高危胃肠间质瘤的临床病理特征及预后分析

目的分析高危胃肠间质瘤（GIST）临床特征及预后影响因素。 方法回顾性分析2009年8月至2016年2月乐山市人民医院收治的241例高危GIST患者临床资料，分析其临床特征及预后影响因素。 结果男女比例为1.131，年龄构成以中老年为主，40岁以上人群构成比达90.87%（219/241）。原发部位以胃和小肠为主，胃50例（20.75%），小肠121例（50.21%）。首发症状以消化道症状为主，临床表现不典型。R0切除232例（96.27%），术后复发转移率为25.31%（61/241），1、3、5年无复发生存率分别为97.23%、86.56%和75.86%，无复发生存时间为（53.12±13.08）个月。肿瘤最大径（RR=4.780，95% CI：3.716~6.052）、核分裂像（RR=5.411，95% CI：2.195~7.119）是影响高危GIST 5年无复发生存率的独立危险因素，服用靶向药物是保护因素（RR=0.504，95% CI：0.288~0.883），差异有统计学意义（P<0.001）。 结论高危GIST临床特征不明显，预后受核分裂像、肿瘤最大径和服用靶向药物影响。

Pathological characteristics and prognosis of high risk gastrointestinal stromal tumors

ObjectiveTo investigate the clinical characteristics and prognosis of high-risk gastrointestinal stromal tumors (GIST). MethodsThe clinical data of two hundred and forty-one high-risk GIST patients admitted to Leshan People’s Hospital from August 2009 to February 2016 were analyzed retrospectively. ResultsThe proportion of men and women was 1.131. The age composition was mainly middle-aged and old people, and the proportion of people over 40 years old was 90.87% (219/241). The primary sites were stomach and small intestine, with 50 cases (20.75%) in stomach and 121 cases (50.21%) in small intestine. The first symptoms were mainly gastrointestinal symptoms, and the clinical manifestations were not typical. 232 patients (96.27%) underwent R0 resection and the recurrence and metastasis rate was 25.31% (61/241). The recurrence free survival rates of 1-, 3-, 5- year were 97.23%, 86.56% and 75.86%, respectively. The recurrence free survival time was (53.12±13.08) months. The tumor maximum diameter (RR=4.780, 95% CI: 3.716-6.052), mitotic image (RR=5.411, 95% CI: 2.195-7.119) were independent risk factors for 5-year recurrence free survival of high-risk GIST, while taking targeted drugs was the protective factor (RR=0.504, 95% CI: 0.288-0.883), the differences were statistically significant (P<0.001). ConclusionThe clinical features of high-risk GIST are not obvious, and the prognosis is affected by mitotic image, the maximum diameter of the tumor and taking targeted drugs.