Gouveia António M, Pimenta Amadeu P, Capelinha Ana F, de la Cruz Dionísio, Silva Paula, Lopes José M
Department of Surgery, Hospital de S. João/Porto Medical School, Al. Prof. Hernani Monteiro, 4202-451, Porto, Portugal.
World J Surg. 2008 Nov;32(11):2375-82. doi: 10.1007/s00268-008-9704-8.
Surgery is the best treatment for primary GIST and may be curative, but resection extension/completeness impact on the prognosis remains controversial. The authors aim was to evaluate the clinicopathological (CP) parameters and surgical margins status influence on GIST patients' outcome.
The study evaluated 113 consecutive patients with sporadic GIST; the influence of CP parameters on recurrence-free survival (RFS) and disease-specific survival (DSS) was determined by univariate analysis (UA) and multivariate analysis (MA).
Of 104 cases, macroscopically complete resection was achieved in 96: R0 surgical margin status in 78 and R1 in 18. Recurrence rates (12.5%) were significantly lower in R0 (9.0%) than in R1 (27.8%). Tumor > 10 cm, mitotic count > 5/50 high power field (HPF), and high-risk GIST predicted poor RFS and DSS (UA). Disease-specific survival was significantly shorter after macroscopic incomplete (R2) resection, for mixed cellular morphology, and in tumors with necrosis (UA). High-risk GIST (p = 0.016) and R2 resection (p = 0.013) predicted poor DSS of patients (MA).
High risk and positive macroscopic surgical margin status are parameters associated with poor disease-specific survival in GIST patients.
手术是原发性胃肠道间质瘤（GIST）的最佳治疗方法，可能治愈，但切除范围/完整性对预后的影响仍存在争议。作者旨在评估临床病理（CP）参数和手术切缘状态对GIST患者预后的影响。
本研究评估了113例连续性散发性GIST患者；通过单因素分析（UA）和多因素分析（MA）确定CP参数对无复发生存期（RFS）和疾病特异性生存期（DSS）的影响。
104例患者中，96例实现了宏观上的完整切除：78例为R0手术切缘状态，18例为R1。R0组的复发率（9.0%）显著低于R1组（27.8%），为12.5%。肿瘤>10 cm、核分裂象计数>5/50高倍视野（HPF）和高危GIST预示着RFS和DSS较差（UA）。宏观上不完全（R2）切除后、混合细胞形态以及有坏死的肿瘤患者的疾病特异性生存期显著缩短（UA）。高危GIST（p = 0.016）和R2切除（p = 0.013）预示着患者的DSS较差（MA）。
高危和宏观手术切缘阳性状态是与GIST患者疾病特异性生存期较差相关的参数。
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