胃肠道间质瘤外科治疗疗效分析

目的　分析胃肠道间质瘤（GIST）外科治疗效果及其影响因素。方法　对1990年1月至2006年3月收治的153例GIST的临床资料和病理切片（含免疫组化检查）重新复核并加以随访,着重分析手术切除的效果以及影响手术疗效的因素。结果　本组中位生存时间为60．0个月,术后1、2、3、4和5年生存率分别为94．9％、83．3％、73．3％、70．5％和64．3％。完全切除术组患者生存率明显优于不完全切除术组（P=0．00）,后者仅2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者生存率之间比较,差异无统计学意义（P〉0．05）;但肿瘤局部切除或肿瘤及所在器官切除两组分别与扩大切除术者比较,差异有统计学意义（P〈0．05）。完全切除术患者的生存率与其性别、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,术后生存率仅与肿瘤大小、肿瘤性质和复发转移相关（P〈0．05）。结论　GIST仍应以外科治疗为主,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生存率。

Surgical treatment for gastrointestinal stromal tumor

OBJECTIVE: To analyze the effects of surgical treatment for gastrointestinal stromal tumors (GISTs) and influential factors of survival. METHODS: The clinical data and the tissue slices including immunohistochemical staining of 153 cases of GISTs from January 1990 to March 2006 were rechecked retrospectively. All patients were followed up carefully. More attention was paid to the surgical effects and the influential factors of survival. RESULTS: The overall survival rates at 1-, 2-, 3-, 4- and 5-year were 94.9%, 83.3%, 73.3%, 70.5% and 64.3%, respectively. The median survival time for patients with tumor resected completely was 66.0 months, and the 2- and 5-year survival rate were 89.4% and 70.9% respectively. The median survival time was 23.8 months for the patients with tumor resected partly, and only two of these patients survived over 2 years. Gender, tumor sites, preoperative metastasis, tumor size, pathological type, karyokinesis and recurrence and metastasis were related with survival rates for the patients with tumor resected completely on univariate analysis, but tumor size, pathology type, recurrence and metastasis were related with survival rates on Cox regression multivariate analysis (P < 0.05). CONCLUSIONS: Surgery should still be the main therapy for GISTs. Local complete resection is the principal treatment. The survival cannot be improved by extensive resection and lymph nodes clearance.