中度复发风险胃胃肠间质瘤预后因素分析

发布时间：2018-06-05 13:08

本文选题：胃肠间质瘤 + 中度复发风险　；参考：《中国实用外科杂志》2017年01期

【摘要】：目的探讨中度复发风险胃胃肠间质瘤的临床和病理学特点,研究甲磺酸伊马替尼(格列卫)术后辅助治疗对其预后的影响。方法回顾性分析2003年1月至2013年12月在复旦大学附属中山医院手术并经病理学检查诊断为中度复发风险胃胃肠间质瘤的123例病人临床和随访资料。结果 123例中,男64例,女59例。中位年龄58岁。部分(39.0%,48例)病人在体检时发现,无明显症状,出现症状者以腹痛、腹胀为主(30.1%,37例),其次为出血、贫血。中位随访58(24~150)个月,27例术后行甲磺酸伊马替尼辅助治疗者,1例出现肝转移;96例未服用甲磺酸伊马替尼者,5例出现复发或转移。6例复发转移病人,按照"WHO良恶性评估"标准,3例属恶性,3例属良性;按照"形态学良恶性评估"标准,5例属恶性,1例属交界性。服用甲磺酸伊马替尼组1、3、5年的无病生存(DFS)率分别为100.0%,95.8%,95.8%,未服用甲磺酸伊马替尼组1、3、5年的DFS分别为98.9%,97.9%,94.4%,两组DFS差异无统计学意义(P=0.760)。"WHO良恶性评估",82例良性GIST与41例恶性GIST间DFS差异无统计学意义(P=0.450)。"形态学良恶性评估",42例恶性间质瘤与81例非恶性间质瘤间DFS差异具有统计学意义(P=0.017)。结论中度复发风险胃GIST经手术R0切除后,术后复发率较低,甲磺酸伊马替尼的辅助治疗对DFS未见明显影响,当然这需要大样本量前瞻性随机对照研究进行证实;形态学指标在临床决策上有参考意义。
[Abstract]:Objective to investigate the clinical and pathological features of moderately relapsed gastric gastrointestinal stromal tumors (GISTs) and to study the effect of adjuvant therapy of imatinib mesylate on the prognosis of gastric gastrointestinal stromal tumors (GISTs). Methods from January 2003 to December 2013, 123 patients with moderate recurrence risk of gastric gastrointestinal stromal tumors (GGIST) were retrospectively analyzed. The clinical data and follow-up data of 123 patients who were operated at Zhongshan Hospital affiliated to Fudan University and diagnosed by pathological examination were analyzed. Results there were 64 males and 59 females in 123 cases. The median age is 58 years. Some 39.0% of 48 patients found that there were no obvious symptoms, the symptoms were abdominal pain, abdominal distension was 30.1%, followed by hemorrhage, anemia. A median follow-up of 58 ~ 24 ~ 150 months was carried out in 27 patients who received imatinib mesylate adjuvant therapy. One patient with hepatic metastasis was found in 96 patients without imatinib mesylate. There were 5 patients with recurrence or 6 patients with recurrence and metastasis without imatinib mesylate. According to the criteria of "WHO evaluation of benign and malignant", 3 cases were benign and 5 cases were borderline according to the criteria of "Morphologic benign and malignant Evaluation". The rates of disease-free survival (DFSs) in the imatinib mesylate group were 100.00.95. 8% and 95. 8%, respectively. The DFS of the control group was 98. 9% and 97. 9% in 5 years, respectively. There was no significant difference in DFS between the two groups (P0. 7600.82 cases of benign GIST and 41 cases of malignant GIST). There was no significant difference in DFS between the two groups. " The difference of DFS between 42 cases of malignant stromal tumors and 81 cases of non-malignant stromal tumors was statistically significant. Conclusion the recurrence rate of gastric GIST with moderate recurrence risk was lower after R0 resection. The adjuvant therapy of imatinib mesylate had no significant effect on DFS. Of course, this need to be confirmed by a large sample of prospective randomized controlled trials. Morphological indexes have reference significance in clinical decision-making.
【作者单位】：复旦大学附属中山医院普外科;复旦大学附属中山医院病理科;
【基金】：上海市科技委员会研究项目(NO.14140902302)
【分类号】：R735

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