中高危险度胃肠间质瘤患者术后治疗的预后分析

doi:10.3877/cma.j.issn.1674-3946.2021.04.030

目的

探索胃肠道间质瘤(GIST)使用甲磺酸伊马替尼(IM)靶向治疗的时机，为胃肠间质瘤患者提供个体化的治疗方案。

方法

回顾分析2011年至2017年收治的482例GIST患者的临床病理及随访资料，数据使用SPSS 22.0进行分析。对所有病例进行倾向评分匹配，使用χ²检验和多变量logistic回归进行分析，合并Kaplan-Meier方法用于术后生存分析。倾向性匹配卡钳值设为0.02, P<0.05差异有统计学意义。

结果

中高危险度患者术后IM辅助服药组比未服药组有更好的5年无复发生存时间(RFS) (71.8% vs. 53.8%, P＝0.026)和5年总体生存时间(OS) (76.0% vs. 54.7%, P＝0.045)，差异有统计学意义。随着治疗时间的增加，患者的3年OS和5年OS均增加，预后较好(OS，P＝0.006，RFS，P＝0.004)。

结论

GIST中高危险度患者术后靶向治疗能够改善预后，并且治疗时间的延长，能够进一步改善预后。

关键词: 胃肠间质瘤, 甲磺酸伊马替尼, 靶向治疗, 危险, 预后

Objective

In order to provide individualized therapeutic treatment for patients with gastrointestinal stromal tumor (GIST), we explored the timing of targeted therapy for gastrointestinal stromal tumor (GIST) with Imatinib mesylate (IM).

Methods

The clinicopathological and follow-up data of 482 GIST patients treated in our center from 2011 to 2017 were analyzed retrospectively, and all the data were analyzed by using SPSS 22.0 software. Propensity score matching was applied to all cases, then we analyzed the clinical data by using χ² test, multivariate logistic regression, and Kaplan-Meier method, which was used for analyzing postoperative survival. The value of propensity score matching calipers was set as 0.02, and a P value of < 0.05 was considered as statistically significant difference.

Results

The 5-year relapse-free survival (RFS) of 71.8% vs. 53.8% (P=0.026) and 5-year overall survival (OS) of 76.0% vs. 54.7% (P=0.045) of patients with medium to high risk of GIST were significantly better in patients who received IM treatment than the untreated patients. With increased therapuetic time with IM, 3/5-year OS of the patients were increased with improved prognosis (OS, P=0.006, RFS, P=0.004).

Conclusion

Targeted therapy after surgery could improve the prognosis of patients with medium to high-risk of GIST , and the increased IM treatment time could further improve the clinical outcome.

Key words: Gastrointestinal stromal tumor, Imatinib mesylate, Targeted therapy, Risk, Prognosis

表1 倾向匹配后148例GIST两组患者基本数据比较(例)

临床特征		未治疗组(n＝74)	治疗组(n＝74)	P值
年龄(岁)
	≤60	36	41	0.411
	>60	38	33	0.411
性别
	男性	37	33	0.510
	女性	37	41	0.510
肿瘤原发部位
	胃	47	51	0.487
	非胃	27	23	0.487
肿瘤直径(cm)
	≤5	14	14	0.473
	5～10	45	51
	>10	15	9
Ki-67指数(%)
	≤5	44	50	0.419
	6～10	21	14
	>10	9	10
危险度分级
	中	28	29	0.866
	高	46	45	0.866
核分裂数(个/50HPF)
	≤5	37	39	0.750
	5～10	17	8
	>10	20	27
基因分型
	C-kit 9	4	2	0.635
	C-kit 11	60	63
	PDGFRA 12	3	1
	PDGFRA 18	3	6
	野生型	4	2

表1 倾向匹配后148例GIST两组患者基本数据比较(例)

临床特征		未治疗组(n＝74)	治疗组(n＝74)	P值
年龄(岁)
	≤60	36	41	0.411
	>60	38	33	0.411
性别
	男性	37	33	0.510
	女性	37	41	0.510
肿瘤原发部位
	胃	47	51	0.487
	非胃	27	23	0.487
肿瘤直径(cm)
	≤5	14	14	0.473
	5～10	45	51
	>10	15	9
Ki-67指数(%)
	≤5	44	50	0.419
	6～10	21	14
	>10	9	10
危险度分级
	中	28	29	0.866
	高	46	45	0.866
核分裂数(个/50HPF)
	≤5	37	39	0.750
	5～10	17	8
	>10	20	27
基因分型
	C-kit 9	4	2	0.635
	C-kit 11	60	63
	PDGFRA 12	3	1
	PDGFRA 18	3	6
	野生型	4	2

图1 148例中高危险度GIST患者术后服药组与非服药组5年OS与RFS比较

图2 146例GIST术后不同伊马替尼治疗时间OS和RFS比较

表2 146例GIST术后不同伊马替尼治疗时间OS和RFS比较(%)

治疗时间	例	3年OS	5年OS	3年RFS	5年RFS
≤12月	39	78.60	60.20	73.40	57.40
12～36月	72	89.20	57.90	77.70	61.60
>36月	35	100	90.00	100	94.10
P值			0.006		0.004

表2 146例GIST术后不同伊马替尼治疗时间OS和RFS比较(%)

治疗时间	例	3年OS	5年OS	3年RFS	5年RFS
≤12月	39	78.60	60.20	73.40	57.40
12～36月	72	89.20	57.90	77.70	61.60
>36月	35	100	90.00	100	94.10
P值			0.006		0.004

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Prognosis analysis of patients with intermediate and high risk gastrointestinal stromal tumor after surgery

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Prognosis analysis of patients with intermediate and high risk gastrointestinal stromal tumor after surgery