Department of General, Vascular and Pediatric Surgery, Wuerzburg University Hospital, Wuerzburg, Germany.
Dig Surg. 2010;27(4):313-9. doi: 10.1159/000280022. Epub 2010 Aug 3.
To evaluate the outcome after surgical resection in patients with gastrointestinal stromal tumors and to determine the factors influencing local tumor recurrence or distant metastatic disease after locally complete tumor resection (R0).
Outcomes of 100 patients with primary gastrointestinal stromal tumors (GIST) surgically managed between 1997 and 2006 at a single institution were reviewed. Univariate and bivariate analyses were used to determine factors affecting recurrence-free and tumor-free survival.
All patients (n = 100) had c-kit-positive GIST. There were 17% (n = 17) very low risk, 41% (n = 41) low risk, 19% (n = 19) intermediate risk and 23% (n = 23) high risk GIST originating from the stomach, small bowel, colon and rectum. The median patient age was 68 years (range 39-92). Seventy-three percent of the patients had symptomatic local disease. Most (94%; n = 94) of them underwent R0 resections of their primary tumor. R0 resection was significantly associated with a lower tumor-related mortality rate (p = 0.0001). The patients with recurrence/metastases had significantly larger tumors (p = 0.0017) and a mitotic index higher than 5/50 HPF (p = 0.0001). Seven of 20 patients from the high-risk group and 2 of 7 patients with metastatic disease developed local recurrence or further metastatatic tumor spread following R0 resection.
Surgical removal continues to be the mainstay of GIST treatment. R0 resection, tumor size and mitotic index are significant prognostic factors. Overall, more than 30% of the patients with high-risk GIST develop local recurrences and distant metastases despite R0 resection. Additional molecular pathological markers are needed to yield a more accurate tumor profile and to thus achieve a better predictability of the biological behavior of GIST.
评估胃肠道间质瘤（GIST）患者手术切除后的疗效，并确定局部肿瘤完全切除（R0）后影响局部肿瘤复发或远处转移疾病的因素。
回顾了 1997 年至 2006 年在一家机构接受手术治疗的 100 例原发性胃肠道间质瘤（GIST）患者的结果。使用单因素和双因素分析来确定影响无复发生存和无肿瘤生存的因素。
所有患者（n=100）均为 c-kit 阳性 GIST。低危患者占 17%（n=17），中危患者占 41%（n=41），高危患者占 19%（n=19），极高危患者占 23%（n=23），GIST 原发于胃、小肠、结肠和直肠。患者中位年龄为 68 岁（范围 39-92 岁）。73%的患者有局部症状性疾病。他们中的大多数（94%；n=94）接受了原发性肿瘤的 R0 切除术。R0 切除与较低的肿瘤相关死亡率显著相关（p=0.0001）。有复发/转移的患者肿瘤明显更大（p=0.0017），核分裂象数高于 5/50 HPF（p=0.0001）。高危组的 20 例患者中有 7 例和转移疾病的 7 例患者中有 2 例在 R0 切除后出现局部复发或进一步转移瘤扩散。
手术切除仍然是 GIST 治疗的主要手段。R0 切除、肿瘤大小和核分裂象数是显著的预后因素。尽管进行了 R0 切除，但超过 30%的高危 GIST 患者仍会出现局部复发和远处转移。需要额外的分子病理标志物来获得更准确的肿瘤特征，从而更好地预测 GIST 的生物学行为。
