甲磺酸伊马替尼治疗腹腔镜切除术后胃肠道间质瘤效果及预后影响因子分析

摘要

Objective To observe the clinical curative effect of postoperative administration of imatinib in treatment of gastrointestinal stromal tumor after laparoscopic resection.Methods A total of 70 patients with gastrointestinal stromal tumor from January 2008 to May 2010 were selected and randomly divided into control group (35 cases) undergoing laparoscopic resection only and observation group (35 cases) receiving postoperative administration of imatinib (400 mg/time,1 time/d) after laparoscopic resection.The survival and recurrence rate of the two groups were compared and the risk factors were analyzed.Results The 1 and 2 year recurrence free survival rate in observation group were 100.0％ (35/35) and 94.3％ (33/35),both significantly higher than those in control group [82.9％ (29/35) and 62.9％ (22/35)].Two cases (5.7％) had recurrence in observation group and 13 cases (37.1％) had recurrence in control group.The significant difference of recurrence free survival rate was found between the two groups (P =0.035).The high risk type,tumor diameter ＞ 10 cm,mitotic index ＞ 5/50 hpf and non-treatment of imatinib after operation were the independence risk factors of prognosis (all P ＜ 0.05).Conclusion Postoperative administration of imatinib after laparoscopic resection can significantly improve prognosis in treatment of gastrointestinal stromal tumor,especial for high-risk patients.%目的 探讨腹腔镜切除术后给予甲磺酸伊马替尼治疗胃肠道间质瘤的临床疗效和影响预后的因素.方法 选取2008年1月至2012年5月在湖南省岳阳市一人民医院行腹腔镜切除术的胃肠道间质瘤患者70例,按随机数字表法分成研究组(35例)和对照组(35例),研究组患者术后给予甲磺酸伊马替尼400 mg/次,1次/d;对照组患者只采用腹腔镜切除术治疗.对2组患者的生存率与复发率进行随访统计,并分析影响预后的因素.结果 研究组和对照组患者1年无复发生存率分别为100.0％(35/35)和82.9％(29/35),2年无复发生存率分别为94.3％ (33/35)和62.9％(22/35),研究组均高于对照组,差异有统计学意义(P＜0.05).高危患者中,研究组2例(5.7％)出现肿瘤复发转移,对照组13例(37.1％)出现肿瘤复发转移,2组差异有统计学意义(P =0.035).采用COX风险比例模型对可能影响患者预后的因素进行单因素分析,结果显示年龄、性别和肿瘤部位对患者1年无复发生存率无影响(P＞0.05),肿瘤直径≥10 cm、核分裂指数＞5/50高倍镜视野、高危、术后不予甲磺酸伊马替尼辅助治疗是影响患者预后的因素(均P＜0.05).将上述单因素分析中有统计学意义的各因素行COX回归分析,显示高危、肿瘤直径≥10 cm、核分裂指数＞5/50高倍镜视野和术后不予甲磺酸伊马替尼辅助治疗是影响预后的独立危险因素(均P＜0.05).结论 腹腔镜切除术后给予甲磺酸伊马替尼治疗中危或高危胃肠道间质瘤患者能明显改善预后,提高其无复发生存率,治疗效果在高危患者中最为明显.