Machado-Aranda David, Malamet Matthew, Chang Yeon-Jeen, Jacobs Michael J, Ferguson Lorenzo, Silapaswan Sumet, Goriel Yousif, Kolachalam R, Mittal Vijay K
Department of Surgery, Providence Hospital and Medical Centers, Southfield, Michigan 48075, USA.
Am Surg. 2009 Jan;75(1):55-60.
The prevalence and characteristics of patients with confirmed gastrointestinal stromal tumor (GIST) in a community hospital over a 6-year period are described. Our objective was to communicate our experience managing this rare tumor of the gastrointestinal tract. A retrospective chart review was performed. Patients were selected based on International Classification of Diseases, 9th Revision codes in correlation with their respective confirmational pathology. Patients with a diagnosis of GIST, cells of Cajal tumor, and/or different varieties of gastrointestinal sarcoma were included in this study. These tumors had to have a positive C-kit on immunohistochemistry. Demographic and clinical data were collected from medical records as well as pathology reports. Follow up from attendings' office records and telephone interviews complemented our data. A total of 61 patients was identified in our institution (averaging 10 patients per year). Females represented 63 per cent of our series. The average ages were 70.2 +/- 19.1 years for females and 59.4 +/- 13.5 years for males (P < 0.01). The most common clinical presentation was an intra-abdominal nonobstructing mass followed by an endoscopically detected mass or incidental tumors found during unrelated surgery. Surgical emergencies such as acute abdomen and gastrointestinal bleed were rare. Over half of these tumors were located in the stomach. Other sites were the small intestine, colon, esophagus, and rectal-vaginal septum. Opened surgical resection was performed in two-thirds of treated cases, whereas laparoscopic resection was done in the remainder. Only 18 per cent of these tumors were considered benign, whereas 35 per cent were considered to have some malignant potential and 47 per cent were of undetermined potential. In surgically resected tumors, we found a 42 per cent recurrence rate with a median average time of recurrence of 22 months. Pathologic grading and type of surgery were not predictors of rate and timing of recurrence. However, the disease tended to be more aggressive in white males and age older than 70 years. Imatinib was used mainly in attempts to downstage, control recurrent disease, and make surgery possible. With the improvement of immunohistochemical techniques, the diagnosis of GIST is increasing. Preoperative diagnosis is highly uncertain and dependent on clinical suspicion. Surgical resection is still the main form of curative therapy. Our experience is similar to large-volume centers. GIST, once recognized, can be treated in community hospitals without compromise of their care.
本文描述了一家社区医院6年间确诊的胃肠道间质瘤（GIST）患者的患病率及特征。我们的目的是分享管理这种罕见胃肠道肿瘤的经验。进行了一项回顾性病历审查。根据国际疾病分类第九版编码并结合各自的确诊病理来选择患者。本研究纳入了诊断为GIST、卡哈尔间质细胞瘤和/或不同类型胃肠道肉瘤的患者。这些肿瘤在免疫组织化学检查中必须C-kit呈阳性。从病历以及病理报告中收集人口统计学和临床数据。主治医师办公室记录和电话访谈的随访补充了我们的数据。我们机构共确定了61例患者（平均每年10例）。女性占我们研究系列的63%。女性的平均年龄为70.2±19.1岁，男性为59.4±13.5岁（P<0.01）。最常见的临床表现是腹腔内无梗阻性肿块，其次是内镜检查发现的肿块或在无关手术中偶然发现的肿瘤。急性腹痛和胃肠道出血等外科急症很少见。这些肿瘤一半以上位于胃。其他部位是小肠、结肠、食管和直肠阴道隔。三分之二的治疗病例进行了开放手术切除，其余病例进行了腹腔镜切除。这些肿瘤中只有18%被认为是良性的，35%被认为有一定恶性潜能，47%的潜能不确定。在手术切除的肿瘤中，我们发现复发率为42%，复发的中位平均时间为22个月。病理分级和手术类型不是复发率和复发时间的预测因素。然而，该疾病在白人男性和70岁以上人群中往往更具侵袭性。伊马替尼主要用于试图降低分期、控制复发性疾病以及使手术成为可能。随着免疫组织化学技术的改进，GIST的诊断率在增加。术前诊断高度不确定，依赖于临床怀疑。手术切除仍然是主要的治愈性治疗方式。我们的经验与大型中心相似。GIST一旦被识别，在社区医院也能得到治疗而不影响治疗效果。
