Gastrointestinal stromal tumours: outcomes of surgical management and analysis of prognostic variables.
Gastrointestinal stromal tumours: outcomes of surgical management and analysis of prognostic variables.
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2009-02
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通讯作者：
H. Unalp;H. Derıcı;E. Kamer;A. Bozdağ;E. Tarcan;M. Onal
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作者：
H. Unalp;H. Derıcı;E. Kamer;A. Bozdağ;E. Tarcan;M. Onal
背景我们试图回顾胃肠道间质瘤（GIST）的临床表现和手术治疗的结果。方法 我们回顾了 41 名 GIST 患者（23 名男性和 18 名女性）的临床和病理记录。我们使用 Kaplan-Meier 方法进行生存分析，并使用单变量分析评估长期生存和影响生存的独立预后因素。我们使用 Cox 比例风险回归模型来估计对总体生存率的同时影响。结果 胃是最常见的起源组织（n = 20，48.8%）。平均肿瘤直径为8.3cm。我们在 22 名 (53.7%) 患者中检测到晚期肿瘤。我们对 31 名 (75.6%) 患者进行了完全切除。 22 名 (53.6%) 患者的有丝分裂计数大于 5/50 高倍视野 [HPF]。 40 名患者 (97.6%) 的 CD117 免疫组织化学染色呈阳性。 5 名患者（12.2%）在术后早期死亡。平均随访期为 38.7 个月。中位生存期为53个月，5年生存率为49.4%。单变量分析显示以下变量的生存率显着提高：患者年龄小于 60 岁 (p = 0.011)、男性 (p = 0.048)、肿瘤直径小于 5 cm (p = 0.029)、根据 Fletcher 分类的低风险肿瘤 (p = 0.022)、完全切除 (p < 0.001) 和无局部复发 (p < 0.001) 和/或转移（p < 0.001）。我们的 Cox 比例风险模型显示，完全切除肿瘤是提高生存率的唯一因素。结论 总生存率明显受到正切缘的影响。具有阴性切缘的完整手术切除是 GIST 根治性治疗的最佳方法。
BACKGROUND We sought to review the clinical presentation and outcomes of surgical management of gastrointestinal stromal tumours (GISTs). METHODS We reviewed clinical and pathological records of 41 patients (23 men and 18 women) with GISTs. We performed survival analyses using the Kaplan- Meier method and evaluated long-term survival and the independent prognostic factors that affect survival using univariate analyses. We used the Cox proportional hazards regression model to estimate the simultaneous effect on overall survival. RESULTS The stomach was the most common tissue of origin (n = 20, 48.8%). The mean tumour diameter was 8.3 cm. We detected advanced-stage tumours in 22 (53.7%) patients. We performed complete resection in 31 (75.6%) patients. Mitotic count was greater than 5/50 high-power field [HPF] in 22 (53.6%) patients. Immunohistochemical staining for CD117 was positive in 40 (97.6%) patients. Five patients (12.2%) died in the early postoperative period. The mean follow-up period was 38.7 months. The median length of survival was 53 months and the 5-year survival rate was 49.4%. Univariate analyses revealed significantly enhanced survival for the following variables: patient age less than 60 years (p = 0.011), male sex (p = 0.048), tumour diameter less than 5 cm (p = 0.029), low-risk tumour according to Fletcher classification (p = 0.022), complete resection (p < 0.001), and lack of local recurrence (p < 0.001) and/or metastasis (p < 0.001). Our Cox proportional hazards model revealed that complete tumour resection was the only factor to increase survival. CONCLUSION Overall survival is significantly affected by positive margins. A complete surgical resection with negative margins is the best method for definitive treatment of GISTs.