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十二指肠降部胃肠道间质瘤预后的影响因素及手术方式选择

Prognostic factors and surgical approach selection for descending duodenal gastrointestinal stromal tumors

    摘要
  • 摘要:
    目的 探讨十二指肠降部胃肠道间质瘤（gastrointestinal stromal tumor, GIST）患者预后的影响因素，分析不同手术方式对预后的影响并构建手术方式选择模型。
    方法 采用单中心回顾性队列研究，纳入2010年1月至2015年1月在复旦大学附属中山医院诊治的原发性十二指肠降部GIST患者，随访截至2025年8月。主要观察指标为术后并发症发生率、无病生存（disease-free survival, DFS）率及总生存（overall survival, OS）率。分别采用Cox回归和logistic回归分析患者预后和手术方式选择的影响因素，并构建手术方式选择的列线图模型。
    结果 共纳入78例十二指肠降部GIST患者，年龄（56.14±11.76）岁。患者1年、5年和10年OS率分别为100%、98.7%和85.7%，DFS率分别为100%、90.9%和82.3%。术中失血量、术后胃瘫、黏膜面溃疡、肿瘤最大径、Ki-67阳性细胞比例是DFS的独立危险因素；肿瘤最大径、核分裂象是OS的独立危险因素（P＜0.05）。局部切除组患者的10年DFS率高于胰十二指肠切除术组（89.45% vs 74.24%; HR＝0.300, P＝0.013），但两组OS率差异无统计学意义。胰十二指肠切除术组患者的术后并发症发生率高于局部切除组（P＜0.001）。肿瘤最大径及肿瘤与十二指肠乳头的距离是手术方式选择的独立影响因素。基于上述两项指标构建的列线图模型经内部验证，区分度、准确性良好。
    结论 十二指肠降部GIST患者的远期预后良好，手术治疗效果理想。本研究构建的列线图模型可有效指导个体化手术方式的选择，为临床决策提供参考。

     

    Abstract:
    Objective To explore the prognostic factors for patients with descending duodenum gastrointestinal stromal tumors (GIST), analyze the impact of different surgical approaches on prognosis, and develop a predictive model for surgical approach selection.
    Methods This single-center retrospective cohort study included patients with primary descending duodenum GIST treated in Zhongshan Hospital, Fudan University from January 2010 to January 2015, with follow-up until August 2025. The primary outcomes were incidence of postoperative complications, disease-free survival (DFS) rate, and overall survival (OS) rate. Cox regression and logistic regression were used to identify factors influencing prognosis and surgical approach selection, respectively. A nomogram model for selecting the surgical approach was constructed.
    Results A total of 78 patients with descending duodenum GIST were included, with age of (56.14±11.76) years. The 1-, 5-, and 10-year OS rates were 100%, 98.7%, and 85.7%, respectively, and the corresponding DFS rates were 100%, 90.9%, and 82.3%. Intraoperative blood loss, postoperative gastroparesis, mucosal ulceration, maximum tumor diameter, and Ki-67-positive cell ratio were independent risk factors for DFS, while maximum tumor diameter and mitotic figure were independent risk factors for OS (P＜0.05). The 10-year DFS rate was higher in the local resection group than in the pancreaticoduodenectomy group (89.45% vs 74.24%; HR＝0.300, P＝0.013), but there was no statistical difference in OS between the two groups. The incidence of postoperative complications in the pancreaticoduodenectomy group was higher than that in the local resection group (P＜0.001). Maximum tumor diameter and distance from tumor to the duodenal papilla were independent factors influencing surgical approach selection. The nomogram model based on these two indices demonstrated good discrimination and accuracy upon internal validation.
    Conclusions The long-term prognosis of patients with descending duodenal GIST is favorable, and surgical treatment achieves satisfactory outcomes. The nomogram model developed in this study can effectively guide individualized surgical approach selection and provide a reference for clinical decision-making.

     

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