十二指肠间质瘤预后危险因素分析及不同手术治疗方式的远期预后比较

Analysis of prognostic risk factors of duodenal gastrointestinal stromal tumor and comparison of long-term prognosis of different treatment

摘要:

目的 探讨影响十二指肠间质瘤（duodenal GIST）预后的相关因素及不同手术方式对其远期预后的影响。方法 从SEER数据库中提取2000年－2019年诊断为duodenal GIST的患者资料，对其进行回顾性分析。采用多因素Cox比例风险模型，分析影响患者预后的危险因素，使用Kaplan-Meier法，分析内镜治疗组和外科手术组远期预后的差异。结果 共纳入473例患者，中位年龄59岁，肿瘤中位直径50 mm。65.1%的患者初诊时为局限期，共390例（82.4%）患者接受手术治疗。其中，内镜治疗46例（11.8%），外科手术344例（88.2%）。多因素Cox分析结果显示，年龄 > 73岁、男性、肿瘤直径 > 67 mm和发生远处转移，是影响duodenal GIST患者肿瘤特异性生存期（CSS）的独立危险因素（P < 0.05），接受内镜或外科手术治疗是CSS的独立保护因素（P < 0.05）。内镜治疗和外科手术治疗duodenal GIST患者的长期生存率相似（5年CSS为84.8%和88.2%，10年CSS为80.1%和80.6%，15年CSS为71.2%和72.3%，P > 0.05）。结论 年龄 > 73岁、男性、肿瘤直径 > 67 mm和肿瘤出现远处转移，是影响duodenal GIST预后的独立危险因素，内镜治疗和外科手术治疗duodenal GIST的长期生存率无明显差异。

Abstract:

Objective To investigate the prognostic factors of duodenal gastrointestinal stromal tumor (duodenal GIST) and the long-term prognostic effects of different therapy methods.Methods The data of patients diagnosed with duodenal GIST from 2000 to 2019 were extracted from SEER database and analyzed retrospectively. Multivariate Cox proportional hazards model was used to analyze the risk factors affecting the prognosis of patients, and Kaplan-Meier method was used to analyze the difference in long-term prognosis between the endoscopic resection group and the surgical resection group.Results 473 patients were included, with a median age of 59 years and a median tumor diameter of 50 mm. 65.1% patients had localized disease when first diagnosed. 390 patients (82.4%) received operative treatment, among which 46 patients (11.8%) received endoscopic treatment and 344 patients (88.2%) received surgical treatment. Multivariate Cox analysis showed that age > 73 years old, male, tumor diameter > 67 mm and distant metastasis were independent risk factors for cancer specific survival (CSS) in duodenal GIST patients (P < 0.05), receiving endoscopic or surgical treatment was an independent protective factor for CSS (P < 0.05). The long-term survival rates of endoscopic resection group and surgical resection group were similar (5 years CSS were 84.8% and 88.2%, 10 years CSS were 80.1% and 80.6%, 15 years CSS were 71.2% and 72.3%, P > 0.05).Conclusion Age > 73 years old, male, tumor diameter > 67 mm and distant metastasis are independent risk factors for prognosis of duodenal GIST. There is no significant difference in long-term survival rate between endoscopic resection treatment and surgical resection treatment.