1、安 徽 医 药 Anhui Medical and Pharmaceutical Journal 2023 Feb，27（2）胃肠道间质瘤术后复发转移危险因素及预测模型构建刘丹丹a，段卡丹b，李朝辉a，刘帅峰a，王云帅a作者单位：洛阳市中心医院，a胃肠外科，b心内科，河南 洛阳471000基金项目：河南省医学科技攻关计划（联合共建）项目（LHGJ20191219）摘要：目的 探讨胃肠道间质瘤（GIST）术后复发转移的危险因素，建立复发转移预测模型，为GIST病人术后复发转移的预防控制提供参考。方法 选取2015年1月至2018年4月洛阳市中心医院GIST手术病人260例，随访资料完整者共247
2、例，对病人随访2年，观察其复发和转移情况，采用logistic回归分析分析病人术后2年复发和转移的危险因素，基于危险因素的回归系数构建风险预测模型，采用受试者工作曲线（ROC）评估预测模型的区分度。结果 临床与随访资料完整的247例GIST病人中共有74例（29.96%）出现复发或者转移，其中37例（50.00%）为单纯复发，28例（37.84%）为单纯转移，其余9例（12.16%）为复发并且转移；不同性别、年龄、浸润深度以及CD117、Dog-1、CD34表达GIST病人术后复发转移情况比较，差异无统计学意义 （P0.05）；logisitic回归分析显示肿瘤原发部位在胃部以外的小肠或腹膜与
3、直肠、手术R1或R2切除、肿瘤长径大、核分裂象数高、GIST危险度高、Ki67指数高是GIST病人术后复发转移发生的独立危险因素，术后服用伊马替尼是术后未发生复发转移的保护因素；GIST 病人术后两年复发转移概率值回归方程为：P1/1+e-（-4.753+0.849肿瘤原发部位+1.620手术根治情况+0.622肿瘤大小+0.777GIST危险度分级+1.007核分裂象数+1.285Ki67-0.647术后服用伊马替尼），采用Hosmer-Lemeshow检验检测回归方程的拟合优度（P=0.210）；对模型进行内部验证，其ROC曲线下面积（AUC）为0.81，95%CI：（0.76，0.87）
4、，灵敏度为73.05%，特异度为75.70%；R语言建立的Nomogram图，能迅速评估GIST术后复发转移发生率。结论 风险评分模型具有较好的判别效度，可用于识别GIST术后复发转移高危人群，以期早期预防与控制。关键词：胃肠道间质瘤；手术治疗；复发转移；危险因素；预测模型Risk factors of recurrence and metastasis after gastrointestinal stromal tumor surgery and establishment of prediction modelLIU Dandana,DUAN Kadanb,LI Chaohuia,LIU
5、 Shuaifenga,WANG YunshuaiaAuthor Affiliation:aDepartment of Gastrointestinal Surgery,bDepartment of Cardiology,Luoyang Central Hospital,Luoyang,Henan 471000,ChinaAbstract：Objective To explore the risk factors of recurrence and metastasis after gastrointestinal stromal tumor(GIST)surgery,and establis
6、h a prediction model for recurrence and metastasis,so as to provide reference for their prevention in GIST patients.Methods A total of 260 patients who underwent GIST surgery in Luoyang Central Hospital from January 2015 to April 2018 were enrolled,including 247 cases with complete follow-up data.Th
7、e patients were followed up for 2 years to observe their recurrence and metastasis.The risk factors of recurrence and metastasis at 2 years after surgery were analyzed by logistic regression analysis.The risk prediction model was established based on regression coefficients of risk factors.The discr
8、imination of the prediction model was evaluated by receiver operator characteristic(ROC)curves.Results Of the 247 GIST patients with complete clinical and follow-up data,there were 74 cases(29.96%)with recurrence or metastasis,including 37 cases(50.00%)with simple recurrence,28 cases(37.84%)with sim
9、ple metastasis and the remaining 9 cases(12.16%)with recurrence and metastasis.There were no significant differences in postoperative recurrence and metastasis among GIST patients with different gender,age,invasion depth,CD117,Dog-1 and CD34 expression(P0.05).Logisitic regression analysis showed tha
10、t the primary site of tumors at small intestine or peritoneum and rectum outside of the stomach,surgical R1 or R2 resection,long tumor diameter,high mitotic figures,high GIST risk and high Ki67 index were independent risk factors of postoperative recurrence and metastasis in GIST patients,while taki
11、ng imatinib after surgery was a protective factor of no recurrence or metastasis.The regression equation for recurrence and metastasis probability in GIST patients at 2 years after surgery was as follow:P=1/1+e-(-4.753+0.849primary tumor site+1.620radical surgery condition+0.622tumor size+0.777GIST
12、risk grade+1.007number of mitotic figures+1.285Ki67-0.647taking imatinib after surgery).The goodness of fit of the regression equation was detected by Hosmer-Lemeshow test(P=0.210).Internal verification of the model was conducted.The area under the ROC curve(AUC),sensitivity and specificity were 0.8
13、1,95%CI:(0.76,0.87),73.05%and 75.70%,respectively.Nomogram graphics established by R language could quickly assess the incidence of recurrence and metastasis after GIST.Conclu临床医学引用本文：刘丹丹，段卡丹，李朝辉，等.胃肠道间质瘤术后复发转移危险因素及预测模型构建 J.安徽医药，2023，27（2）：297-302.DOI：10.3969/j.issn.1009-6469.2023.02.019.297安 徽 医 药
14、Anhui Medical and Pharmaceutical Journal 2023 Feb，27（2）sion The established risk scoring model is of good discriminative validity,which can be applied to identify high-risk groups with recurrence and metastasis after GIST surgery so as to conduct early prevention and control.Key words：Gastrointestin
15、al stromal tumor;Surgical treatment;Recurrence and metastasis;Risk factor;Prediction model胃肠道间质瘤（gastrointestinal stromal tumor，GIST）对传统的放疗与化疗手段敏感性差，外科手术目前被认为是原发性局限性GIST唯一可能治愈方法，然而临床上即使完整切除，术后仍有较高的复发风险，一旦发生复发转移，病人再次进行手术切除可能性较低，即使再次手术也很难达到令人满意的临床疗效1-2。相关研究表明GIST复发转移中位时间约2年，常见转移部位包括肝脏、腹膜、网膜、腹腔内等，分析GIS
16、T复发转移危险因素对指导临床治疗、判断病人预后状态具有重要价值3。既往研究中针对GIST 病人术后复发转移的危险因素研究较多，但针对疾病复发转移危险因素进一步建立风险预测模型，提供个体化的、具体的预测GIST 病人术后的复发风险概率的研究较少4-5。基于此，本研究分析GIST手术病人术后复发转移的危险因素，建立风险预测模型，旨在为临床预防和控制GIST 术后复发转移的发生提供参考。1资料与方法1.1一般资料选取2015年1月至2018年4月洛阳市中心医院GIST手术病人260例，临床与随访资料完整者共247例，其中男性162例，女性85例；年龄10.0 cm者71例；核分裂象数：5/HPF者81例，610/HPF者 109例，10/HPF者 57例；GIST危险度分级：极低或低危 62 例，中危 77 例，高危 108 例；CD117阳性238例，阴性9例；Dog-1阳性234例，阴性13例；CD34阳性208例，阴性39例；Ki67：5%者90 例，55%者 157 例；术后服用伊马替尼：是 121例，否126例。1.2纳入标准和排除标准纳入标准：（1）确诊为GIST，经手术治疗；（