.266~0.760）、术中有无肿瘤破裂（RR= 0.557，95%CI：0.336~0.924）、危险度分级（RR= 0.309，95%CI：0.164~0.580）和术后有无服用伊马替尼（RR= 1.993，95%CI：1.350~2.922）是影响胃GIST患者预后的独立因素。结论依据病灶大小选择内镜切除、局部切除、胃大部切除或全胃切除等手术方式均可取得较好的治疗效果。NIH 2008危险度分级标准对我国胃GIST患者的预后有较高的预测价值。肿瘤原�
Objective To summarize the treatment status of gastric gastrointestinal stromal tumor （GIST） in Shandong province,by analyzing the clinicopathologieal features and prognostic factors. Methods Clinicopathological and follow-up data of 1 165 patients with gastric GIST between January 2000 and December 2013 from 23 tertiary referral hospitals in Shandong Province were collected to establish a database. The risk stratification of all cases was performed according to the National Institutes of Health （NIH） criteria proposed in 2008. Kaplan-Meier method was used to calculate the survival rate. Log-rank test and Cox regression model were used for univariate and multivariate prognostic analyses. Results Among 1 165 cases of gastric GIST, 557 were male and 608 were female. The median age of onset was 60 （range 15 - 89） years. Primary tumors were located in the gastric fundus and cardia in 623 cases （53.5%）, gastric body in 346 cases （29.7%）, gastric antrum in 196 cases （16.8%）. All the cases underwent resection of tumors, including endoscopic resection （n= 106）, local resection （n=589）, subtotal gastrectomy（n=399）, and total gastrectomy（n=72）. Based on the NIH risk stratification, there were 256 cases （22.0%） at very low risk, 435 （37.3%） at low risk, 251 cases （21.5%） at intermediate risk, and 223 cases （19.1%） at high risk. A total of 1 116 cases （95.8%） were followed up and the median follow-up period was 40 （range, 1-60） months. During the period, 337 patients relapsed and the median time to recurrence was 34 （range 1-60） months. The 1-,3-, and 5-year survival rates were 98.6%, 86.1% and 73.4%, respectively. The 5-year survival rates of patients at very low, low, intermediate, and high risk were 93.1%, 85.8%, 65.0% and 42.3% respectively, with a statistically significant difference （P=0.000）. Multivariate analysis showed that primary tumor site （RR = 0.580, 95%CI： 0.402 - 0.835）, tumor size （RR= 0.450, 95%C1：0.266 - 0.760）, intraoperat
出处
《中华胃肠外科杂志》
CAS
CSCD
北大核心
2017年第9期1025-1030,共6页
Chinese Journal of Gastrointestinal Surgery
基金
山东省自然科学基金（ZR2013HL045）
山东省重点研发计划项目（2016GGB01022）
关键词
胃肠问质瘤
胃
山东省
危险度分级
外科手术
预后
Gastrointestinal stromal tumors, gastric
Shandong Province
Risk stratification
Surgical procedures
Prognosis
