内镜手术治疗2～5 cm胃肠道间质肿瘤的效果及预后评价

Efficacy and prognosis of endoscopic resection for 2~5 cm gastrointestinal stromal tumor

摘要:

目的 探讨内镜手术治疗2～5 cm胃肠道间质肿瘤（GIST）的效果及预后评价。方法 从SEER数据库中提取直径在2～5 cm，经病理确诊的GIST 754例。根据治疗方式分为内镜手术组和传统手术组，分析两组患者的病理特征，采用单因素和多因素Cox回归模型筛选预后相关因素，通过Kaplan-Meier生存曲线分析患者预后。结果 共有754例患者被纳入研究。其中，内镜手术组103例（13.66%），传统手术组651例（86.34%）。统计分析显示，两组患者年龄、性别、人种、婚姻状况、是否化疗、肿瘤发生部位、核分裂象和平均生存时间等比较，差异均无统计学意义（P > 0.05），内镜手术组肿瘤直径小于传统手术组，差异有统计学意义（P < 0.05）。单因素Cox分析显示，年龄（P = 0.004）、人种（P = 0.022）和化疗（P = 0.003）是影响肿瘤特异性生存期（CSS）的关键因素，年龄（P = 0.015，P = 0.000）、人种（P = 0.019，P = 0.011）和婚姻（P = 0.005）是影响总生存期（OS）的关键因素。多因素Cox分析显示，性别（P = 0.040）、年龄（P = 0.001）、人种（P = 0.029）和化疗（P = 0.002）是影响CSS的关键因素，年龄（P = 0.004，P = 0.000）、人种（P = 0.014）和婚姻（P = 0.023）是影响OS的关键因素。而治疗方式并不是影响CSS和OS的关键因素。Kaplan-Meier分析显示，在校正了年龄、性别、人种、婚姻、肿瘤发生部位和肿瘤大小等因素后，两组患者CSS和OS比较，差异均无统计学意义（P > 0.05）。结论 内镜手术治疗2～5 cm GIST与传统手术疗效相当，但内镜治疗的手术时间短，术后恢复快，具有良好的经济-效益成本，可能是更好的选择。

Abstract:

Objective To analyze the efficacy and prognosis of endoscopic reseciton and traditional surgical operation for 2~5 cm gastrointestinal stromal tumor (GIST) based on SEER database.Methods 754 cases pathologically confirmed GIST with a diameter of 2 ~ 5 cm were extracted from SEER database and divided into endoscopic surgical group and traditional surgical group according to treatment methods. The pathological features of the two groups were analyzed, univariate and multivariate Cox regression models were used to identify prognostic factors, cancer-specific survival (CSS) and overall survival (OS) rates were calculated using the Kaplan-Meier method and compared using a log-rank test.Results 754 patients were included in the study, including 103 patients (13.66%) in the endoscopic surgical group and 651 patients (86.34%) in the traditional surgical group. Statistical analysis showed that there were no statistically significant differences in age, gender, race, marriage, chemotherapy、tumor location, mitosis and mean survival time between the two groups (P > 0.05). The tumor diameter of the endoscopic surgical group was shorter than that of the traditional surgical group, and the difference was statistically significant (P < 0.05). Univariate Cox analysis showed that age (P = 0.004), race (P = 0.022) and chemotherapy (P = 0.003) were the key factors affecting CSS, age (P = 0.015, P = 0.000), race (P = 0.019, P = 0.011) and marriage (P = 0.005) were the key factors affecting OS. Multivariate Cox analysis showed that gender (P = 0.040), age (P = 0.001), race (P = 0.029) and chemotherapy (P = 0.002) were the key factors affecting CSS, age (P = 0.004, P = 0.000), race (P = 0.014) and marriage (P = 0.023) were the key factors affecting OS. However, treatment method was not the key factor affecting CSS and OS. Kaplan-Meier analysis showed that after adjusting for age, gender, race, marriage, tumor location and tumor size, there was no statistical difference in CSS and OS between the two groups.Conclusion Endoscopic resection for 2~5 cm GIST has the same efficacy as traditional surgery, but the endoscopic treatment has advantages such as short operation time, quick postoperative recovery, and good economy-benefit cost. Therefore, endoscopic treatment is a feasible choice for gastric stromal.