Xie Yi-bin, DU Jia, Li Qian, Zhao Dong-bing, Wang Cheng-feng, Cai Jian-qiang, Dai Min, Zhao Ping
Department of Abdominal Surgical Oncology, Cancer Hospital & Institute, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100021, China.
Zhonghua Yi Xue Za Zhi. 2012 Jun 26;92(24):1694-7.
To evaluate the clinical characteristics and survival factors of patients with duodenal gastrointestinal stromal tumors (GIST).
The clinical data of 41 patients with duodenal GIST were analyzed retrospectively at Cancer Hospital and Institute, Chinese Academy of Medical Sciences from June 1996 to August 2011. Kaplan-Meier method was used to calculate the recurrence-free survival rate and the Cox proportional hazard regression model employed for the recurrence-free survival analysis.
The lesions of duodenal GIST were predominantly located in the descending (n = 26, 63.4%) and transverse portions (n = 10, 24.4%). Most duodenal GIST presented commonly with upper gastrointestinal bleeding (n = 18, 43.9%) and 12 cases (29.3%) were incidentally detected by physical examinations. Eight patients underwent pancreatoduodenectomy and 27 limited resection. The tumor size varied from 0.6 cm to 30.0 cm (mean: 8.4 cm). The recurrence-free survival rates analyzed by Kaplan-Meier method at 1, 2 and 5-year were 94.1%, 77.5% and 65.0% respectively. The results of Cox proportional hazards regression model indicated that the patients with >10/50 HP mitotic count showed a worse recurrence-free survival than those with ≤ 10/50 HP (HR = 3.7, 95%CI 1.0 - 13.7, P = 0.049). After adjusting other confounding factors, mitotic activity was one significant prognostic factor of recurrence (P = 0.024). There was no significant association between the risk of recurrence and other prognostic factors, including diagnostic age, tumor size, type of operation and the risk of aggressive behaviors (all P > 0.05).
Mitotic activity is one prognostic factor of duodenal GIST. And R(0) resection should be regarded as an optional treatment for duodenal GIST.
评估十二指肠胃肠道间质瘤（GIST）患者的临床特征及生存因素。
回顾性分析1996年6月至2011年8月在中国医学科学院肿瘤医院收治的41例十二指肠GIST患者的临床资料。采用Kaplan-Meier法计算无复发生存率，并用Cox比例风险回归模型进行无复发生存分析。
十二指肠GIST病变主要位于降部（n = 26，63.4%）和横部（n = 10，24.4%）。多数十二指肠GIST常见表现为上消化道出血（n = 18，43.9%），12例（29.3%）通过体检偶然发现。8例行胰十二指肠切除术，27例行局限性切除术。肿瘤大小为0.6 cm至30.0 cm（平均：8.4 cm）。采用Kaplan-Meier法分析的1年、2年和5年无复发生存率分别为94.1%、77.5%和65.0%。Cox比例风险回归模型结果显示，核分裂象计数>10/50 HP的患者无复发生存情况比≤10/50 HP的患者差（HR = 3.7，95%CI 1.0 - 13.7，P = 0.049）。调整其他混杂因素后，核分裂象活性是复发的一个重要预后因素（P = 0.024）。复发风险与其他预后因素之间无显著相关性，包括诊断年龄、肿瘤大小、手术类型及侵袭性行为风险（均P > 0.05）。
核分裂象活性是十二指肠GIST的一个预后因素。R(0)切除应被视为十二指肠GIST的一种可选治疗方法。
