摘要
目的探讨中危胃间质瘤的预后影响因素和术后伊马替尼辅助治疗的疗效。方法回顾性分析2005年1月至2016年12月间华中科技大学同济医学院附属协和医院经外科手术治疗的93例中危胃间质瘤患者的临床病理及随访资料,对其预后因素进行单因素和多因素分析,并根据多因素分析结果进行亚组分析伊马替尼辅助治疗的疗效。结果本组93例中危胃间质瘤患者均取得完整切除,术后42例患者(45%)接受伊马替尼辅助治疗,中位辅助治疗时间为12(6~72)个月。80例患者(86%)获得有效随访,中位随访时间为46(6~120)个月,全组1、3、5年总体无复发生存率分别为100%、91.5%、88.5%。多因素分析结果显示,核分裂象(P=0.040,RR=6.078,95%CI:0.541~68.274)和中性粒细胞淋巴细胞比值(P=0.036,RR=6.102,95%CI:0.782~47.632)是影响本组中危胃间质瘤患者无复发生存率的独立因素。对于核分裂象>2/50HPF且中性粒细胞淋巴细胞比值>2.3的中危胃间质瘤患者,服用伊马替尼辅助治疗可显著提高无复发生存率,改善预后。结论核分裂象和中性粒细胞淋巴细胞比值是影响中危胃间质瘤患者预后的独立因素。对核分裂象>2/50HPF且中性粒细胞淋巴细胞比值>2.3的中危胃间质瘤患者需强调术后伊马替尼的辅助治疗。
Objective To explore the clinical prognosis and efficacy of adjuvant therapy with imatinib of postoperative patients with gastric intermediate-risk gastrointestinal stromal tumor (GIST). Methods The clinicopathological data and follow-up data of 93 gastric intermediate-risk GIST cases from Jan 2005 to Dec 2016 at Union Hospital were analyzed retrospectively.Univariate and multivariate analysis were performed to assess the prognostic factors. Results There were 93 patients undergoing complete GIST resection with 42(45%) cases receiving post-op imatinib 400 mg/d for targeted therapy.The median target therapy period was 12(6-72) months.86% (80 cases) patients were followed up for 46(6-120) months.The 1-,3-,5-year recurrence-free survival rate (RFS) of the whole group were 100%,91.5%,88.5% respectively.Multivariate analysis revealed that mitotic count (P=0.040,RR=6.078,95%CI: 0.541-68.274) and neutrophil-lymphocyte ratio (NLR) (P=0.036,RR=6.102,95%CI: 0.782-47.632) were prognostic risk factors of RFS.For those mitotic count >2/50 HPF and NLR>2.3,adjuvant therapy with imatinib significantly increases RFS. Conclusion Mitotic count and NLR were independent risk factors of RFS in gastric intermediate-risk GIST.For those with mitotic count >2/50 HPF and NLR>2.3,postoperative adjuvant therapy with imatinib helps improve the prognosis.
作者
张鹏
曾祥宇
王心吉
吴秀丽
李燕
万文泽
王涛
蔡明
高金波
帅晓明
王国斌
陶凯雄
Zhang Peng;Zeng Xiangyu;Wang Xinji;Wu Xiuli;Li Yan;Wan Wenze;Wang Tao;Cai Ming;Gao Jinbo;Shuai Xiaoming;Wang Guobin;Tao Kaixiong(Department of Gastrointestinal Surgery,Union Hospital,Tongi Medical College,Huazhong University of Science and Technology,Wuhan 430022,China;Department of Pathology,Union Hospital,Tongi Medical College,Huazhong University of Science and Technology,Wuhan 430022,China)
出处
《中华普通外科杂志》
CSCD
北大核心
2019年第1期1-4,共4页
Chinese Journal of General Surgery
基金
国家自然科学基金(81572413、81702386).
关键词
胃肠道间质肿瘤
肿瘤辅助疗法
预后
伊马替尼
Gastrointestinal stromal tumors
Neoadjuvant therapy
Prognosis
Imatinib
