Artigas Raventós Vicente, López Pousa Antonio, Ortega Medina Luis, Díaz de Liaño Argüelles Alvaro, Fernández Hernández Juan Ángel, Lucena de la Poza José Luis
Unidad de Cirurgia HBP/Oncològica, Servei de Cirurgia General i Digestiva, Hospital Santa Creu i Sant Pau, UAB, Barcelona.
Cir Esp. 2013 Feb;91(2):96-102. doi: 10.1016/j.ciresp.2012.05.002. Epub 2012 Jun 28.
Radical surgery is the standard treatment for localised gastrointestinal stromal tumours (GIST). A series of primary GIST, their treatment and pre-established risk of recurrence after their follow-up is evaluated.
A retrospective, descriptive and multicentre study was conducted on primary, non-metastatic GIST operated on between June 2007 and December 2008. The variables of greater relevance were analysed, including, location, size, mitotic index, and NHI and AFIP recurrence prognostic criteria, and their correlation with the disease-free survival (DFS) of the patients.
The series included 141 patients with a mean age of 65 years. The most frequent GIST location was in the stomach (70.8%) and small intestine (22.9%), and with a mean tumour size of 6.7 cm (0.5-35 cm). The surgery was R0 in 97.2% of cases (laparoscopic approach, 21.5%). The distribution according to NHI/Flescher criteria was, high (31.95%), and intermediate (26.4%), and according to AFIP/Miettinen criteria it was, high (22.9%) and intermediate (12.5%). After a mean follow-up of 20.3 months, there was a 7.1% (10 cases) recurrence, with only 2 cases belonging to the group with a «low risk» using the NHI and AFIP prognostic criteria. The DFS at one year was 95.5% and 91.5% at 2 years.
The series showed a high DFS and a good correlation with both the Flescher and the Miettinen criteria. However, the risk of recurrence varied according to the AFIP criteria (intermediate/high, 58.3%), or the AFIP criteria (intermediate/high, 35.4%) which included the tumour location. For this reason, we consider these latter criteria as the most adequate for assessing the prognostic risk of GIST recurrence.
根治性手术是局限性胃肠道间质瘤（GIST）的标准治疗方法。对一系列原发性GIST、其治疗方法以及随访后预先确定的复发风险进行评估。
对2007年6月至2008年12月间接受手术的原发性、非转移性GIST进行了一项回顾性、描述性多中心研究。分析了更相关的变量，包括位置、大小、有丝分裂指数以及NHI和AFIP复发预后标准，及其与患者无病生存期（DFS）的相关性。
该系列包括141例患者，平均年龄65岁。GIST最常见的位置是胃（70.8%）和小肠（22.9%），肿瘤平均大小为6.7厘米（0.5 - 35厘米）。97.2%的病例手术切缘为R0（腹腔镜手术占21.5%）。根据NHI/Flescher标准分布为高风险（31.95%）和中风险（26.4%），根据AFIP/Miettinen标准为高风险（22.9%）和中风险（12.5%）。平均随访20.3个月后，复发率为7.1%（10例），使用NHI和AFIP预后标准时，只有2例属于“低风险”组。1年时的无病生存率为95.5%，2年时为91.5%。
该系列显示出较高的无病生存率，且与Flescher和Miettinen标准均具有良好的相关性。然而，根据AFIP标准（中/高风险，58.3%）或包含肿瘤位置的AFIP标准（中/高风险，35.4%），复发风险有所不同。因此，我们认为后一种标准最适合评估GIST复发的预后风险。
