伊马替尼在进展期胃肠间质瘤的应用分析

目的探讨伊马替尼治疗进展期胃肠间质瘤（GIST）患者的临床疗效及其影响因素。方法回顾性分析2004年4月至2010年1月间在中山大学附属第一医院接受伊马替尼治疗的73例成人进展期GIST患者的临床资料。分析其治疗效果和影响疗效的因素。结果73例GIST患者接受伊马替尼治疗后完全缓解1例,部分缓解53例,疾病稳定14例,疾病进展5例。全组均获随访,随访时间12～76（中位随访32）个月,中位无进展生存期45．0个月（95％CI：34．2～55．8个月）,1、3、5年无进展生存率（PFS）分别为87．7％、63．6％和39．6％。多因素分析显示,基因突变情况和治疗前体力状态评分是伊马替尼治疗疗效的独立影响因素：c-kit外显子11突变患者PFS优于外显子9突变者;治疗前体力状态低评分者优于高评分者（均P〈0．01）。结论伊马替尼治疗进展期GIST疗效肯定,c-kit外显子9突变和体力状态不良的患者接受伊马替尼治疗效果不佳。

Clinical analysis of imatinib in patients with advanced gastrointestinal stromal tumor

Objective To evaluate the efficacy and influencing factors of imatinib in patients with advanced gastrointestinal stromal tumor （GIST）. Methods From April 2004 to January 2010, clinicopathologieal data of 73 adult patients with advanced GIST treated with imatinib at the First Affiliated Hospital of Sun Yat-sen University were retrospectively analyzed. The treatment outcomes and associated factors were investigated. Results Treatment outcomes included complete response in l （1.4%） patients, partial response in 53 （72.6%）, stable disease in 14 （19.2%）, and primary resistant in 5 （6.8%）. All the patients had routine followed up, the length of which ranged from 12 to 76 （median 32） months. The median progression-free survival was 45.0 months （95% confidence interval, 34.2-55.8）. The progression-free survival（PFS） rate was 87.7% in 1 year, 63.6% in 3 year, and 39.6% in 5 years. On multivariate analysis, both mutation status and patient performance were independent factors influencing the efficacy of imatinib treatment （both P〈0.01 ）. PFS was significantly better in patients with c-kit exon 11 mutations than those with exon 9 mutations, and better in lower ECOG scales than in higher ones. Conclusion Imatinib is effective in treating patients with advanced GIST, c-kit exon 9 mutations and poor performance status predict an adverse survival benefit of imatinib therapy.