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目的:探讨术前血浆D-二聚体(D-D)及纤维蛋白原含量(FIB)对胃肠道间质瘤(GIST)患者术后预后的预测价值。方法:收集2010年1月—2015年12月手术治疗的170例GIST患者临床病理及随访资料,分析术前D-D及FIB水平与患者预后的关系。结果:170例GIST患者中男91例,女79例;多见于50~70岁年龄段;肿瘤原发部位最常见于胃(122例,71.8%),其次为小肠(34例,20.0%)。全组术后3、5年无复发生存率(RFS)分别为85%、75%。以生存结局(出现转移或复发)为状态变量的ROC曲线显示,D-D与FIB的最佳截点值分别为1.24mg/L、3.24g/L。单因素分析显示,D-D≥1.24mg/L、FIB≥3.24g/L、NIH危险度分级中高危、肿瘤直径>5cm及胃以外部位肿瘤均与GIST患者术后3、5年RFS降低有关(均P<0.05);多因素分析显示,D-D(RR=0.382,95%CI=0.151~0.967,P=0.042)、FIB(RR=0.123,95%CI=0.035~0.430,P=0.001)、肿瘤NIH危险度分级(RR=0.149,95%CI=0.042~0.524,P=0.003)是影响GIST患者术后预后的独立危险因素。GIST患者NIH危险度分级与D-D、FIB之间均存在明显相关性(r=0.648、0.868,均P<0.01)。结论:术前血浆D-D及FIB可作为预测GIST患者术后预后的参考指标。
Objective: To investigate the predictive value of preoperative plasma D-dimer (D-D) and fibrinogen (FIB) on the prognosis of patients with gastrointestinal stromal tumors (GIST). Methods: The clinical data of 170 GIST patients surgically treated from January 2010 to December 2015 were collected. The preoperative D-D and FIB levels were compared with the prognosis of patients. Results: Of the 170 patients with GIST, 91 were male and 79 were female, and were more common in patients aged 50-70 years. The primary tumor was found in the stomach (122 cases, 71.8%) followed by the small intestine (34 cases, 20.0%), . The 3 and 5 year postoperative recurrence free survival (RFS) were 85% and 75% respectively. The ROC curve with survival outcome (metastasis or recurrence) as the state variable showed that the optimal cut-off values of D-D and FIB were 1.24mg / L and 3.24g / L, respectively. Univariate analysis showed that DD≥1.24mg / L, FIB≥3.24g / L, high NIH risk grade, tumor diameter> 5cm and tumor outside the stomach were all related to the decrease of RFS at 3 and 5 years after GIST P <0.05). Multivariate analysis showed that the incidence of DDI was significantly higher in DDI patients than those in the control group (DD = 0.382, 95% CI = 0.151-0.967, P = 0.042), FIB (RR = 0.123, 95% CI = 0.035-0.430, Risk grade (RR = 0.149, 95% CI = 0.042-0.524, P = 0.003) was an independent risk factor for postoperative prognosis in patients with GIST. There was a significant correlation between NIH risk grade and D-D and FIB in GIST patients (r = 0.648,0.868, all P <0.01). Conclusion: Preoperative plasma D-D and FIB can be used as a reference index to predict postoperative prognosis of GIST patients.