国际肿瘤学杂志

国际肿瘤学杂志 ›› 2026, Vol. 53 ›› Issue (5): 283-289.doi: 10.3760/cma.j.cn371439-20250826-00046

• 论著 • 上一篇    下一篇

伊马替尼辅助治疗对非胃原发高危GIST患者术后预后的影响

杨松1, 郑相云2, 潘映雪3, 王嘉明1, 张焕虎1,2,3()   

  1. 1 山东第二医科大学临床医学院， 潍坊 261053
    2 山东大学附属威海市立医院结直肠、肛肠外科， 威海 264200
    3 滨州医学院第二临床医学院， 烟台 265699
  • 收稿日期:2025-08-26 出版日期:2026-05-08 发布日期:2026-05-06
  • 通讯作者: 张焕虎，Email： whslyyzxy@163.com
  • 基金资助:
    山东省自然科学基金(ZR2021MH409)

Impact of imatinib adjuvant therapy on the postoperative prognosis of patients with non-gastric primary high-risk GIST

Yang Song1, Zheng Xiangyun2, Pan Yingxue3, Wang Jiaming1, Zhang Huanhu1,2,3()   

  1. 1 School of Clinical Medicine， Shandong Second Medical University， Weifang 261053， China
    2 Department of Colorectal and Anorectal， Weihai Municipal Hospital Affiliated to Shandong University， Weihai 264200， China
    3 Second Clinical College of Binzhou Medical University， Yantai 265699， China
  • Received:2025-08-26 Online:2026-05-08 Published:2026-05-06
  • Supported by:
    Natural Science Foundation of Shandong Province of China(ZR2021MH409)

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摘要：

目的 探讨伊马替尼辅助治疗对非胃原发高危胃肠道间质瘤（GIST）患者术后预后的影响。方法 回顾性分析山东大学附属威海市立医院2010年1月1日至2022年5月30日收治的40例非胃原发高危GIST患者的临床资料、术后治疗及生存信息，所有患者均行根治性手术治疗，接受伊马替尼（400 mg/d）辅助治疗的患者自术后4~8周开始用药。应用Cox风险比例回归模型对患者预后的影响因素进行单因素及多因素分析；绘制Kaplan-Meier生存曲线，根据术后接受伊马替尼辅助治疗是否满3年和5年进行分组，组间比较采用log-rank检验。结果 至随访结束，40例患者中，37例接受辅助治疗，16例发生肿瘤进展，其中7例因肿瘤进展死亡；3例未接受辅助治疗，其中2例因肿瘤进展死亡；患者的3、5、10年无瘤生存（DFS）率分别为79.1％、60.0％和25.3％，3、5、10年总生存（OS）率分别为94.1％、90.6%和54.1%。单因素分析显示，Ki-67（HR=4.01，95%CI为1.04~15.27，P=0.048）和伊马替尼辅助治疗（HR=4.59，95%CI为1.05~20.23，P=0.041）均为患者DFS的影响因素；肿瘤数目（HR=5.83，95%CI为1.06~21.93，P=0.042）和伊马替尼辅助治疗（HR=5.05，95%CI为1.03~24.26，P=0.044）均为患者OS的影响因素。多因素分析显示，Ki-67>5%（HR=4.21，95%CI为1.03~20.73，P=0.046）和术后未行伊马替尼辅助治疗（HR=6.23，95%CI为1.23~31.59，P=0.027）均为影响患者DFS的独立危险因素；肿瘤数目为多发（HR=8.77，95%CI为1.40~55.01，P=0.020）和术后未行伊马替尼辅助治疗（HR=7.70，95%CI为1.28~46.41，P=0.026）均为影响患者OS的独立危险因素。术后接受伊马替尼辅助治疗不足3年组的5年DFS率和OS率分别为46.2%和90.0%，超过3年组的5年DFS率和OS率分别为90.0%和100%，差异均具有统计学意义（χ2=8.24，P=0.004；χ2=6.34，P=0.012）；术后接受伊马替尼辅助治疗不足5年组的5年DFS率和OS率分别为55.0%和92.2%，超过5年组的5年DFS率和OS率分别为100%和100%，两组间5年DFS率差异有统计学意义（χ2=3.94，P=0.047），5年OS率差异无统计学意义（χ2=2.10，P=0.147）。结论 Ki-67>5%、肿瘤数目为多发和术后未行伊马替尼辅助治疗是影响非胃原发高危GIST患者术后预后的独立危险因素。伊马替尼辅助治疗5年可延长非胃原发高危GIST患者术后的DFS，改善预后。

关键词: 胃肠道间质肿瘤, 肿瘤辅助疗法, 预后, 伊马替尼

Abstract:

Objective To analyze the impact of imatinib adjuvant therapy on the postoperative prognosis of patients with non-gastric primary high-risk gastrointestinal stromal tumor （GIST）. Methods A retrospective analysis was conducted on the clinical data， postoperative treatment and survival information of 40 patients with non-gastric primary high-risk GIST admitted to Weihai Municipal Hospital Affiliated to Shandong University from January 1， 2010 to May 30， 2022. All patients underwent radical surgical resection. Patients receiving imatinib （400 mg/d） as adjuvant therapy started taking the medication 4 to 8 weeks after the surgery. Univariate and multivariate analyses of factors influencing patient prognosis were performed using the Cox proportional hazards regression model. Kaplan-Meier survival curves were plotted， and patients were stratified based on whether they completed 3-year or 5-year postoperative imatinib adjuvant therapy. Inter-group comparisons were made using the log-rank test. Results By the end of the follow-up period， among the 40 patients， 37 received adjuvant therapy， of whom 16 experienced tumor progression and 7 of these died due to tumor progression； 3 patients did not receive adjuvant therapy， and 2 of them died due to tumor progression. The 3-， 5-， and 10-year disease-free survival （DFS） rates were 79.1%， 60.0%， and 25.3%， respectively， while the 3-， 5-， and 10-year overall survival （OS） rates were 94.1%， 90.6%， and 54.1%， respectively. Univariate analysis revealed that the Ki-67 （HR=4.01， 95%CI： 1.04-15.27， P=0.048） and imatinib adjuvant therapy （HR=4.59， 95%CI： 1.05-20.23， P=0.041） were factors influencing DFS. Tumor number （HR=5.83， 95%CI： 1.06-21.93， P=0.042） and imatinib adjuvant therapy （HR=5.05， 95%CI： 1.03-24.26， P=0.044） were factors influencing OS. Multivariate analysis identified Ki-67>5% （HR=4.21， 95%CI： 1.03-20.73， P=0.046） and without postoperative imatinib adjuvant therapy （HR=6.23， 95%CI： 1.23-31.59， P=0.027） as independent risk factors for DFS. Multiple tumor numbers （HR=8.77， 95%CI： 1.40-55.01， P=0.020） and not receiving postoperative imatinib adjuvant therapy （HR=7.70， 95%CI： 1.28-46.41， P=0.026） were independent risk factors for OS. The 5-year DFS and OS rates were 46.2% and 90.0% in the group receiving postoperative imatinib adjuvant therapy for less than 3 years， compared to 90.0% and 100.0% in the group receiving therapy for more than 3 years， with statistically significant differences （χ2=8.24， P=0.004； χ2=6.34， P=0.012）. The 5-year DFS and OS rates were 55.0% and 92.2% in the group receiving postoperative imatinib adjuvant therapy for less than 5 years， compared to 100% and 100% in the group receiving therapy for more than 5 years. There was a statistically significant difference in the 5-year DFS rate between the two groups （χ2=3.94， P=0.047）， but no statistically significant difference in the 5-year OS rate （χ2=2.10， P=0.147）. Conclusions Ki-67>5%， multiple tumor numbers and without postoperative imatinib adjuvant therapy are independent risk factors affecting the postoperative prognosis of non-gastric primary high-risk GIST patients. 5-year imatinib adjuvant therapy can prolong the postoperative DFS of non-gastric primary high-risk GIST patients and improve their prognosis.

Key words: Gastrointestinal stromal tumors, Neoadjuvant therapy, Prognosis, Imatinib