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。

Surgical treatment and prognosis of gastrointestinal stromal tumor

Objective To investigate the outcome of surgical treatment for gastrointestinal stromal tumor (GIST) and the associated factors.Methods A total of 277 patients with GIST underwent primary surgical treatment from January 1990 to February 2010 at the Cancer Center of Sun Yat-sen University.The clinical data were retrospectively reviewed and the pathological examination was reviewed.Follow-up was performed.Results There were 176 males and 101 females.The age ranged from 20 to 81 years old (median,57).Location of the tumor included colorectum (n=28),small bowel(n=76),stomach(n=173).All the patients had en bloc resection,including local excision in 98 patients,organ resection in 64,and extended resection in 115.The 5-year survival rates were 83.5％,71.9％,and 61.9％ in the three different procedures,respectively,and the difference was not statistically significant (P＞0.05).Cox model showed that the tumor size,recurrence and metastasis were independent risk factors associated with the prognosis in GIST patients (P＜0.05).Conclusions Surgery remains the major approach for gastrointestinal GIST.Complete resection is the principal treatment.Extensive resection or extended lymph nodes dissection is not associated with improved survival.