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目的 分析山东省胃胃肠间质瘤(GIST)的临床病理特点及预后影响因素,以了解山东省胃GIST的诊治现状.方法 收集山东省内23家三级甲等医院2001年1月至2014年12月期间手术切除并经病理证实、 且完成临床病理学资料复核的1165例胃GIST病例资料及随访信息,建立数据库,进行回顾性分析.依照美国国立卫生研究院(NIH)于2008年推荐的GIST危险度分级标准对全组病例进行危险度分级.采用Kaplan-Meier法计算患者生存率,分别采用Log-rank检验和Cox风险回归模型进行单因素和多因素预后分析.结果 1165例胃GIST患者中男性557例,女性608例,中位发病年龄60(15~89)岁.肿瘤位于胃底贲门623例(53.5%),胃体346例(29.7%),胃窦196例(16.8%).行内镜下切除106例,局部切除术589例,胃大部切除术399例,全胃切除术72例.危险度分极:极低危256例(22.0%),低危435例(37.3%),中危251例(21.5%),高危223例(19.1%).1116例患者(95.8%)获得随访,随访时间1~60(中位数40)月.随访期间共有337例患者出现复发,中位复发时间为34月(1~60月).全组患者1、3和5年生存率分别为98.6%、86.1%和73.4%,其中极低危、低危、中危和高危患者5年生存率分别为93.1%、85.8%、63.0%和42.3%,差异有统计学意义(P=0.000).多因素预后分析结果显示,肿瘤原发部位(RR=0.580,95%CI:0.402~0.835)、肿瘤大小(RR=0.450,95%CI:0.266~0.760)、术中有无肿瘤破裂(RR=0.557,95%CI:0.336~0.924)、危险度分级(RR=0.309,95%CI:0.164~0.580)和术后有无服用伊马替尼(RR=1.993,95%CI:1.350~2.922)是影响胃GIST患者预后的独立因素.结论 依据病灶大小选择内镜切除、局部切除、胃大部切除或全胃切除等手术方式均可取得较好的治疗效果.NIH 2008危险度分级标准对我国胃GIST患者的预后有较高的预测价值.肿瘤原发部位、肿瘤大小、是否术中破裂、危险度分级和是否术后服用伊马替尼是影响胃GIST患者预后的独立因素.

Objective To summarize the treatment status of gastric gastrointestinal stromal tumor (GIST) in Shandong province,by analyzing the clinicopathological features and prognostic factors. Methods Clinicopathological and follow-up data of 1165 patients with gastric GIST between January 2000 and December 2013 from 23 tertiary referral hospitals in Shandong Province were collected to establish a database. The risk stratification of all cases was performed according to the National Institutes of Health (NIH) criteria proposed in 2008. Kaplan-Meier method was used to calculate the survival rate. Log-rank test and Cox regression model were used for univariate and multivariate prognostic analyses. Results Among 1165 cases of gastric GIST, 557 were male and 608 were female. The median age of onset was 60 (range 15-89) years. Primary tumors were located in the gastric fundus and cardia in 623 cases (53.5%), gastric body in 346 cases (29.7%), gastric antrum in 196 cases (16.8%). All the cases underwent resection of tumors, including endoscopic resection (n=106), local resection (n=589), subtotal gastrectomy(n=399), and total gastrectomy(n=72). Based on the NIH risk stratification, there were 256 cases (22.0%) at very low risk, 435 (37.3%) at low risk, 251 cases (21.5%) at intermediate risk, and 223 cases (19.1%) at high risk. A total of 1116 cases (95.8%) were followed up and the median follow-up period was 40 (range, 1-60) months. During the period, 337 patients relapsed and the median time to recurrence was 34 (range 1-60) months. The 1-,3-, and 5-year survival rates were 98.6%, 86.1% and 73.4%, respectively. The 5-year survival rates of patients at very low, low, intermediate, and high risk were 93.1%, 85.8%, 63.0% and 42.3% respectively, with a statistically significant difference (P=0.000). Multivariate analysis showed that primary tumor site (RR=0.580, 95%CI:0.402-0.835), tumor size (RR=0.450, 95%CI:0.266-0.760), intraoperative tumor rupture(RR=0.557,95%CI:0.336-0.924), risk classification (RR=0.309, 95%CI:0.164-0.580) and the use of imatinib after surgery (RR = 1.993, 95%CI:1.350 - 2.922) were independent prognostic factors. Conclusions The choice of surgical procedure for gastric GIST patients should be based on tumor size. All the routine procedures including endoscopic resection, local excision, subtotal gastrectomy and total gastrectomy can obtain satisfactory curative outcomes. NIH classification has a high value for the prediction of prognosis. Primary tumor site , tumor size, intraoperative tumor rupture, risk stratification and postoperative use of imatinib are independent prognostic factors in gastric GIST patients.