收稿日期: 2019-11-18
网络出版日期: 2020-04-18
基金资助
国家自然科学基金(81101870);国家临床重点专科建设项目(2013-544);天津市卫生健康委员会重点项目(16kg127)
Clinicopathological features and prognosis of colorectal stromal tumor
Received date: 2019-11-18
Online published: 2020-04-18
Supported by
Supported by the National Natural Science Foundation of China(81101870);the National Key Clinical Specialty Construction Project(2013-544);the Key Project of Tianjin Health and Family Planning Commission(16kg127)
目的 探究结直肠间质瘤预后相关因素,并通过列线图预测该肿瘤生存概率,为指导临床评估预后提供依据.方法: 通过监测流行病学和最终结果(surveillance, epidemiology, and end results, SEER)数据库获取1992年1月至2015年12月结直肠间质瘤临床病理及预后相关资料,对入组患者进行生存分析,将分析得到的独立预后因素绘制成列线图,之后采用校准曲线评估列线图预测生存准确性.结果: 546例结直肠间质瘤患者被纳入研究.中位发病年龄64岁,区域淋巴结转移率9.4%.546例患者多因素生存分析显示发病年龄 > 64岁,未婚/离婚,结肠间质瘤(与直肠间质瘤相比),非手术治疗,组织分化级别高,区域淋巴结转移及远处转移具有更差的肿瘤特异性生存和总生存(P均<0.05), 美国东部地区诊治患者比西部地区患者具有更长的总生存时间(P = 0.027),以上独立预后因素预测肿瘤特异性生存率和总生存率的C指数分别为0.76(95%CI: 0.72-0.80)和0.75(95%CI: 0.72-0.78).在174例组织分化级别和肿瘤部位明确的患者中,影响肿瘤特异性生存和总生存的独立预后因素为年龄,组织分化级别和是否行手术治疗(P均<0.05),而肿瘤部位仅与肿瘤特异性生存显著相关(P = 0.041),未证实与总生存显著相关(P = 0.057),采用这4个预后影响因素预测546例患者肿瘤特异性生存率和总生存率的C指数分别是0.71(95%CI: 0.66-0.75)和0.73(95%CI: 0.70-0.77), 能较准确预测结直肠间质瘤患者总生存率.结论: 结直肠间质瘤预后受多个临床病理因素影响,列线图能为预测结直肠间质瘤患者生存率提供依据.
王文鹏 , 王捷夫 , 胡均 , 王俊锋 , 刘嘉 , 孔大陆 , 李健 . 结直肠间质瘤临床病理特征及预后分析[J]. 北京大学学报（医学版）, 2020 , 52(2) : 353 -361 . DOI: 10.19723/j.issn.1671-167X.2020.02.025
Objective: The incidence of colorectal stromal tumor is low among digestive tract tumors, therefore the literatures about clinicopathological features and prognosis of colorectal stromal tumor are few at home and abroad. In this study, we performed survival analyses for colorectal stromal tumor. The nomogram made by prognostic factors provided basis for evaluation of prognosis.Methods: The clinico-pathological and prognostic data of colorectal stromal tumor between January 1992 and December 2015 were collected from the surveillance, epidemiology, and end results (SEER) database. The survival analyses were made by SPSS 24.0 software. The nomogram and calibration curve were made by RMS package in R 3.5.2 software.Results: In the study, 546 patients with colorectal stromal tumor were included. The median age of onset was 64 years. The regional lymph node metastasis (LNM) rate was 9.4%. The multivariate Cox regression analyses of the 546 cases showed that the older age of onset (>64 years), single or divorce, colon tumor (compared with rectal tumor), non-surgery, high histological grade, LNM and distant metastasis were associated with worse cancer specific survival (CSS) and overall survival (OS), P < 0.05 for all. The treatment district was independent prognostic factor of OS (P = 0.027). The C-index of independent prognostic factors predicting CSS and OS probability were 0.76 (95%CI: 0.72-0.80) and 0.75 (95%CI: 0.72-0.78), respectively. Multivariate analyses were further carried out in the 174 patients with definite histological grade and tumor location, which revealed that the age of onset, histological grade, surgery or not were independent prognostic factors of CSS and OS (P < 0.05 for all). Tumor location was associated with CSS (P = 0.041) but not OS (P = 0.057) among the 174 cases. Four independent prognostic factors influencing the 174 patients' prognosis were used to make nomogram for predicting survival probability of 546 cases. The C-index of four prognostic factors predicting probability of CSS and OS of the 546 cases were separately 0.71 (95%CI: 0.66-0.75) and 0.73 (95%CI: 0.70-0.77). The nomogram had more accuracy for predicting OS probability of colorectal stromal tumors.Conclusion: The prognosis of colorectal stromal tumor was affected by multiple clinicopathological factors. The nomogram provided the basis for predicting the survival probability of patients with colorectal stromal tumor.
| [1] | Nilsson B, Bumming P, Meis-Kindblom JM , 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] | Parab TM , DeRogatis MJ, Boaz AM, et al. Gastrointestinal stromal tumors: a comprehensive review[J]. J Gastrointest Oncol, 2019,10(1):144-154. |
| [3] | Kindblom LG, Remotti HE, Aldenborg F , et al. Gastrointestinal pacemaker cell tumor (GIPACT): gastrointestinal stromal tumors show phenotypic characteristics of the interstitial cells of Cajal[J]. Am J Pathol, 1998,152(5):1259-1269. |
| [4] | Soreide K, Sandvik OM, Soreide JA , et al. Global epidemiology of gastrointestinal stromal tumours (GIST): A systematic review of population-based cohort studies[J]. Cancer Epidemiol, 2016,40:39-46. |
| [5] | Corbin KS, Kindler HL, Liauw SL . Considering the role of radiation therapy for gastrointestinal stromal tumor[J]. Onco Targets Ther, 2014,7:713-718. |
| [6] | Wu PC, Langerman A, Ryan CW , et al. Surgical treatment of gastrointestinal stromal tumors in the imatinib (STI-571) era[J]. Surgery, 2003,134(4):656-665. |
| [7] | 杨朝纲, 熊斌 . 结直肠间质瘤诊治进展[J]. 实用癌症杂志, 2015,30(10):1575-1577. |
| [8] | Miettinen M, Lasota J, Sobin LH . Gastrointestinal stromal tumors of the stomach: A clinicopathologic, immunohistochemical, and molecular genetic study of 1 765 cases with longterm follow-up[J]. Am J Surg Pathol, 2005,29(10):1373-1381. |
| [9] | Al-Thani H, El-Menyar A, Rasul KI , et al. Clinical presentation, management and outcomes of gastrointestinal stromal tumors[J]. Int J Surg, 2014,12(10):1127-1133. |
| [10] | Cao H, Zhang Y, Wang M , et al. Prognostic analysis of patients with gastrointestinal stromal tumors: a single unit experience with surgical treatment of primary disease[J]. Chin Med J (Engl), 2010,123(2):131-136. |
| [11] | Varshney VK, Gupta RK, Saluja SS , et al. Analysis of clinicopathological and immunohistochemical parameters and correlation of outcomes in gastrointestinal stromal tumors[J]. Indian J Can-cer, 2019,56(2):135-143. |
| [12] | Ghanem N, Altehoefer C, Furtwangler A , et al. Computed tomography in gastrointestinal stromal tumors[J]. Eur Radiol, 2003,13(7):1669-1678. |
| [13] | Tateishi U, Hasegawa T, Satake M , et al. Gastrointestinal stromal tumor. Correlation of computed tomography findings with tumor grade and mortality[J]. J Comput Assist Tomogr, 2003,27(5):792-798. |
| [14] | Gaitanidis A, El Lakis M, Alevizakos M , et al. Predictors of lymph node metastasis in patients with gastrointestinal stromal tumors (GISTs)[J]. Langenbecks Arch Surg, 2018,403(5):599-606. |
| [15] | Tokunaga M, Ohyama S, Hiki N , et al. Incidence and prognostic value of lymph node metastasis on c-Kit-positive gastrointestinal stromal tumors of the stomach[J]. Hepatogastroenterology, 2011,58(109):1224-1228. |
| [16] | Zhu R, Liu F, Grisotti G , et al. Distinctive features of gastrointestinal stromal tumors arising from the colon and rectum[J]. J Gastrointest Oncol, 2018,9(2):231-240. |
| [17] | 黄湘辉, 裘科跃, 袁旦平 , 等. 102例胃肠间质瘤外科手术疗效及预后影响因素分析[J]. 解放军医学院学报, 2019,40(7):655-659. |
| [18] | Ge XY, Lei LW, Ge F , et al. Analysis of risk factors of gastrointestinal stromal tumors in different age groups based on SEER database[J]. Scand J Gastroenterol, 2019,54(4):480-484. |
| [19] | Buja A, Lago L, Lago S , et al. Marital status and stage of cancer at diagnosis: A systematic review[J]. Eur J Cancer Care (Engl), 2018,27 (2017-08-29)[2019-10-30]. |
| [20] | Li J, Ye Y, Wang J , et al. Chinese consensus guidelines for diagnosis and management of gastrointestinal stromal tumor[J]. Chinese Journal of Cancer Research, 2017,29(4):281-293. |
| [21] | Wada R, Arai H, Kure S , et al. "Wild type" GIST: Clinicopathological features and clinical practice[J]. Pathol Int, 2016,66(8):431-437. |
| [22] | 艾力·赛丁, 艾克拜尔·艾力, 张成 , 等. DOG1在胃肠道间质瘤中的表达及其临床意义[J]. 现代肿瘤医学, 2016,24(21):3418-3421. |
| [23] | 李超亿, 梁小波, 马俊杰 , 等. C-kit与血小板源性生长因子受体基因突变特征与胃肠间质瘤患者预后的关系[J]. 中华胃肠外科杂志, 2012,15(3):271-275. |
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