Lei Cheng, Liu Lin, Wang Qisan, Wang Haijiang
Department of Gastrointestinal Surgery, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi 830011, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2016 Nov 25;19(11):1300-1304.
To investigate the treatment methods and prognostic factors of high-risk gastrointestinal stromal tumor (GIST).
Clinicopathological date and follow-up data of 108 patients with high-risk GIST from January 2002 to February 2016 treated at our department were retrospectively reviewed. The patients were divided into two groups according to whether they received adjuvant therapy after surgery. A group of patients received imatinib adjuvant therapy(adjuvant therapy group, 69 cases). Another group of patients were not treated with imatinib until they were found to have disease progression(follow-up observation group, 39 cases). The survival rate and recurrence rate were compared between two groups, and the risk factors of prognosis were analyzed by Cox regression model.
All the cases were followed up with a median time of 48 months(1 to 161 months). Recurrence and / or metastasis occurred in 57(52.8%) patients during follow-up. The postoperative recurrence and / or metastasis rate was 34.8%(24/69) and 84.6%(33/39) respectively in the adjuvant therapy group and the follow-up observation group, the difference was statistically significant(P=0.000). Twenty-eight(25.9%) patients died. The 1-, 3-, 5-, 10-year survival rates of the 108 patients undergoing follow-up were estimated to be 99.8%, 87.7%, 76.0% and 42.7% respectively. The 5-year survival rates were 79.3% and 72.3% in the adjuvant therapy group and the follow-up observation group, the difference was not statistically significant (P=0.648). Univariate analysis showed that mitotic count, radical degree and tumor rupture were predictive factors of survival after resection of primary high-risk GIST (all P<0.05). Multivariate analysis using Cox regression model revealed that the mitotic count (P=0.013, RR=2.400, 95%CI:1.206 to 4.779) and radical degree(P=0.003, RR=3.968, 95%CI:1.609 to 9.784) were independent prognostic factors.
Comprehensive treatment of radical surgery combined with targeted therapy and close followed up can lead to better long-term survival of high-risk patients with GIST.
探讨高危胃肠道间质瘤（GIST）的治疗方法及预后因素。
回顾性分析2002年1月至2016年2月在我科治疗的108例高危GIST患者的临床病理资料及随访数据。根据患者术后是否接受辅助治疗分为两组。一组患者接受伊马替尼辅助治疗（辅助治疗组，69例）。另一组患者在发现疾病进展前未接受伊马替尼治疗（随访观察组，39例）。比较两组的生存率和复发率，并采用Cox回归模型分析预后的危险因素。
所有病例均获随访，中位随访时间48个月（1至161个月）。随访期间57例（52.8%）患者出现复发和/或转移。辅助治疗组和随访观察组术后复发和/或转移率分别为34.8%（24/69）和84.6%（33/39），差异有统计学意义（P = 0.000）。28例（25.9%）患者死亡。108例接受随访患者的1、3、5、10年生存率分别估计为99.8%、87.7%、76.0%和42.7%。辅助治疗组和随访观察组的5年生存率分别为79.3%和72.3%，差异无统计学意义（P = 0.648）。单因素分析显示，核分裂象计数、根治程度和肿瘤破裂是原发性高危GIST切除术后生存的预测因素（均P < 第5页共5页0.05）。采用Cox回归模型进行多因素分析显示，核分裂象计数（P = 0.013，RR = 2.400，95%CI：1.206至4.779）和根治程度（P = 0.003，RR = 3.968，95%CI：1.609至9.784）是独立的预后因素。
根治性手术联合靶向治疗及密切随访的综合治疗可使高危GIST患者获得较好的长期生存。
