胃肠道间质瘤术后复发转移的危险因素分析

目的 分析胃肠道间质瘤术后复发转移患者的临床特点及危险因素。方法 收集大连医科大学附属第二医院2010-2016年诊治的55例胃肠间质瘤患者的临床资料。总结术后用药、随访及复发转移等情况，并使用卡方检验对年龄、性别、肿瘤直径、核分裂像、肿瘤原发部位、Ki-67指数、肿瘤浸润深度、出血坏死等因素与患者术后复发转移情况进行单因素分析，从中筛选有意义的因素使用二元Logistic回归进行多因素分析，并使用卡方检验研究Ki-67指数与临床病理因素的关系。结果 胃肠道间质瘤术后未行标准剂量辅助治疗或未规律的行标准剂量辅助治疗的患者复发转移率明显高于术后行规律的标准剂量辅助治疗者。肿瘤直径、核分裂像、肿瘤原发部位、Ki-67指数、肿瘤浸润深度和出血坏死等因素与胃肠道间质瘤术后复发转移相关（P<0.05）。多因素分析发现Ki-67指数是影响患者术后复发转移的独立危险因素（P<0.05）。Ki-67指数与肿瘤部位、直径、核分裂像数目、危险度分级等因素有关（P<0.05）。结论 胃肠道间质瘤术后需行规律的标准剂量辅助治疗。影响胃肠道间质瘤术后复发转移的危险因素为肿瘤直径、核分裂像、肿瘤原发部位、Ki-67指数、肿瘤浸润深度和出血坏死；Ki-67指数与胃肠道间质瘤的危险度分级有关，可能用于指导胃肠道间质瘤术后标准剂量的辅助治疗。

Analysis of risk factors for recurrence and metastasis of gastrointestinal stromal tumors

Objective To analyze clinical features and related risk factors in patients with recurrent metastasis of gastrointestinal stromal tumor (GIST) after surgery. Methods Retrospective analysis was performed on 55 patients of GIST in the Second Affiliated Hospital of Dalian Medical University from 2010 to 2016. Chi-square test was used for single factor analysis, such as age, sex, tumor diameter, nuclear mitosis, primary site, Ki-67 index, depth of tumor invasion, and hemorrhagic necrosis. Meaningful factors were then extracted for multivariate analysis by binary Logistic regression analysis. Additionally, chi-square was used to analyze the relationship between Ki-67 index with current clinical pathological factors. Results The recurrence rate in GIST patients without standard dose adjuvant therapy or without regular standard dose adjuvant therapy was significantly higher than that in patients with regular standard dose adjuvant therapy. Single factor analysis revealed that tumor diameter, mitotic rate, primary tumor site, Ki-67 index, depth of tumor invasion and hemorrhagic necrosis were related to recurrent metastasis of GIST after surgery (P<0.05). Multivariate analysis demonstrated that Ki-67 index was the independent risk factor for postoperative recurrence and metastasis (P<0.05). Ki-67 index was closely related to tumor location, diameter, mitotic rate and risk classification (P<0.05). Conclusions Standard dose adjuvant therapy should be performed regularly after resection of GISTs. The risk factors for postoperative recurrence and metastasis of GIST include tumor diameter, mitotic rate, tumor primary site, Ki-67 index, depth of tumor invasion, and hemorrhagic necrosis. Ki-67 index is related to the risk grade of GISTs and may be useful for guiding postoperative standard dose adjuvant therapy.