Zhuang Chun, Wang Ming, Qiu Wei-qing, Xu Jia, Shen Zhi-yong, Cao Hui
Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2013 Mar;16(3):234-8.
To explore the clinicopathologic features, treatment and prognosis of gastrointestinal stromal tumor (GIST) complicated with synchronous other alimentary malignant tumors.
Clinical data of 525 patients with GIST undergoing surgical treatment from August 2004 to November 2012 in Shanghai Renji Hospital were reviewed retrospectively, among whom 46 patients presented synchronous other alimentary malignancy.
GIST and other alimentary malignancy coexisting cases were less likely to be screened out preoperatively (2.2%, 1/46) and associated with elder age (P=0.001), more likely arise from stomach (P=0.000), smaller tumor maximum diameter (P=0.000), and lower mitotic count (P=0.000). According to NIH postoperative risk classification, there were 36 at very low risk, 9 at low risk, and 1 at high risk. Although the risk of GIST recurrence was lower for GIST and other alimentary malignancy coexisting cases, their 5-year survival rate was lower than that of patients with GIST alone (36.1%VS. 82.2%, P=0.000).
GIST patients complicated with synchronous alimentary malignant tumor are usually low or very low risk and has minimal impact on the prognosis. Survival depends primarily on the synchronous alimentary malignant tumors. Therefore, it is reasonable to lay emphasis on the treatment of the alimentary malignant tumor, and perform synchronous resection of GIST if possible.
探讨胃肠道间质瘤(GIST)合并同时性其他消化道恶性肿瘤的临床病理特征、治疗方法及预后。
回顾性分析2004年8月至2012年11月在上海仁济医院接受手术治疗的525例GIST患者的临床资料,其中46例患者合并同时性其他消化道恶性肿瘤。
GIST与其他消化道恶性肿瘤共存的病例术前较难筛查出(2.2%,1/46),且与老年相关(P = 0.001),更易发生于胃(P = 0.000),肿瘤最大直径较小(P = 0.000),核分裂象计数较低(P = 0.000)。根据美国国立卫生研究院(NIH)术后风险分类,极低风险36例,低风险9例,高风险1例。虽然GIST与其他消化道恶性肿瘤共存病例的GIST复发风险较低,但其5年生存率低于单纯GIST患者(36.1%对82.2%,P = 0.000)。
合并同时性消化道恶性肿瘤的GIST患者通常为低风险或极低风险,对预后影响极小。生存主要取决于同时性消化道恶性肿瘤。因此,重视消化道恶性肿瘤的治疗并尽可能同期切除GIST是合理的。