摘要
目的探讨十二指肠间质瘤的临床特征、诊断方法、外科治疗效果及预后的影响因素。方法回顾性分析中国医学科学院肿瘤医院1999年6月至2011年8月治疗的41例十二指肠问质瘤的临床资料。运用Kaplan．Meier法计算患者无瘤生存率及Cox比例风险回归模型分析复发的影响因素。结果十二指肠间质瘤主要集中于降部（26例，63．4％）和水平部（10例，24．4％）；最常见的症状是上消化道出血（18例，43．9％），体检发现者占29．3％（12例）；8例患者行胰十二指肠切除术，27例患者行十二指肠局部切除术；肿瘤直径为0．6-30．0cm，平均直径8．4cm。用Kaplan-Meier法计算术后1、2和5年的无瘤生存率分别为94．1％、77．5％和65．0％。Cox回归分析结果显示，核分裂象〉10个／50高倍镜视野（HP）的患者复发的危险性高于核分裂象≤10个／50HP的患者（HR=3．7，95％CI1．0-13．7，P=0．049），调整其他混杂因素的影响后，核分裂象对预后的影响更为显著（P=0．024）。未发现年龄、肿瘤大小、手术方式及恶性程度等因素与十二指肠间质瘤复发的显著性关系（均P〉0．05）。结论高核分裂象是十二指肠间质瘤复发的影响因素之一，外科根治性切除是十二指肠间质瘤首选的治疗手段。
Objective To evaluate the clinical characteristics and survival factors of patients with duodenal gastrointestinal stromal tumors （GIST）. Methods 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-Mei^r method was used to calculate the recurrence-free survival rate and the Cox proportional hazard regression model employed for the recurrence-free survival analysis. Results 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 em （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 ）. Conclusions Mitotic activity is one prognostic factor of duodenal GIST. And R0 resection should be regarded as an optional treatment for duodenal GIST.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2012年第24期1694-1697,共4页
National Medical Journal of China
关键词
胃肠道间质肿瘤
十二指肠
外科手术
预后
Gastrointestinal stromal tumors
Duodenum
Surgical procedures, operative
Prognosis
