摘要
目的分析术前接受新辅助治疗或术后接受辅助治疗对局部胃肠道间质瘤(GIST)患者生存结局的影响。方法从监测、流行病学和最终结果数据库中获取2000年至2021年病理确诊为单原发性GIST的1623例患者的病理资料,其中接受术后辅助治疗1275例(术后组),接受术前新辅助治疗201例(术前组),术前和术后均接受辅助治疗141例(术前术后组),术后接受辅助治疗后再次手术6例。采用多因素logistic回归分析影响患者治疗选择的因素;采用多重补差填补缺失数据,使用1∶1倾向评分匹配、Kaplan-Meier法和多因素Cox回归分析影响患者总生存率的因素。结果多因素logistic回归分析显示,年龄>75岁(P=0.008)的患者更有可能选择术前新辅助治疗。肿瘤位置在小肠(P<0.001)、肿瘤分期为Ⅲ期(P<0.001)、组织学分级高(P=0.020)的患者更有可能选择术后辅助治疗。生存分析结果显示,相比术后组,术前组患者总生存率较低。治疗方案是局部GIST预后影响因素(P=0.041),年龄>75岁是影响局部GIST患者总生存率的独立危险因素(P<0.001)。亚组分析显示,肿瘤位于胃(P=0.014)和肿瘤直径为5~10 cm(P=0.037)的患者,选择术前新辅助治疗的总生存率显著更低。结论术后辅助治疗在改善局部GIST患者预后方面具有显著优势,尤其对于一部分非高危GIST患者。
Objective To investigate the impact of preoperative neoadjuvant therapy or postoperative adjuvant therapy on survival outcomes of patients with localized gastrointestinal stromal tumors(GIST).Methods Pathological data of 1623 patients with pathologically confirmed single primary GIST from 2000 to 2021 were obtained from Surveillance,Epidemiology,and End Results databases,including 1275 patients receiving postoperative adjuvant therapy(postoperative group)and 201 patients receiving preoperative neoadjuvant therapy(preoperative group).A total of 141 patients received adjuvant treatment before and after surgery(pre-and postoperative groups),and 6 patients received adjuvant treatment after surgery.Multivariate logistic regression was used to analyze the factors affecting the treatment choice of patients.Multiple imputation was used to handle missing data;1∶1 propensity score matching was performed,and Kaplan-Meier method and multivariate Cox regression analysis were used to analyze factors influencing overall survival.Results Multivariate logistic regression analysis of patient treatment choices revealed that patients older than 75 years(P=0.008)were more likely to choose preoperative neoadjuvant therapy.In contrast,patients with tumors located in the small intestine(P<0.001),stageⅢof the tumor(P<0.001),and high histological grade(P=0.020)were more likely to choose postoperative adjuvant therapy.Survival analysis showed that compared to the postoperative group,the preoperative group had a lower overall survival rate,and treatment sequence was a prognostic factor for localized GIST(P=0.041),age>75 years was identified as an independent risk factor for overall survival in localized GIST(P<0.001).Subgroup analysis demonstrated that patients with tumors located in the stomach(P=0.014)and tumor size of 5-10 cm(P=0.037)who received preoperative neoadjuvant therapy had significantly worse overall survival.Conclusion Postoperative adjuvant therapy demonstrates significant advantages in improving the prognosis of patients with localized GIST,particularly for a subset of non-high-risk GIST patients.
作者
邵彦熹
吕敏
方质斌
朱玉萍
SHAO Yanxi;LYU Min;FANG Zhibin;ZHU Yuping(Postgraduate Training Base Alliance,Wenzhou Medical University,Hangzhou 310022,China;不详)
出处
《浙江医学》
2025年第5期469-476,共8页
Zhejiang Medical Journal
基金
国家中医药管理局科技司-浙江省中医药管理局共建科技计划项目(GZY-ZJ-KJ-24005)
浙江省中医药卫生计划项目(2022ZA030)
浙江省医药卫生科技计划项目(2024KY797)。
关键词
胃肠道间质瘤
新辅助治疗
辅助治疗
总生存率
Gastrointestinal stromal tumors
Neoadjuvant therapy
Adjuvant therapy
Overall survival
