摘要
目的探讨合并消化道恶性肿瘤的胃间质瘤临床病理特征与预后。方法采用回顾性队列研究方法。收集2002年1月至2021年12月华中科技大学同济医学院附属协和医院收治的1163例原发胃间质瘤患者的临床病理资料;男606例,女557例;年龄为59(20~94)岁。1163例患者中,合并其他消化道恶性肿瘤129例,设为合并组;未合并其他消化道恶性肿瘤1034例,设为无合并组。观察指标:(1)患者临床病理特征。(2)手术治疗与术后并发症情况。(3)随访和生存情况。(4)预后影响因素分析。采用门诊复查、电话及网络平台等方式进行随访,随访内容为患者生存情况。总生存时间定义为手术治疗至末次随访或结局事件(如死亡、失访等)发生时间。随访时间截至2022年1月。正态分布的计量资料以x±s表示,偏态分布的计量资料以M(范围)表示。计数资料以绝对数表示,组间比较采用χ^(2)检验。等级资料比较采用非参数Mann-Whitney U检验。采用Kaplan-Meier法绘制生存曲线并计算生存率,Log-rank检验进行生存分析。单因素和多因素分析采用COX比例风险模型。结果(1)患者临床病理特征。129例合并组患者中,合并胃癌81例、食管癌39例、结肠癌8例、直肠癌1例。合并组原发胃间质瘤患者的性别(男、女),年龄(≤60岁、>60岁),术前发生临床症状(无、有),胃间质瘤肿瘤长径(<2 cm、2~5 cm、5~10 cm、>10 cm),核分裂象计数(<5个/50高倍视野、5~10个/50高倍视野、>10个/50高倍视野),细胞增殖指数Ki-67(≤5%、>5%),改良美国国立卫生研究院(NIH)危险度分级(极低危、低危、中危、高危),胃间质瘤肿瘤坏死(无、有),伊马替尼辅助治疗(无、有),免疫组织化学检测指标DOG-1(阳性、阴性),CD34(阳性、阴性)分别为92、37例,30、99例,9、120例,114、10、3、2例,126、1、2例,122、2例,112、8、5、4例,129、0例,121、8例,118、3例,117、12例;无合并组患者上述指标分别为514、520例,585、449例,194、840例,383、360、201、90例,799、155、80例,851、143例,337、308、192、197例,960、74例,769、265例,850、80例,990、44例;两组患者上述指标比较,差异均有统计学意义(χ^(2)=21.46、51.11、11.06,Z=-10.27、-5.34,χ^(2)=15.94,Z=-10.61,χ^(2)=9.86、24.10、5.52、6.37,P<0.05)。1163例患者中,12例术前拟诊为胃间质瘤(合并组),1例术前胃镜及病理学检查确诊为胃间质瘤(合并组);1150例均为术中探查或术后病理学检查确诊。(2)手术治疗与术后并发症情况。合并组129例患者中,行开放手术72例,行腹腔镜或胸腔镜手术57例(中转开放手术3例)。无合并组1034例患者中,行内镜手术治疗207例,行开放手术371例,行腹腔镜或胸腔镜手术456例(中转开放手术8例)。合并组和无合并组患者术后并发症发生率分别为10.078%(13/129)和2.321%(24/1034),两组比较,差异有统计学意义(χ^(2)=22.40,P<0.05)。(3)随访和生存情况。1163例患者中,1046例获得随访,随访时间为44(1~220)个月,术后5年总生存率为87.2%;合并组和无合并组术后5年总生存率分别为51.2%和91.4%,两组比较,差异有统计学意义(χ^(2)=169.07,P<0.05)。(4)预后影响因素分析。单因素分析结果显示:性别,年龄,胃间质瘤肿瘤长径(2~5 cm、5~10 cm、>10 cm),合并消化道恶性肿瘤,核分裂象计数(>10个/50高倍视野),胃间质瘤肿瘤坏死是影响胃间质瘤患者术后5年总生存率的相关因素(风险比=2.16,2.27,0.46,0.57,1.75,7.58,2.70,1.80,95%可信区间为1.52~3.07,1.60~3.22,0.29~0.71,0.34~0.94,1.11~2.77,5.29~10.85,1.67~4.38,1.08~2.98,P<0.05)。多因素分析结果显示:性别、年龄、胃间质瘤肿瘤长径、合并消化道恶性肿瘤、核分裂象计数是胃间质瘤患者术后5年总生存率的独立影响因素(风险比=1.91,1.82,2.10,7.11、2.75,95%可信区间为1.33~2.75,1.27~2.62,1.14~3.87,4.58~11.04,1.50~5.03,P<0.05)。结论合并消化道恶性肿瘤的胃间质瘤肿瘤长径小,改良NIH危险度分级更低;性别、年龄、胃间质瘤肿瘤长径、合并消化道恶性肿瘤、核分裂象计数是胃间质瘤患者术后5年总生存率的独立影响因素。
Objective To investigate the clinicopathological features and prognosis of patients with gastric gastrointestinal stromal tumor(GIST)combined with digestive tract cancer.Methods The retrospective cohort study was conducted.The clinicopathological data of 1163 patients with gastric GIST who were admitted to the Union Hospital admitted to Tongji Medical College of Huazhong University of Science and Technology from January 2002 to December 2021 were collected.There were 606 males and 557 females,aged 59(range,20‒94)years.Of the 1163 patients,129 cases with gastric GIST combined with other digestive tract cancer were divided into the combined group,and 1034 cases with only gastric GIST were divided into the non-combined group.Observation indicators:(1)clinicopathological features of patients;(2)surgical situations and postoperative complications;(3)follow-up and survival of patients;(4)analysis of prognosis associated affecting factors.Follow-up was conducted using outpatient examination,telephone and online interview to detect survival of patients up to January 2022.The overall survival time was defined as the time from surgery to the last tine of follow-up or the outcome events,such as death of patient,loss of follow-up,etc.Measurement data with normal distribution were represented as Mean±SD,and measure-ment data with skewed distribution were represented as M(range).Count data were described as absolute numbers,and comparison between groups was conducted using the chi-square test.Com-parison of ordinal data was conducted using the non-parameter Mann-Whitney U test.Kaplan-Meier method was used to draw survival curves and calculate survival rates,and Log-Rank test was used to conduct survival analysis.The COX proportional hazard model was used for univariate and multivariate analyses.Results(1)Clinicopathological features of patients.Of the 129 patients in the combined group,there were 81 cases combined with gastric cancer,39 cases combined with esophageal cancer,8 cases combined with colon cancer and 1 case combined with rectal cancer.Gender(male,female),cases with age≤60 years or>60 years,cases without or with clinical symp-toms before surgery,cases with tumor diameter of gastric GIST as<2 cm,2‒5 cm,5‒10 cm,>10 cm,cases with mitotic index as<5/50×high power field,5‒10/50×high power field,>10/50×high power field,cases with cell proliferation index of Ki-67 as≤5%or>5%,cases classified as extremely low risk,low risk,medium risk and high risk of the modified national institutes of health(NIH)risk classification,cases with or without tumor necrosis of the gastric GIST,cases without or with adjuvant imatinib therapy,cases with the expression of DOG-1 detected by immunohistochemical staining as positive or negative,cases with the expression of CD34 as positive or negative were 92,37,30,99,9,120,114,10,3,2,126,1,2,122,2,112,8,5,4,129,0,121,8,118,3,117,12 in the combined group,versus 514,520,585,449,194,840,383,360,201,90,799,155,80,851,143,337,308,192,197,960,74,769,265,850,80,990,44 in the non-combined group,showing significant differences in the above indicators between the two groups(χ^(2)=21.46,51.11,11.06,Z=‒10.27,‒5.34,χ^(2)=15.94,Z=‒10.61,χ^(2)=9.86,24.10,5.52,6.37,P<0.05).Of the 1163 patients,there were 12 cases of the combined group suspected diagnosed as gastric GIST before surgery and 1 case of the combined group dia-gnosed as gastric GIST by gastroscopy and pathological examination before surgery.The rest of 1150 patients were diagnosed as gastric GIST by intraoperative exploration or postoperative pathological examination.(2)Surgical situations and postoperative complications.Of the 129 patients in the combined group,72 cases underwent open surgery and 57 cases underwent laparoscopic or thoracoscopic surgery including 3 cases converted to open surgery.Of the 1034 patients in the non-combined group,207 cases underwent endoscopic surgery,371 cases underwent open surgery,and 456 cases underwent laparoscopic or thoracoscopic surgery including 8 cases converted to open surgery.Incidence of postoperative complications was 10.078%(13/129)in the combined group,versus 2.321%(24/1034)in the non-combined group,showing a significant difference between the two groups(χ^(2)=22.40,P<0.05).(3)Follow-up and survival of patients.Of the 1163 patients,1046 cases were followed up for 44(range,1‒220)months,with the postoperative 5-year overall survival rate as 87.2%.The postoperative 5-year overall survival rate was 51.2%in the combined group,versus 91.4%in the non-combined group,showing a significant difference between the two groups(χ^(2)=169.07,P<0.05).(4)Analysis of prognosis associated affecting factors.Results of univariate analysis showed that gender,age,tumor diameter of gastric GIST as 2‒5 cm,5‒10 cm and>10 cm,combined with other digestive tract cancer,mitotic index as>10/50×high power field and tumor necrosis of the gastric GIST were related factors affecting the postoperative 5-year overall survival rate of patients with gastric GIST(hazard ratio=2.16,2.27,0.46,0.57,1.75,7.58,2.70,1.80,95%confidence intervals as 1.52‒3.07,1.60‒3.22,0.29‒0.71,0.34‒0.94,1.11‒2.77,5.29‒10.85,1.67‒4.38,1.08‒2.98,P<0.05).Results of multivariate analysis showed that gender,age,tumor diameter of gastric GIST,combined with other digestive tract cancer and mitotic index were independent factors affecting the post-operative 5-year overall survival rate of patients with gastric GIST(hazard ratio=1.91,1.82,2.10,7.11,2.75,95%confidence intervals as 1.33‒2.75,1.27‒2.62,1.14‒3.87,4.58‒11.04,1.50‒5.03,P<0.05).Conclusions The tumor diameter of gastric GIST is short in patients combined with other digestive tract cancer,and the risk grade of modified NIH risk classification is lower.Gender,age,tumor diameter of gastric GIST,combined with other digestive tract cancer and mitotic index are independent factors affecting the postoperative 5-year overall survival rate of patients with gastric GIST.
作者
毛淦
王涛
杨文昶
沈乾
蒋祈
吕剑波
曾新宇
贾杰
刘炜圳
曾祥宇
陶凯雄
张鹏
Mao Gan;Wang Tao;Yang Wenchang;Shen Qian;Jiang Qi;Lyu Jianbo;Zeng Xinyu;Jia Jie;Liu Weizhen;Zeng Xiangyu;Tao Kaixiong;Zhang Peng(Department of Gastrointestinal Surgery,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China)
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2022年第8期1071-1077,共7页
Chinese Journal of Digestive Surgery
基金
国家自然科学基金(81702386,82072736)
湖北省自然科学基金面上项目(2021CFB566)
白求恩·胃肠间质瘤精准治疗专项研究基金(WCJZL202107)。
关键词
胃肿瘤
胃肠间质瘤
食管癌
结肠癌
直肠癌
临床病理特征
预后
Stomach neoplasms
Gastrointestinal stromal tumor
Esophageal cancer
Colon cancer
Rectal cancer
Clinicopathological features
Prognosis
