老年中危胃间质瘤病人临床病理特征及预后

doi:10.3969/j.issn.1003-9198.2022.08.022

摘要/Abstract

摘要： 目的探讨老年中危胃间质瘤病人的临床病理特征及长期预后。方法回顾性分析2009年12月至2020年7月鼓楼医院收治的62例老年中危胃间质瘤病人的临床病理特征及长期预后。结果 62例老年中危胃间质瘤病人平均年龄为(67.7±5.3)岁。临床表现主要为体检发现24例(38.7%)及腹部不适30例(48.4%)。病变部位以胃上1/3(46.8%)及胃中1/3(46.8%)多见。肿瘤平均直径为(5.4±2.3)cm,核分裂像≤5/50高倍镜视野(HPF)者40例(64.5%),＞5/50HPF 22例(35.5%)。49例(79%)病人采用外科手术治疗,13例(21%)病人采用内镜手术。外科手术组及内镜手术组术后予伊马替尼治疗的病人分别为23例和3例。中位随访时间为53个月,外科手术组出现2例非疾病特异性死亡病例。62例患者均未出现复发及转移,总体生存率为96.3%,疾病特异性生存率为100%。结论老年中危胃间质瘤病人无论术后是否使用伊马替尼辅助治疗,预后都较好。内镜治疗老年病人的中危胃间质瘤可能是一种安全、有效的方式。

关键词: 胃间质瘤, 老年人, 临床病理特征, 预后

Abstract: Objective To investigate the clinicopathological features and long-term prognosis of the elderly patients with intermediate-risk gastric stromal tumors. Methods A total of 62 elderly patients with intermediate-risk gastric stromal tumors from December 2009 to July 2020 were analyzed retrospectively. The clinical features, pathological data, and long-term prognosis were collected and analyzed. Results Among the 62 patients, there were an average age of 67.7±5.3 years old. The major symptom was abdominal discomfort (48.4%), and 38.7% of the cases were found by physical examination. The main lesion sites were the upper part (46.8%) and the middle part (46.8%) of the stomach. The average diameter of the tumor was 5.4±2.3 cm. The mitotic number was ≤ 5/50HPF in 40 cases (64.5%), and 49 patients were treated with surgery and 13 patients treated with endoscopic resection. There were 23 and 3 patients receiving imatinib in the surgical group and endoscopic group, respectively. During a median follow-up of 53 months, 2 cases of non-disease-specific death occurred in the surgical group. None of the 62 patients presented with recurrence or metastasis, with an overall survival rate of 96.3% and a disease-specific survival rate of 100%. Conclusions The prognosis of the elderly patients with intermediate-risk gastric stromal tumors is good, regardless of whether they are treated with imatinib or not. Endoscopic treatment for moderate-risk gastric stromal tumors in the elderly patients may be a safe and effective way.

Key words: gastric stromal tumors, aged, clinicopathological features, prognosis

中图分类号:

R735.3

任喜梅, 杨金萍, 倪牧含, 刘金燕, 郑畅, 王亚楠, 王雷, 徐桂芳. 老年中危胃间质瘤病人临床病理特征及预后[J]. 实用老年医学, 2022, 36(8): 846-849.

REN Xi-mei, YANG Jin-ping, NI Mu-han, LIU Jin-yan, ZHENG Chang, WANG Ya-nan, WANG Lei, XU Gui-fang. Clinicopathological features and prognosis of intermediate-risk gastric stromal tumors in the elderly[J]. Practical Geriatrics, 2022, 36(8): 846-849.

参考文献

[1] NILSSON B, BÜMMING P, MEIS-KINDBLOM J M, et al. Gastrointestinal stromal tumors: the incidence, prevalence, clinical course, and prognostication in the preimatinib mesylate era-a population-based study in western Sweden[J]. Cancer, 2005, 103(4): 821-829.
[2] DEMETRI G D, VON MEHREN M, ANTONESCU C R, et al. NCCN Task Force report: update on the management of patients with gastrointestinal stromal tumors[J]. J Natl Compr Canc Netw, 2010, 8(Suppl 2): S1-S41.
[3] CASALI P G, ABECASSIS N, ARO H T, et al. Gastrointestinal stromal tumours: ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up[J]. Ann Oncol, 2018, 29(Suppl 4): iv68-iv78.
[4] CATALANO F, RODELLA L, LOMBARDO F, et al. Endoscopic submucosal dissection in the treatment of gastric submucosal tumors: results from a retrospective cohort study[J]. Gastric Cancer, 2013, 16(4): 563-570.
[5] JEONG I H, KIM J H, LEE S R, et al. Minimally invasive treatment of gastric gastrointestinal stromal tumors: laparoscopic and endoscopic approach[J]. Surg Laparosc Endosc Percutan Tech, 2012, 22(3): 244-250.
[6] 赵燕, 徐桂芳, 李伏超, 等. 115例老年胃间质瘤病人内镜治疗有效性及安全性分析[J]. 实用老年医学, 2020, 34(11): 1180-1182.
[7] LE SAUX O, FALANDRY C, GAN H K, et al. Inclusion of elderly patients in oncology clinical trials[J]. Ann Oncol, 2016, 27(9): 1799-1804.
[8] YANG Z, FENG X, ZHANG P, et al. Clinicopathological outcomes and prognosis of elderly patients (≥65 years) with gastric gastrointestinal stromal tumors (GISTs) undergoing curative-intent resection: a multicenter data review[J]. J Gastrointest Surg, 2019, 23(5): 904-913.
[9] PANG T, ZHAO Y, FAN T, et al. Comparison of safety and outcomes between endoscopic and surgical resections of small (≤ 5 cm) primary gastric gastrointestinal stromal tumors[J]. J Cancer, 2019, 10(17): 4132-4141.
[10] MENG Y, LI W, HAN L, et al. Long-term outcomes of endoscopic submucosal dissection versus laparoscopic resection for gastric stromal tumors less than 2 cm[J]. J Gastroenterol Hepatol, 2017, 32(10): 1693-1697.
[11] DAI W J, LIU G, WANG M, et al. Endoscopic versus laparoscopic resection of gastric gastrointestinal stromal tumors: a multicenter study[J]. Oncotarget, 2017, 8(7): 11259-11267.
[12] MENG F S, ZHANG Z H, HONG Y Y, et al. Comparison of endoscopic submucosal dissection and surgery for the treatment of gastric submucosal tumors originating from the muscularis propria layer: a single-center study (with video)[J]. Surg Endosc, 2016, 30(11): 5099-5107.
[13] MIETTINEN M, SOBIN L H, LASOTA J. Gastrointestinal stromal tumors of the stomach: a clinicopathologic, immunohistochemical, and molecular genetic study of 1765 cases with long-term follow-up[J]. Am J Surg Pathol, 2005, 29(1): 52-68.
[14] LI J, YE Y, WANG J, et al. Chinese consensus guidelines for diagnosis and management of gastrointestinal stromal tumor[J]. Chin J Cancer Res, 2017, 29(4): 281-293.
[15] JOENSUU H, ERIKSSON M, SUNDBY HALL K, et al. One vs three years of adjuvant imatinib for operable gastrointestinal stromal tumor: a randomized trial[J]. JAMA, 2012, 307(12): 1265-1272.
[16] 杨弘鑫, 陈海宁, 张波, 等. 伊马替尼治疗中危胃间质瘤效果及预后临床分析[J]. 中华医学杂志, 2013, 93(16): 1230-1233.
[17] WU X, LI J, XU W, et al. Postoperative imatinib in patients with intermediate risk gastrointestinal stromal tumor[J]. Future Oncol, 2018, 14(17): 1721-1729.