Division of Surgical Oncology and Thoracic Surgery, Department of Surgery, University Medical Center and Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany.
Ann Surg Oncol. 2013 Feb;20(2):586-92. doi: 10.1245/s10434-012-2647-1. Epub 2012 Sep 11.
The rectum is a rare site of gastrointestinal stromal tumor (GIST), and factors determining long-term outcome remain unclear. In a population study, we assessed the outcome of rectal GIST patients treated at two referral centers.
A total of 39 patients diagnosed with rectal GIST between January 2002 and December 2010 were identified in prospective databases. Tumor and patient characteristics, treatment details, and outcome were evaluated. Median follow-up was 41 (3-110) months.
A male predominance was noticed (M/F = 29/10). Median age was 53 years (range, 32-80 years). The cohort included, of 39 patients, 12 low-risk, 26 high-risk, and 1 with M1 disease. Of 38 patients with nonmetastatic disease, 36 underwent surgery as transabdominal (15 of 36) or local (21 of 36) resection. There were 21 patients who received preoperative and/or postoperative imatinib treatment. Patients with preoperative imatinib (16 of 36) had a significantly higher rate of R0 resections (p = .02). Five patients developed local recurrences. All of them had undergone local tumor excision with positive margins and without perioperative imatinib. Also, five patients suffered from distant metastases. All belonged to the high-risk group and underwent tumor surgery (3 R0, 2 R1) without receiving perioperative imatinib. A total of three patients died of disease. Perioperative imatinib was associated with improved local disease-free, disease-free, and overall survival (p < .01, p < .01, and p = .03, respectively). Local disease-free survival was significantly improved by negative resection margins (p < .01).
Complete resection is recommended to achieve local disease control. Preoperative imatinib was associated with improved surgical margins. Perioperative imatinib was associated with improved local disease-free, disease-free, and overall survival.
直肠是胃肠道间质瘤（GIST）的罕见部位，决定长期预后的因素仍不清楚。在一项人群研究中，我们评估了在两个转诊中心治疗的直肠 GIST 患者的结局。
在前瞻性数据库中确定了 2002 年 1 月至 2010 年 12 月期间诊断为直肠 GIST 的 39 例患者。评估了肿瘤和患者特征、治疗细节和结局。中位随访时间为 41 个月（3-110 个月）。
观察到男性为主（M/F=29/10）。中位年龄为 53 岁（范围 32-80 岁）。该队列包括 39 例患者，其中 12 例为低危，26 例为高危，1 例为 M1 期。在 38 例非转移性疾病患者中，36 例接受了经腹（36 例中的 15 例）或局部（36 例中的 21 例）切除术。有 21 例患者接受了术前和/或术后伊马替尼治疗。接受术前伊马替尼治疗的患者（36 例中的 16 例）R0 切除率显著更高（p=0.02）。5 例患者发生局部复发。所有患者均行局部肿瘤切除术，切缘阳性，无围手术期伊马替尼治疗。此外，5 例患者发生远处转移。所有患者均属于高危组，行肿瘤切除术（3 例 R0，2 例 R1），无围手术期伊马替尼治疗。共有 3 例患者死于疾病。围手术期伊马替尼治疗与改善局部无病生存、无病生存和总生存相关（p<0.01、p<0.01 和 p=0.03）。阴性切缘与局部无病生存显著改善相关（p<0.01）。
建议行完全切除术以实现局部疾病控制。术前伊马替尼与改善手术切缘相关。围手术期伊马替尼与改善局部无病生存、无病生存和总生存相关。
