Bümming P, Ahlman H, Andersson J, Meis-Kindblom J M, Kindblom L-G, Nilsson B
Department of Surgery, The Lundberg Laboratory for Cancer Research, Sahlgrenska University Hospital, Göteborg University, Göteborg, Sweden.
Br J Surg. 2006 Jul;93(7):836-43. doi: 10.1002/bjs.5350.
The aim of this retrospective population-based study, which was conducted before the introduction of imatinib, was to evaluate the role of surgery in patients with gastrointestinal stromal tumours (GISTs) and clarify which subgroups might benefit from adjuvant treatment.
Two hundred and fifty-nine patients with clinically detected GISTs were studied. Univariate and multivariate analyses were performed to identify predictors for recurrent disease and survival.
Thirty of 48 patients with high-risk GISTs and all of those with overtly malignant tumours developed recurrent tumour after complete (R0) resection. Thirty-four of 38 first recurrences occurred within 36 months of surgery. No recurrence was observed after 72 months. R0 resection, achieved in 48 (80 per cent) of 60 patients with high-risk tumours, was significantly associated with a decreased risk of death from tumour recurrence (P = 0.008).
Completeness of surgical resection is an independent prognostic factor in patients with high-risk GISTs. A period of adjuvant treatment with imatinib is recommended in patients with high-risk or overtly malignant GISTs who have undergone R0 resection and have a tumour-free interval of less than 6 years.
这项基于人群的回顾性研究在伊马替尼引入之前进行，旨在评估手术在胃肠道间质瘤（GIST）患者中的作用，并明确哪些亚组可能从辅助治疗中获益。
对259例临床检测出GIST的患者进行研究。进行单因素和多因素分析以确定疾病复发和生存的预测因素。
48例高危GIST患者中有30例以及所有明显恶性肿瘤患者在完全（R0）切除后出现肿瘤复发。38例首次复发中有34例发生在术后36个月内。72个月后未观察到复发。60例高危肿瘤患者中有48例（80%）实现了R0切除，这与肿瘤复发导致的死亡风险降低显著相关（P = 0.008）。
手术切除的完整性是高危GIST患者的独立预后因素。对于接受R0切除且无瘤间期小于6年的高危或明显恶性GIST患者，建议进行一段时间的伊马替尼辅助治疗。
