Woodall Charles E, Brock Guy N, Fan Jie, Byam Jerome A, Scoggins Charles R, McMasters Kelly M, Martin Robert C G
Division of Surgical Oncology, Department of Surgery, University of Louisville, Norton Healthcare Pavilion, Louisville, KY 40202, USA.
Arch Surg. 2009 Jul;144(7):670-8. doi: 10.1001/archsurg.2009.108.
A gastrointestinal stromal tumor (GIST) staging system can be created with the Surveillance, Epidemiology and End Results (SEER) database.
A review of records in the SEER database from 2537 patients with GISTs from June 1, 1977, through August 1, 2004.
Patients were compared using all available clinicopathologic factors, and a TGM (tumor, grade, metastasis) staging system was created according to these parameters. Survival data were analyzed using Kaplan-Meier methods, log-rank analyses, and Cox regression models.
Median follow-up time was 21 months, 47.6% of patients were men, and the median age was 64 years; 5.0% had lymph node involvement, and 22.6% had distant metastasis. Tumor size (T1, < or =70 mm; T2, >70 mm; P <.001), grade (G1, grades I and II; G2, grades III and IV; P <.001), and the presence of metastases (M0, no; M1, yes; P <.001) did affect overall survival. When combined in a TGM staging system, grade and metastasis were the factors most predictive of survival.
A staging system for GISTs that provides valuable prognostic information was developed. Further work to refine this system and validate it with other data sets should be undertaken. Mitotic index and standardized reporting may provide additional prognostic information and should be recorded for all tumors so that the most accurate staging system can be created.
利用监测、流行病学与最终结果（SEER）数据库可创建胃肠道间质瘤（GIST）分期系统。
回顾SEER数据库中1977年6月1日至2004年8月1日期间2537例GIST患者的记录。
使用所有可用的临床病理因素对患者进行比较，并根据这些参数创建TGM（肿瘤、分级、转移）分期系统。采用Kaplan-Meier法、对数秩分析和Cox回归模型分析生存数据。
中位随访时间为21个月，47.6%的患者为男性，中位年龄为64岁；5.0%有淋巴结受累，22.6%有远处转移。肿瘤大小（T1，≤70mm；T2，>70mm；P<.001）、分级（G1，I级和II级；G2，III级和IV级；P<.001）以及转移情况（M0，无；M1，有；P<.001）确实影响总生存期。在TGM分期系统中，分级和转移是最能预测生存的因素。
开发了一种能提供有价值预后信息的GIST分期系统。应进一步开展工作完善该系统，并使用其他数据集进行验证。有丝分裂指数和标准化报告可能提供额外的预后信息，应对所有肿瘤进行记录，以便创建最准确的分期系统。
