| 摘要: |
| 目的：旨在研究局部胃肠道间质瘤的患者在术前接受新辅助治疗或术后接受辅助治疗的生存情况。方法：从美国SEER数据库中获取2000年至2021年病理确诊为胃肠道间质瘤的单原发性病例。采用多重补差（MI）来填补缺失数据。在1：1倾向评分匹配（PSM）后，使用Kaplan-Meier方法和多因素Cox回归分析影响患者总生存期（OS）的因素。结果：共纳入1623例患者，其中，1275例（78.5%）为术后进行辅助治疗（术后组），201例（12.3%）为术前进行新辅助治疗（术前组），141例（8.6%）为术前和术后均接受辅助治疗（术前及术后组），6例（0.3%）为术后接受辅助治疗后再次手术，主要分析术前组和术后组。多因素logistic回归分析显示，年龄大于75岁（优势比OR 2.047 [1.208～3.471]，P = 0.008）、分期为III期（优势比OR 2.047 [0.252～0.682]，P < 0.001）的患者更有可能选择术前接受新辅助治疗。而肿瘤位置在小肠（优势比OR 0.414 [0.276～0.620]，P < 0.001）、组织学分级高（优势比OR 0.619 [0.413～0.927]，P = 0.020）的患者更有可能选择术后辅助治疗。倾向匹配后剩余400例患者，Kaplan-Meier分析结果显示，相比与术后接受辅助治疗，术前接受新辅助治疗的患者OS更差，是局部GIST的预后风险因素（HR＝1.75，95%CI 1.02～2.99，P ＝ 0.041）。多变量COX分析发现，年龄大于75岁是局部GIST总生存率（HR＝7.235，95%CI 2.748～19.048， P＜0.001）和肿瘤特异性生存率（HR＝4.384，95%CI 1.583～12.139，P = 0.004）的独立风险因素。亚组分析显示，与早期切除术后辅助治疗相比，肿瘤位于胃（HR＝2.56，95%CI 1.21～5.42，P = 0.014）和肿瘤大小在5-10cm（HR＝1.86，95%CI 1.04～3.32，P = 0.037）的患者选择术前新辅助治疗的总生存率显著更差。结论：术前新辅助治疗对局部GIST患者是预后危险因素。尤其对于一部分非高危GIST患者新辅助治疗的生存获益不如早期切除加术后辅助治疗。 |
| 关键词: 胃肠道间质瘤,新辅助治疗,辅助治疗,总生存率 |
| DOI： |
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| 基金项目: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),浙江省中医药卫生项目(2022ZA030),浙江省医药卫生科技项目(2024KY797) |
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| Effect of neoadjuvant/adjuvant therapy on survival outcomes in patients with local gastrointestinal stromal tumors: an analysis using the SEER database |
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Shaoyanxi1, Lvmin2, Fangzhibin1, zhuyuping1,3
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1.Postgraduate training base Alliance of Wenzhou Medical University (Zhejiang Cancer Hospital);2.Department of Ultrasound, Zhejiang Cancer Hospital;3.Department of Colorectal Surgery, Zhejiang Cancer Hospital
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| Abstract: |
| Objective: The aim of the study was to identify the survival of patients with locally gastrointestinal stromal tumors (GISTs) and investigate the effect of preoperative neoadjuvant therapy and/or postoperative adjuvant therapy on the prognosis of patients. Methods: Single primary cases with pathologically confirmed gastrointestinal stromal tumors from 2000 to 2021 were obtained from the SEER database. Multiple imputation was used to address missing data. After 1:1 propensity score matching, Kaplan-Meier methods and multivariable Cox regression assessed overall survival (OS). Result: A total of 1623 patients were included, of which 1275 (78.5%) received adjuvant therapy after surgery (postoperative group), 201 (12.3%) received neoadjuvant therapy before surgery (preoperative group), and 141 (8.6%) received adjuvant therapy both before and after surgery (preoperative and postoperative groups). Six cases (0.3%) underwent reoperation after receiving adjuvant therapy. Preoperative group and postoperative group were mainly analyzed. Multivariate logistic regression analysis showed that the patients were older than 75 years old (odds ratio OR 2.047 [1.208-3.471], P = 0.008) and stage III (odds ratio OR 2.047 [0.252-0.682], P < 0.001) were more likely to choose preoperative neoadjuvant therapy. The tumor was located in the small intestine (odds ratio OR 0.414 [0.276-0.620], P < 0.001), and high histological grade(odds ratio OR 0.619 [0.413-0.927], P = 0.020) were more likely to choose postoperative adjuvant therapy. After propensity score matching, 400 patients remained. Kaplan-Meier analysis indicated that compared with postoperative adjuvant therapy, patients receiving neoadjuvant therapy before surgery had worse OS, which was a prognostic risk factor for locally GIST (HR = 1.75, 95%CI1.02-2.99, P = 0.041). Multivariate COX analysis showed that age over 75 years was an independent risk factor for OS of locally GIST (HR = 7.235, 95%CI2.748-19.048, P < 0.001) and CSS (HR = 4.384, 95%CI1.583-12.139, P = 0.004). Subgroup analysis demonstrated that tumors were located in the stomach (HR = 2.56, 95%CI1.21-5.42, P = 0.014) and in patients with tumor sizes of 5-10cm (HR = 1.86, 95%CI 1.04 - 3.32, P = 0.037), patients who chose preoperative neoadjuvant therapy were associated with poor overall survival. Conclusion: Preoperative neoadjuvant therapy is a prognostic risk factor for patients with locally GIST. Especially for some non-high-risk GIST patients, the survival benefit of neoadjuvant therapy is not as good as that of early resection plus postoperative adjuvant therapy. |
| Key words: Gastrointestinal stromal tumors, neoadjuvant therapy, adjuvant therapy, overall survival |