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。     

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.     

胃肠道间质瘤的外科治疗

目的 分析胃肠道间质瘤(gastrointestinal stromal tumor，GIST)外科治疗效果以及影响手术疗效的因素。方法 对我院1990年1月至2003年5月外科治疗的97例GIST。患的临床资料和病理切片(含免疫组织化学检查)重新复核并对患进行随访。结果 本组中位生存时间为57．3个月。完全切除术组患生存率明显优于不完全切除术组(P=0．00)，后无1例生存期超过2年。完全切除术组中．肿瘤局部切除和肿瘤及所在器官切除患生存率之间比较，差异无显性意义(P=0．2795)；但肿瘤局部切除和肿瘤及所在器官切除两组分别与扩大切除术组比较。差异却有显性意义(P=0．00)。完全切除术患的生存率与其性别、肿瘤部位和大小、肿瘤性质、核分裂及复发转移有关；但多因素的Cox回归分析显示，其术后生存率仅与肿瘤大小、肿瘤性质和复发转移相关。结论 GIST以外科治疗为主，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其生存率。     

40例直肠胃肠间质瘤的预后分析

目的探讨直肠胃肠间质瘤（GIST）的预后特点。方法对新疆医科大学附属中医医院和天津市人民医院1979年6月至2010年6月间收治的40例直肠GIST患者的临床和随访资料进行回顾性分析。结果40例直肠GIST中男性23例,女性17例,年龄28～81（中位数54．5）岁。术后随访1～300（中位52．5）个月,复发和转移18例,其中单纯局部复发7例,单纯远处转移6例,局部复发并远处转移5例。术后1、3及5年生存率分别为82．5％、60．0％及42．5％。单因素预后分析显示。患者术后生存率与肿瘤大小（P〈0．01）、肿瘤Fletcher分级（P〈0．01）、核分裂像（P〈0．01）及术后远处转移（P〈0．05）有关;多因素预后分析显示,肿瘤大小（P〈0．05）、核分裂像（P〈0．01）和术后远处转移fP〈0．01）是直肠GIST的独立预后因素。结论直肠GIST治疗仍以手术切除为主,肿瘤原发灶大小、核分裂像和术后远处转移是影响预后的独立因素。     

胃间质瘤的外科治疗

目的分析胃的胃肠道间质瘤(gastrointestinalstromaltumor,GIST)外科治疗效果及其影响因素。方法总结我院1990年1月至2004年12月外科治疗的70例胃的GIST临床资料,对其病理切片(含免疫组织化学检查)重新复核并加以随访,分析手术切除的效果以及影响手术疗效的因素。结果行完全切除术63例,其中扩大切除术20例,肿瘤及所在器官切除24例,肿瘤局部切除19例;行不完全切除7例。全组中位生存时间为60.2月,术后1~、3~和5~年生存率分别为96.3%、72.1%和61.9%。完全切除术组患者生存率明显优于不完全切除术组(P<0.05),后者无一例生存超过2年。完全切除术组中,肿瘤局部切除和肿瘤及所在器官切除患者生存率之间比较,差异无显著意义(P>0.05),但二者分别与扩大切除术者比较,差异却有显著性意义(P<0.05)。完全切除术患者的生存率与其性别、肿瘤大小和性质、核分裂数及复发转移有关;但多因素的Cox回归分析显示,术后生存率仅与肿瘤大小、核分裂和复发转移相关(P<0.05)。结论胃的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不能提高生存率。     

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。     

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。     

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。     

低位直肠癌局部切除术后复发因素分析

目的探讨低位直肠癌局部切除术后复发的相关因素。方法回顾分析1975年4月至2005年4月间收治的97例早期低位直肠癌行局部切除治疗患者的临床资料。结果全组Tis、T1和T2期病变者分别为28例、48例和21例;有17例（17．5％）患者出现复发,其中局部复发13例．局部复发伴远处转移2例．局部复发率15．5％;Tis、T1和T2期病变者局部复发率分别为7．1％、12．5％和33．3％：另有2例远处转移。局部切除术后复发时问为4～173（中位时间27）个月。肿瘤大体类型和T分期为局部切除术后局部复发的相关因素（P〈0．05）。T2期病变者局部切除术后行和未行辅助治疗的局部复发率分别为21．4％和57．1％（P=0．127）。带蒂肿瘤、无蒂肿瘤和溃疡型肿瘤的局部复发率分别为10．5％、13．7％和3／5。15例局部复发者经治疗后的5年生存率为59．6％。结论低位直肠癌局部切除术后T分期和肿瘤的大体类型是局部复发的主要因素,T2期病变局部切除后需行辅助治疗或行根治性切除术。     

局部复发直肠癌187例手术疗效及预后因素分析

目的探讨局部复发直肠癌（LRRC）患者的手术疗效及预后影响因素。方法回顾性分析1985年1月至2009年12月北京大学第一医院手术治疗的187例LRRC患者的病例资料。结果行局部切除术34例,腹会阴联合切除术35例,后盆腔脏器切除术17例,全盆腔脏器切除术（TPE）98例,TPE联合骶尾骨切除2例,TPE联合半骨盆切除1例。R0、R1、R2切除分别为87、60、40例;手术根治性与初次手术方式及盆壁受侵固定程度有关（P〈0．05）。手术并发症发生率为47．5％（89／187）,围手术期死亡率2．7％（5／187）,术后局部复发率44．4％（64／144）。144例术后3、5年生存率分别为42．2％和30．7％,手术根治性和淋巴结转移是影响预后的独立危险因素（P〈0．01）。R0、R1与R2切除者5年生存率分别为42．6％、17．2％和0（P〈0．01）;淋巴结转移阴性与阳性者5年生存率分别为40．5％与5．6％（P〈0．01）。结论术前准确评估肿瘤固定范围、提高R0切除率是提高LRRC患者手术疗效的关键。     

Tumor size is a major determinant of recurrence in patients with resectable gastrointestinal stromal tumor

BACKGROUND: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumor of the gastrointestinal tract. Surgery remains the mainstay of curative treatment. Recurrence after surgery was frequent and was associated with poor prognosis. In this study, we tried to identify predictors of recurrence in resectable GISTs. METHODS: Between January 1995 and December 2005, 100 patients undergoing surgical resection for GISTs in 2 hospitals were studied. RESULTS: There were 67 gastric and 33 intestinal GISTs. Recurrence was noted in 11 patients (median follow-up of 43 months). Overall 5-year survival was 84%. Multivariate analysis demonstrated that tumor size > or = 10 cm was associated with higher recurrence rates (P = .032) and was the only independent poor prognostic factor for survival (P = .020). CONCLUSIONS: We concluded that tumor size > or = 10 cm carried both a higher risk of recurrence and worse survival in resectable GISTs and could be considered an indicator for adjuvant therapy.     

胃肠间质瘤135例临床诊治分析

目的探讨胃肠道平滑肌肿瘤与胃肠间质瘤(GIST)的关系及外科治疗的效果。方法重新调出1993-2003年间收治的资料完整的86例胃肠道平滑肌瘤或平滑肌肉瘤患者的病理组织重新病理复检,结合2000年1月至2005年7月确诊GIST的71例病例资料进行分析。并完成随访。结果86例原诊断胃肠道平滑肌瘤或平滑肌肉瘤的患者共有78例完成免疫组化检测,有64例(82.1%)被纠正诊断为GIST。共计135例GIST患者中,男性65例,女性70例;平均发病年龄53岁。均接受手术治疗,130例(96.3%)为完全切除;术后总体5年生存率为79.7%。完全切除者术后总体生存率与首诊转移、肿瘤大小、核分裂和术后复发转移有关(P<0.01);无病生存率的多因素回归分析中发现,完全切除术后无病生存率与首诊已有转移和核分裂数有关(P<0.01)。结论既往胃肠道平滑肌肿瘤大部分应纠正诊断为GIST。GIST以外科治疗为主。完全切除很重要。首诊肿瘤转移和核分裂数是独立的预后因素。     

Duodenal gastrointestinal stromal tumor: clinicopathological characteristics,surgical outcomes,long term survival and predictors for adverse outcomes

Background

Gastrointestinal stromal tumors (GISTs) occur rarely in the duodenum. Because of their low incidence, data on long-term survival and prognostic factors are limited. The aims of this study were to present the authors' experiences in the diagnosis and treatment of this disease and to evaluate long-term surgical outcomes.

Methods

Clinical data from 22 consecutive patients with duodenal GISTs surgically managed from May 1999 to August 2011 were retrospectively studied. A pooled analysis was done by systematically reviewing other case series reported in the English literature. Recurrence-free survival and independent predictors of adverse outcomes were analyzed using the Kaplan-Meier method and multivariate Cox regression.

Results

Duodenal GISTs had a mild male predominance (68.2%), occurring primarily in older adults (median age, 58 years), with a frequency of 7.49% among all GISTs. Clinical presentations were nonspecific, with gastrointestinal bleeding and abdominal pain or discomfort being the most common symptoms. The tumors were located mainly in the second portion of the duodenum, in 14 patients (63.6%), with a median size of 3.75 cm (range, 1.4 to 14). All patients underwent curative surgical resection, including 9 pancreaticoduodenectomy, 3 segmental duodenectomy, and 10 local resection. Eighteen patients were alive without evidence of recurrence after a median follow-up period of 67.5 months (range, 3 to 118). The 1-year, 2-year, and 3-year rates of recurrence-free survival were 95%, 89.5%, and 86.7%, respectively. Kaplan-Meier analysis and log-rank tests showed that surgical pattern, mitosis, and risk grade were significantly associated with recurrence-free survival (P < .05 for all). However, only high mitosis was a significant predictive factor for adverse outcomes on multivariate analysis (hazard ratio, 16.414; 95% confidence interval, 1.914 to 140.756; P = .011).

Conclusions

Duodenal GIST is an unusual neoplasm with favorable survival after curative resection. Mitotic activity was more influential than tumor size and risk grade in predicting adverse outcomes. All patients with duodenal GISTs require long-term follow-up, because late relapse can occur even if the tumor has low malignant potential.     

Early recurrence of completely resected N2-positive non-small-cell lung cancer

Objective Postoperative early recurrence, defined as recurrence within 1 year postoperatively, is often experienced with completely resected N2 disease. In this study, we evaluated the risk factors for early recurrence with completely resected N2 disease. Methods Potential risk factors for postoperative early recurrence were evaluated in 75 patients with N2 disease who underwent complete resection without any preoperative therapy. Prognostic significance was determined by univariate and multivariate analyses. Results The median follow-up period was 24 months, and the 5-year survival rate was 23%. Thirty-nine patients developed postoperative early recurrence. The 1-, 3-, and 5-year survival rates of patients with early recurrence were 64%, 10%, and 5%, respectively, and 100%, 51%, and 34%, respectively (p < 0.001). Multistation N1 metastasis was a risk factor for postoperative early recurrence by univariate analysis and an independent risk factor by multivariate analysis. Conclusions Early recurrence is a significant poor prognostic factor for completely resected N2 disease. It is suggested that the number of N1 stations with metastasis is a risk factor for early recurrence and a poor prognostic factor in N2 disease.     

Laparoscopic resection for gastrointestinal stromal tumors of the stomach

BACKGROUND: We reviewed our experience with primary gastrointestinal tumors (GISTs) after surgical treatment. METHODS: Between 1998 and 2003, 56 patients who underwent surgical treatment for primary GIST of the stomach were enrolled in this study. Statistical analyses of the risk factors for recurrence were assessed. RESULTS: The proportion of cases undergoing laparoscopic surgery was 25 of 56 (44%) in these retrospective data. The site of recurrence was only the liver in all cases. These recurrent cases were defined as high-risk category. Tumors measuring over 2 cm in size tended to recur earlier, namely within 32 months. A statistical analysis showed a statistically significant correlation between the disease progression and the pathological phenotype. CONCLUSIONS: This retrospective study has shown that an initial laparoscopic resection of gastric GISTs is feasible even when the tumor size is relatively small (2-5 cm). The pathological phenotype (especially tumor mitosis) directly correlates to the patient's survival even if the resected tumor size was relatively small.     

Surgical Resection of Gastrointestinal Stromal Tumors After Treatment with Imatinib

Background Surgical resection of gastrointestinal stromal tumors (GISTs) has been the most effective therapy for these rare tumors. Imatinib has been introduced as systemic therapy for locally advanced and metastatic GIST. In this study, the surgical resection rates and long-term outcomes of patients treated with preoperative imatinib for locally advanced primary, recurrent, or metastatic GISTs were evaluated. Methods Patients were retrospectively assessed for completeness of surgical resection and for disease-free and overall survival after resection. Results Forty-six patients underwent surgery after treatment with imatinib. Eleven were treated for locally advanced primary GISTs for a median of 11.9 months, followed by complete surgical resection. All eleven were alive at a median of 19.5 months, and ten were free of disease. Thirty-five patients were treated for recurrent or metastatic GIST. Of these, eleven underwent complete resection. Six of the eleven patients had recurrent disease at a median of 15.1 months. All eleven patients were alive at a median of 30.7 months. Patients with a partial radiographic tumor response to imatinib had significantly higher complete resection rates than patients with progressive disease (91% vs. 4%; P < .001). Of the 24 patients with incomplete resection, 18 initially responded to imatinib but were unable to undergo complete resection after they progressed before surgery. Conclusions Preoperative imatinib can decrease tumor volume and is associated with complete surgical resection in locally advanced primary GISTs. Early surgical intervention should be considered for imatinib-responsive recurrent or metastatic GIST, since complete resection is rarely achieved once tumor progression occurs. Presented in part at the Annual Meeting of the Society of Surgical Oncology, Atlanta, GA, March 2005.     

216例胃肠间质瘤预后分析

目的探讨不同部位胃肠间质瘤（GIST）患者的生存情况及手术治疗和药物治疗对患者生存时间的影响。方法回顾性分析2004年1月至2010年12月解放军总医院收治并具有完整病理及随访资料的216例原发GIST患者的临床及随访资料。结果216例患者术后随访1～83（中位22）个月。1、3、5年的生存率分别为90％、87％和82％。GIST位于胃、小肠和胃肠道外患者例数分别为103、45和41例,其5年生存率分别为93％、75％和30％,差异有统计学意义（P〈0．05）;而18例十二指肠GIST和9例直肠GIST随访期间无死亡病例。完整切除加药物（伊马替尼）治疗、完整切除未服用药物、未完整切除加药物治疗及未完整切除未服用药物患者的例数分别为26、155、22和11例．其3年生存率分别为100％、98％、49％和14％,差异有统计学意义（P〈O．05）。结论不同部位的GIST患者预后明显不同．手术完整切除肿瘤和术后服用伊马替尼可改善患者预后。     

Prognostic Factors of Primary Small Bowel Adenocarcinoma: Univariate and Multivariate Analysis

Background Adenocarcinoma of the small bowel is relatively less common than malignancies of the esophagus, stomach, and colorectum. In small bowel adenocarcinoma, various prognostic factors influence the disease-free status and overall survival rates. Materials and Methods Eighty patients who were diagnosed with small bowel adenocarcinoma and treated at our institute between 1983 and 2003 were retrospectively reviewed. Results The patients included 40 men and 40 women with an age range of 15 to 93 years (median: 62 years). Only 51.3% of patients were accurately proved preoperatively to have a malignancy by endoscopic biopsy. Sixty patients underwent surgical treatment, and 45 of those patients had curative resection. The follow-up period ranged from 2.5 to 229.7 months, with a median of 9.1 months. The cumulative 1-, 3-, and 5-year survival rates for all patients (excluding 3 patients who died in the immediate postoperative period) were 43.6%, 22.8%, and 17.5%, respectively. The cumulative 1-, 3-, and 5-year disease-free survival rate for all 43 patients with curative resection (excluding 2 patients who died in the immediate postoperative period) was 54.9%, 30.5%, and 27.4%, respectively. Meanwhile, multivariate analysis with Cox proportional hazards analysis demonstrated that earlier tumor stages (stages I and II) and curative resection were two independent factors influencing favorable overall survival. Lymph node metastasis was the only independent factor predicting poor disease-free survival in patients undergoing curative resection. Conclusions Poor prognosis of small bowel adenocarcinoma may be related to a delay in the diagnosis and treatment of the disease. Curative resection is the aim of surgical treatment for small bowel adenocarcinoma. Lymph node metastasis at presentation of the disease predicts tumor recurrence and distant metastasis after curative surgical treatment.