140例胃间质瘤的外科治疗分析

目的 分析位于胃的胃肠道间质瘤（GIST）外科治疗效果及其影响因素.方法 对中山大学肿瘤防治中心外科1990年1月至2008年12月间收治的140例胃GIST临床资料和病理切片（含免疫组织化学检查）重新复核并加以随访,分析手术切除效果及影响手术疗效的因素.结果全组患者1、3、5年生存率分别为96.8%、86.7%和79.3%.肿瘤完全切除组术后1、3、5年生存率分别为98.1%、90.0%和85.4%,明显优于不完全切除术组的38.1%、0和0（P＜0.05）.完全切除术组中,肿瘤局部切除组与肿瘤及所在器官联合切除组患者的生存率比较,差异无统计学意义（P＞0.05）,但这两组分别与扩大切除术组生存率比较,差异有统计学意义（P＜0.05）.完全切除术组患者的生存率与肿瘤大小、肿瘤性质、核分裂及肿瘤复发转移有关;多因素Cox回归分析显示,患者术后生存率仅与肿瘤大小、核分裂和复发转移相关（P＜0.05）.结论 胃GIST仍以外科治疗为主,原则上施行局部完全切除即可.     

Results of hepatic resection for sarcoma metastatic to liver

OBJECTIVE: To evaluate the outcome of patients with liver metastases from sarcoma who underwent hepatic resection at a single institution and were followed up prospectively. SUMMARY BACKGROUND DATA: The value of hepatic resection for metastatic sarcoma is unknown. METHODS: There were 331 patients with liver metastases from sarcoma who were admitted to Memorial Hospital from 1982 to 2000, and 56 of them underwent resection of all gross hepatic disease. Patient, tumor, and treatment variables were analyzed to assess outcome. RESULTS: Of the 56 patients who underwent complete resection, 34 (61%) had gastrointestinal stromal tumors or gastrointestinal leiomyosarcomas. Half of the patients required an hepatic lobectomy or extended lobectomy. There were no perioperative deaths in the completely resected group, although 3 of the 75 patients who underwent exploration (4%) died. The postoperative 1-, 3-, and 5-year actuarial survival rates were 88%, 50%, and 30%, respectively, with a median of 39 months. In contrast, the 5-year survival rate of patients who did not undergo complete resection was 4%. On multivariate analysis, a time interval from the primary tumor to the development of liver metastasis greater than 2 years was a significant predictor of survival after hepatectomy. CONCLUSIONS: Complete resection of liver metastases from sarcoma in selected patients is associated with prolonged survival. Hepatectomy should be considered when complete gross resection is possible, especially when the time to the development of liver metastasis exceeds 2 years.     

The effect of surgery and grade on outcome of gastrointestinal stromal tumors

HYPOTHESIS: Gastrointestinal stromal tumors (GIST) are aggressive, rare, and difficult-to-cure gastrointestinal tumors. We believe that the clinical behavior of these tumors can be predicted by reproducible prognostic factors. DESIGN AND SETTING: A retrospective review of all patients (N = 70) with GIST treated at a tertiary care center from 1973 to 1998. PATIENTS: Adequate data for evaluation were available for 69 patients. Male-female distribution was 40:29. Median age was 60 years. Median follow-up duration was 38 months. MAIN OUTCOME MEASURES: Tumor grade, stage, and histologic subtype at presentation; effect of grade, surgery and adjuvant therapy on recurrence, salvage, and survival. RESULTS: Tumor distribution included 61% in the upper, 23% in the middle, and 16% in the lower digestive tract, with a median tumor size of 7.9 cm (range, 1.8-25 cm). Tumors with more than 1 mitosis per 10 high-power fields constituted 57% of neoplasia in the series. Distant disease at initial visit occurred in 49% of patients. Complete gross resection occurred in 59% of patients. After complete resection, the 5-year survival rate was 42%, compared with 9% after incomplete resection (hazard ratio = 0.27, P<.001). Neither radiation nor chemotherapy demonstrated any significant benefit. Among 39 patients who were disease free after complete resection, 2% developed lymph node recurrence, 25% developed local recurrence, and 33% developed distant recurrences (54% liver, 20% peritoneum). By multivariate analysis the risk of local and/or distant metastases was significantly increased for tumors with more than 1 mitosis and size larger than 5 cm (P<.05). Multivariate analysis in all 69 patients revealed that incomplete resection, age greater than 50 years, non-smooth muscle histological feature, tumor with more than 1 mitosis, and tumor size larger than 5 cm significantly decreased survival. CONCLUSION: Complete gross surgical resection is presently the only means of cure for GIST. Tumors with more than 1 mitosis and a size larger than 5 cm have an especially poor prognosis, with decreased survival, and increased local and/or distant recurrence.     

Surgery and Imatinib in the Management of GIST: Emerging Approaches to Adjuvant and Neoadjuvant Therapy

Gastrointestinal stromal tumor (GIST) is a neoplasm of the gastrointestinal tract, mesentery, or omentum that expresses the protein-tyrosine kinase KIT (CD117) and is the most common mesenchymal tumor arising at these sites. Surgical resection is the first-line intervention for operable GISTs, particularly localized primary tumors, and it was historically the only effective treatment. However, more than half of all GIST patients present with locally advanced, recurrent, or metastatic disease. The 5-year survival rate ranges from 50% to 65% after complete resection of a localized primary GIST and decreases to approximately 35% for patients with advanced disease who undergo complete surgical resection. A total of 40% to 90% of all GIST surgical patients subsequently have postoperative recurrence or metastasis. Imatinib is a potent, specific inhibitor of KIT that has demonstrated significant activity and tolerability in the treatment of malignant unresectable or metastatic GIST, inducing tumor shrinkage of 50% or more or stabilizing disease in most patients. A key strategy for prolonging the survival of patients with GIST is to improve the outcome of surgery. It is possible that the adjuvant and neoadjuvant use of imatinib (e.g., rendering initially inoperable tumors resectable) in the overall management approach to advanced GIST may contribute to surgeons success in attaining this objective.     

Gastrointestinal stromal tumor (GIST)--medical rarities?

Although their overall incidence is low, GISTs are distinctive subgroup of gastrointestinal mesenchymal tumors which express CD117 or platelet derived growth factor receptor alpha (PDGFRA). Considered as rare digestive cancers, tumors like schwannomas, neurofibromas, gastrointestinal leiomiomas are now reclassified as GIST based on immunohistochemistry studies. GIST are more frequent in stomach (40-70%), small bowel (20-40%), colon (5-15%), meanwhile locations such as mesentery, omentum, retro peritoneum in less of 5%. 10 GIST patients were surgically managed during 2004-2009. 5 gastric and 5 small bowel GIST. Most with symptomatic disease: palpable tumor, abdominal pain, anemia, fatigue, superior digestive hemorrhage or occlusion. Imagistic diagnosis consisted of: barium swallow, abdominal sonography, CT and PET-CT. Confirmation was made by hystopathological exam and immunohistochemistry. All patients had more or less wide surgical resections. For some patients there was also a specific adjuvant treatment. All patients survived after surgery. The principle of surgery for GIST is RO resection of the tumor. Tumor rupture or R1 resection of the primary tumor has a negative impact on disease free survival. Some patients (great volume tumors, R1 or R2 resection) had adjuvant treatment. Imatinib mesylate and derivates showed a significant improvement of recurrence free survival with one condition: permanent treatment. Surgery remains the mainstay of treatment in patients with localized, resectable GIST. Recurrence rate of 17-21% and 5 years survival rate of 48-70%, even in resectable GIST, impose an adjuvant treatment.     

影响胃肠间质瘤完全切除术后复发转移及预后的相关生物标志物研究

目的探讨影响胃肠间质瘤（GIST）完全切除术后复发转移及预后的生物标志物。方法收集1990年1月至2008年12月中山大学肿瘤防治中心148例完全切除术后的GIST标本．利用免疫组织化学技术、以组织芯片为载体,检测Ki-67、E-cadherin、MMP7、CD44、nm23、P53、Survivin、CyclinD1、COX．2和VEGF共10个生物指标,研究其表达与GIST完全切除术后复发转移和预后的关系。结果单因素预后分析（Log-rank检验）结果显示,Ki-67、E-cadherin、MMP7、CD44、P53和Survivin与GIST术后无瘤生存有关（均P〈0．05）,Kj-67、E-cadherin、P53和Survivin与总体生存有关（均P〈0．05）。多因素预后分析（Cox回归模型）结果显示,Ki．67、CD44和P53是影响GIST完全切除术后复发转移的独立因素（均P〈0．05）;Ki-67是影响术后生存的独立因素（P〈0．05）。结论Ki．67、CD44和P53与GIST完全切除术后复发转移密切相关．Ki-67还能提示预后。     

61例直肠胃肠间质瘤临床分析

目的探讨直肠胃肠间质瘤（GIST）的临床特征和治疗及其预后因素。方法对中山大学肿瘤防治中心1990年1月至2012年10月收治的61例直肠GIST患者的临床资料和随访资料进行回顾性分析,并对病理标本进行复核;应用Kaplan。Meier法计算生存率,分别应用Log．rank检验和Cox回归模型对影响预后的因素进行单因素和多因素分析。结果61例直肠GIST患者中,男42例,女19例,中位年龄59岁。18例（29．5％）为术前活检确诊为GIST;46例首次病理诊断为GIST,另15例（24．6％,15／61;其中14例原诊断为平滑肌瘤或肉瘤,1例诊为神经鞘膜瘤）经复核病理标本后修正为GIST。肿瘤位于腹膜反折以上12例（19．7％）,反折以下49例（80．3％）。经手术治疗52例．其中扩大切除术（同时作淋巴结清扫或联合脏器切除）21例,局部切除术（肿瘤剔除或直肠壁部分切除）31例。11例术前予以伊马替尼400mg／d新辅助治疗,41例患者术后或活检诊断后以伊马替尼治疗,其中25例为术后复发姑息治疗。中位随访时间为55（6～391）月,52例手术者1、2、3和5年生存率分别为98．0％、95．6％、86．0％和73．7％;扩大切除术组5年生存率为82．6％,局部切除术组则为77．3％,两组差异无统计学意义（P=0．947）;单因素分析结果显示,生存率仅与复发转移相关（辟0．038）。多因素cox回归分析显示,各项因素均与术后生存率无关（均P〉0．05）。但术后复发及远处转移患者口服伊马替尼治疗者的3年生存率优于未服药者（82．7％比71．4％）。结论直肠GIST多见于直肠下段。外科手术仍是治疗的核心,原则上施行局部完全切除即可,广泛切除或扩大淋巴结清扫不能提高生存率。伊马替尼有助于改善复发转移患者的预后。     

伊马替尼术后辅助治疗胃肠间质瘤的多中心前瞻性临床试验中期报告

目的评价具复发转移高风险的胃肠间质瘤(GIST)患者术后予以伊马替尼(imatinib,IM)辅助治疗的安全性和疗效。方法2004年8月16日至2005年12月15日期间,国内16家医院共同参加的多中心前瞻性临床研究。选择18岁以上、肿瘤最大径在5 cm及以上、病理核分裂相在5/50个高倍视野及以上、CD117阳性、肿瘤能作完整切除的GIST患者,手术后4周内开始服用IM,每天400 mg；疗程持续12个月或以上。主要终点观察指标为术后1、3年的肿瘤复发或转移率；次要终点指标为无病生存期、总生存期、不良事件和生活质量。按方案完成12个月或以上的IM治疗,且至少有1次主要终点指标评估者归入符合方案(PP)分析,至少服用过1次研究药物者归入意向治疗(ITT)分析。结果符合入选标准者57例,其中男34例,年龄(50．6±12．2)岁；女23例,年龄(50．0±10．8)岁。肿瘤部位：胃50．9%,小肠38．6%,结直肠10．5%；全部接受根治性手术切除。归入PP分析者12例,归入ITT分析者57例。至中期报告随访期间,所有受试者均未发现肿瘤复发、转移和死亡；无病生存期ITT分析为(268．3±120．2)d,PP分析为(396．7±38．2)d；不良事件发生率44．4%。患者的生活质量与基线评估指标相比,差异无统计学意义(P＞0．05)。结论对于有高度恶性倾向的胃肠间质瘤完整切除术后患者,每天口服400 mg的IM可降低肿瘤的转移率和复发率；其不良反应是可以接受的。     

������θ�����������ζԲ߼�����

??Strategy and evaluation of diagnosis and treatment on recurrent gastrointestinal stromal tumor LIU Tong, ZHAO Zhi-cheng. Department of General Surgery, Tianjin Medical University General Hospital and Tianjin Institute of General Surgery??Tianjin 300052, China
Corresponding author: LIU Tong, E-mail: liutonga@126.com
Abstract The recurrence following complete resection of primary gastrointestinal stromal tumor (GIST) is a common clinical problem, including three types which are local recurrence in situ, peritoneal dissemination and distant organ metastases. As targeted therapy, the availability of imatinib has altered the treatment approach and improved the outcome of recurrent GIST. Accurate assessment of recurrent lesions using imaging modalities, careful understanding of patient’s medication administrating and general physical condition could be helpful for the choice of therapeutic strategy scientifically. Imatinib is the first line treatment for recurrent GIST and should be administrated continually until patient intolerant or disease progresses because of rare pathologic complete respond. Combined with targeted therapy, appropriate surgical intervention to resection of recurrent or metastatic focus can bring a survival benefit to the patients.     

胃肠间质瘤术后247例预后分析

目的探讨胃肠间质瘤（GIST）手术患者的预后影响因素。方法回顾性分析2003年1月至2012年11月青岛大学医学院附属医院收治的247例GIST术后患者的临床病理资料,采用Log．rank检验和Cox比例风险模型分别对其预后影响因素进行单因素和多因素分析。结果随访1～113（中位26）个月,26例出现复发或（和）转移,18例死亡,1、3、5年生存率分别为94％、91％和83％。单因素预后分析显示,年龄、肿瘤部位、肿瘤大小、核分裂像及肿瘤是否破裂与患者预后有关（均P〈0．01）。对于中、高风险患者,术后服用伊马替尼者5年总体生存率明显高于未服用者（85．7％比81．0％。P〈0．05）。多因素预后分析显示,肿瘤大小（P-0．030,RR=2．248,95％CI：1．081-4．677）、核分裂像（P=0．041,RR=2．220,95％C1：1．032—4．776）和肿瘤是否破裂（P=0．004,RR=5．183,95％CI：1．677—16．017）是影响术后患者预后的独立因素。结论肿瘤大小、核分裂像及肿瘤是否破裂是G1sT术后患者预后的独立影响因素：伊马替尼可改善GIST术后中、高风险患者总体生存。     

胃肠间质瘤的外科治疗及预后分析

目的探讨胃肠间质瘤（GIST）~科治疗效果及其影响因素。方法对中山大学肿瘤防治中心1990年1月至2010年2月间收治的首次进行外科治疗且能够完全切除的277例GIST患者临床资料进行回顾性分析,对其病理切片重新复核并加以随访。结果277例患者中男性176例,女性101例,年龄20～81（中位年龄57）岁;肿瘤位于结直肠28例,小肠76例,胃173例。均予以肿瘤完整切除,其中局部切除98例,肿瘤及所在器官切除64例。扩大切除术115例：3种切除方式患者术后5年生存率分别为83．5％、71．9％和61．9％,差异无统计学意义（P〉0．05）。Cox模型分析显示,肿瘤大小和复发转移是影响GIST患者预后的独立因素（P〈0．05）。结论胃肠道GIST仍以外科治疗为主．原则上施行肿瘤完全切除即可．广泛切除或扩大淋巴结清扫并不能提高生存率。     

胃肠道间质瘤肝转移的诊断和治疗

目的 探讨胃肠道间质瘤(gastrointestinal stromal tumor,GIST)肝转移的诊断和治疗.方法 回顾性分析1993年12月至2007年5月收治的16例GIST肝转移患者的临床资料.结果 14例行根治性切除术,2例行姑息性切除术.3例根治性切除术及2例姑息性切除术患者术后服用伊马替尼治疗.术后随访时间3～161个月,14例根治性切除患者中共8例复发、转移.其中7例肝转移,3例采用肝动脉栓塞治疗,1例服用伊马替尼,2例手术切除,1例未治疗;1例腹壁转移,行手术切除.本组16例患者1、3年生存率分别为92%和74%.结论 GIST肝转移术后复发率高,手术治疗GIST肝转移及术后复发、转移效果较好,联合服用伊马替尼可进一步提高患者生存率.     

217例胃肠间质瘤临床分析

目的探讨胃肠间质瘤（GIST）的临床特征、诊治及影响预后的因素。方法回顾性分析2005年1月至2010年9月华中科技大学同济医学院附属协和医院经手术治疗的217例GIST患者的临床病理资料。比较不同因素对患者预后的影响。结果217例患者中男性103例,女性114例,中位年龄55岁。除4例患者因广泛浸润未完整切除外,其余213例均行完整切除,其中35例行腹腔镜手术;48例术后EI服伊马替尼。178例（82．0％）患者获得术后随访,随访时间3。74个月。随访期间有16例（9．0％）发生术后复发和（或）转移,Logistic回归分析显示．肿瘤部位（OR=2．547,95％CI：1．466～4．424）和核分裂像（OR=6．556,95％CI：2．974。14．449）是影响根治术后复发和（或）转移的独立危险因素。随访患者中带瘤生存者5例,11例死于GIST,其中小肠GIST7例,肠道外GIST4例。Cox回归分析显示,核分裂像（RR=2．654,95％CI：1．094～6．438）与复发和（或）转移（RR=32．988,95％CI：3．879～280．529）是GIST患者的独立预后因素。结论肿瘤部位与核分裂像是影响GIST根治术后复发和（或）转移的独立因素,核分裂像与术后复发和（或）转移是影响GIST预后的独立因素。外科手术完整切除联合靶向治疗可使GIST患者获得满意疗效。     

靶向治疗高危胃肠道间质瘤的临床疗效

目的:探讨应用伊马替尼治疗高危胃肠道间质瘤(GIST)的临床疗效。方法:回顾性分析2010年1月—2015年6月收治的56例接受伊马替尼靶向治疗的高危GIST患者临床资料,并对疗效进行分析。结果:19例无手术切除机会的患者经伊马替尼(400 mg/d)治疗6~8个月后,无完全缓解(CR)者,部分缓解(PR)14例,疾病稳定(SD)4例,疾病进展(PD)1例;7例(36.8%)PR患者获得手术切除机会。35例行手术切除后服用伊马替尼(400 mg/d)1年,随访3例复发,1年复发率8.6%;2例终断服药,无法评估疗效。结论:伊马替尼治疗GIST疗效肯定,对于高危GIST患者,术前新辅助化疗能让无法手术切除的肿瘤获得手术机会,术后辅助化疗可能提高无瘤生存率,不良反应较轻能够耐受。     

27例胃肠道间质瘤外科处理分析

目的探讨不同手术方式对胃肠道间质瘤（GIST）复发及预后的影响。方法回顾性分析我科8年来收治的GIST患者临床资料,根据手术方式不同分为两组,A组为行肿瘤局部切除术者14例,B组为行肿瘤所在器官大部分切除、全切或包括淋巴结清扫的扩大切除术者12例,对两组病例进行随访,分别计算中位生存期、1年、2年和5年生存率、复发率,并对两组数据进行比较。结果A组14例中13例获得随访,中位生存时间36个月,B组12例均获得随访,中位生存时间40个月,两组比较,P〉0.05;A组1年、2年和5年生存率分别为92．3％、85．4％和69．2％,B组1年、2年和5年生存率分别为91．7％、83．3％和66．7％,两组比较,P〉0．05。说明两组手术对患者生存时间的影响无统计学意义。A组术后出现复发和转移2例,占14．3％,B组术后出现复发和转移2例,占16．7％,两组比较,P〉0．05,说明两种手术方式对复发和转移率的影响无统计学意义。结论手术切除是治疗GIST的最好方法,只要肿瘤完整切除,采用局部切除或扩大切除对术后复发和转移影响不大。     

Limited resection for duodenal gastrointestinal stromal tumors:Surgical management and clinical outcome

AIM:To analyze our experience in patients with duodenal gastrointestinal stromal tumors(GIST) and review the appropriate surgical approach.METHODS:We retrospectively reviewed the medical records of all patients with duodenal GIST surgically treated at our medical institution between 2002 and 2011.Patient files,operative reports,radiological charts and pathology were analyzed.For surgical therapy open and laparoscopic wedge resections and segmental resections were performed for limited resection(LR).For extended resection pancreatoduodenectomy was performed.Age,gender,clinical symptoms of the tumor,anatomical localization,tumor size,mitotic count,type of resection resectional status,neoadjuvant therapy,adjuvant therapy,risk classification and follow-up details were investigated in this retrospective study.RESULTS:Nine patients(5 males/4 females) with a median age of 58 years were surgically treated.The median follow-up period was 45 mo(range 6-111 mo).The initial symptom in 6 of 9 patients was gastrointestinal bleeding(67%).Tumors were found in all four parts of the duodenum,but were predominantly located in the first and second part of the duodenum with each 3 of 9 patients(33%).Two patients received neoadjuvant medical treatment with 400 mg imatinib per day for 12 wk before resection.In one patient,the GIST resection was done by pancreatoduodenectomy.The 8 LRs included a segmental resection of pars 4 of the duodenum,5 wedge resections with primary closure and a wedge resection with luminal closure by Roux-Y duodeno-jejunostomy.One of these LRs was done minimally invasive;seven were done in open fashion.The median diameter of the tumors was 54 mm(14-110 mm).Using the Fletcher classification scheme,3/9(33%) tumors had high risk,1/9(11%) had intermediate risk,4/9(44%) had low risk,and 1/9(11%) had very low risk for aggressive behaviour.Seven resections showed microscopically negative transsection margins(R0),two showed positive margins(R1).No patient developed local recurrence during follow-up.The one patient who underwent pancreatoduodenectomy died due to progressive disease with hepatic metastasis but without evidence of local recurrence.Another patient died in complete remission due to cardiac disease.Seven of the nine patients are alive disease-free.CONCLUSION:In patients with duodenal GIST,limited surgical resection with microscopically negative margins,but also with microscopically positive margins,lead to very good local and systemic disease-free survival.     

Primary gastrointestinal sarcomas: analysis of prognostic factors and results of surgical management

BACKGROUND: This study was done to review the clinical presentation, surgical management, and prognostic factors for primary gastrointestinal sarcomas. METHODS: We reviewed medical records of 55 patients who were treated for primary gastrointestinal sarcomas from 1981 through 1996. Mean follow-up time was 32 months. RESULTS: Clinical findings included gastrointestinal bleeding (51%), palpable mass (36%), and abdominal pain (33%). The stomach was the most common site of disease (53%), followed by the small intestine (33%). Tumors were high grade in 76% of patients and low-grade in 24% of patients. Complete resection of all gross disease was accomplished in 35 patients (64%), incomplete resection in 17 patients (31%), and biopsy only in 3 patients (5%). Adjacent organ resection was required in 19 patients (35%). Overall actuarial survival was 22% (median survival, 32 months). Unfavorable prognostic factors were incomplete resection, high-grade histologic features, and tumor size of 5 cm or more (P<.05). En bloc resection of contiguous organs did not adversely effect survival. In patients with complete resections, tumor grade was the most important prognostic factor (median survival, 55 months vs 19 months for low-grade vs high-grade tumors; P<.05). CONCLUSIONS: Aggressive surgical resection, including en bloc resection of locally advanced tumors, appears warranted. Despite complete resections, patients with high-grade tumors remain at risk for recurrence.     

Completely resected recurrent soft tissue sarcoma: primary anatomic site governs outcomes

BACKGROUND: We define the natural history and influence of primary anatomic site for completely resected locally recurrent soft tissue sarcoma (STS) without distant metastasis. STUDY DESIGN: We selected 290 patients having at least one local recurrence (LR) after complete resection of primary STS (all sites) between 1982 and 1999. Of these, 239 patients had complete resection of their first LR: 161 extremity-trunk and 78 retroperitoneal-head and neck-visceral-thoracic sarcomas. Study end points included second local recurrence-free survival, distant recurrence-free survival, and disease-specific survival, estimated by the Kaplan-Meier method. Univariate and multivariate analyses were performed using a log-rank test and Cox's proportional hazards model for extremity-trunk and retroperitoneal (RP; n 39) tumor sites only. RESULTS: Median followup was 82 months. Complete gross resection rates declined with each subsequent recurrence. Primary tumor site (extremity-trunk: relative risk ERR] 0.74, confidence interval [CI] 0.57 to 0.96, p = 0.03) and microscopic resection margin (negative: RR 0.80, CI 0.62 to 0.99, p 0.04) independently predicted subsequent local control. Extremity-trunk sire and high tumor grade were significant independent predictors of distant disease relapse after complete resection of LR. Site also had a notable influence on disease-specific survival: RP recurrence was associated with 1.4 times increased risk of tumor-related mortality (p = 0.02; 5-year disease-specific survival: extremity-trunk 70% versus RP 57%). High tumor grade was the most marked predictor of tumor-related mortality (RR 1.66, CI 1.28 to 2.18, p<0.001. Nine percent of extremity-trunk and 77% of RP STS-related deaths were caused by advanced LR without synchronous metastasis. CONCLUSIONS: Site governs local control, distant recurrence-free and disease-specific survival for completely resected locally recurrent sarcoma without metastasis. Distant disease relapse determines outcomes for recurrent extremity-trunk STS, and local recurrence is the determinant of tumor-related death in the RP.     

胃肠道间质瘤预后因素的临床分析

目的探讨影响胃肠道间质瘤(GIST)的预后因素。方法回顾性分析2000-2003年间41例GIST患者的免疫组织化学表达情况及肿瘤的大小、生长部位、核分裂数及手术的切除程度与该病预后的关系。结果GIST患者的病理切片中CD117、CD34和波形蛋白(vimentin)的表达比较高,分别为92.7%、82.9%和78.0%。生长在小肠的GIST比生长在胃和结直肠者预后差(P<0.05);肿瘤直径大于5cm患者的预后较小于或等于5cm的差(3年生存率为54%比72%,P<0.05);核分裂大于5/50HPF者预后较小于或等于5/50HPF者差(P<0.05);行不完全性切除手术者比行完全性切除者预后差(P<0.05)。结论完全性手术切除肿瘤能明显提高GIST患者的预后。生长在小肠的肿瘤、肿瘤直径大于5cm和核分裂大于5/50HPF是影响肿瘤预后的因素。     

山东省胃肠间质瘤多中心回顾性调查

目的探讨山东省胃肠间质瘤（GIST）手术患者的临床病理学特征、预后及其影响因素。方法回顾性收集2001年1月至2013年6月山东省4家大学的教学医院GIST手术患者的临床病理学资料,对所有病例进行病理学复核及随访,对其预后影响因素进行单因素和多因素分析。结果共收集1039例GIST病例,其中男509例,女530例,年龄18。87（中位数58）岁。术后随访时间1—150（中位数34）月,期间93例因肿瘤进展死亡,1、3、5年生存率分别为94．6％、91．7％和87．8％。R0手术患者5年总体生存率高于R1手术患者（88．8％比69．0％,P〈0．叭）。中度复发风险患者术后是否服用伊马替尼,其5年总体生存率的差异无统计学意义（94．4％比89．2％,P〉0．05）;高复发风险患者术后服用伊马替尼,其5年总体生存率明显高于未服药者（76．8％比67．7％,P〈0．05）。预后因素分析结果显示,肿瘤大小（P〈0．01,RR=1．988,95％CI：1．497—2．641）、核分裂象（P〈0．01,RR=2．326,95％CI：1．686—3．208）和肿瘤是否破裂（P〈0．01,RR=3．032,95％CI：1．732～5．308）是GIST手术患者的独立预后因素。结论肿瘤大小、核分裂象和肿瘤是否破裂是GIST术后患者预后的独立影响因素;Ro手术是原发局限性GIST首选治疗方式;伊马替尼可改善术后高复发风险患者的预后。