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目的:探讨胃肠道间质瘤(gastrointestinal stromal tumors,GIST)的临床诊断、治疗方式及预后因素.方法:回顾性分析华中科技大学同济医学院附属协和医院普外科2002-01/2008-10收治的GIST患者67例的临床病理及随访资料,采用Kaplan-meier法比较不同因素对生存率的影响,并用Cox多因素回归分析评价其预后.结果:间质瘤67例,位于胃31例、小肠23例、直肠7例、胃肠道外6例.免疫组织化学检测CD117分子阳性率为97.0%,CD34分子阳性率为85.1%.所有随访患者53例其1年、3年、5年生存率分别为96.2%、81.1%、70.5%.单因素分析显示美国国立卫生研究院(national institute of health,NIH)2008年关于GIST的危险度分级与生存率有密切关系(P<0.05).高风险组中甲磺酸伊马替尼辅助治疗者较单纯手术治疗者疗效显著提高(P<0.05).多因素分析显示危险分级和甲磺酸伊马替尼治疗是影响预后的因素.结论:GIST的NIH危险度分级和甲磺酸伊马替尼辅助治疗与患者术后生存率密切相关.肿瘤手术后复发主要发生于高风险组,高风险组患者给予甲磺酸伊马替尼治疗可获得更大收益.
Objective: To investigate the clinical diagnosis, treatment and prognostic factors of gastrointestinal stromal tumors (GIST) .Methods: A retrospective analysis was performed on the general surgery department of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2002 to October 2008. Of 67 cases of GIST patients with clinical pathology and follow-up data using Kaplan-meier method to compare the impact of different factors on survival and Cox regression analysis to evaluate the prognosis.Results: GISTs in 67 cases, located in the stomach in 31 cases, small intestine 23 cases, 7 cases of rectum, 6 cases of gastrointestinal tract.Immunohistochemical detection of CD117 positive rate was 97.0%, CD34 positive rate was 85.1% .All follow-up patients 53 cases of 1 year, 3 years, 5 years survival rates were Were 96.2%, 81.1% and 70.5%, respectively.Univariate analysis showed that the national institute of health (NIH) risk rank of GIST in 2008 was closely related to the survival rate (P <0.05) (P <0.05) .Multivariate analysis showed that the risk classification and imatinib mesylate treatment were the prognostic factors.Conclusion: The effect of GIST on imatinib mesylate adjuvant therapy was significantly higher than that of the simple surgeries NIH hazard classification and The adjuvant therapy with imatinib mesylate is closely related to the postoperative survival rate.Postoperative recurrence of the tumor mainly occurs in the high risk group, and patients in the high risk group receive more benefit from imatinib mesylate treatment.