Pancreatic Disease Institute, Department of Pancreatic Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, China.
Am J Surg. 2013 Sep;206(3):360-7. doi: 10.1016/j.amjsurg.2012.11.010. Epub 2013 May 11.
Gastrointestinal stromal tumors (GISTs) occur rarely in the duodenum. Because of their low incidence, data on long-term survival and prognostic factors are limited. The aims of this study were to present the authors' experiences in the diagnosis and treatment of this disease and to evaluate long-term surgical outcomes.
Clinical data from 22 consecutive patients with duodenal GISTs surgically managed from May 1999 to August 2011 were retrospectively studied. A pooled analysis was done by systematically reviewing other case series reported in the English literature. Recurrence-free survival and independent predictors of adverse outcomes were analyzed using the Kaplan-Meier method and multivariate Cox regression.
Duodenal GISTs had a mild male predominance (68.2%), occurring primarily in older adults (median age, 58 years), with a frequency of 7.49% among all GISTs. Clinical presentations were nonspecific, with gastrointestinal bleeding and abdominal pain or discomfort being the most common symptoms. The tumors were located mainly in the second portion of the duodenum, in 14 patients (63.6%), with a median size of 3.75 cm (range, 1.4 to 14). All patients underwent curative surgical resection, including 9 pancreaticoduodenectomy, 3 segmental duodenectomy, and 10 local resection. Eighteen patients were alive without evidence of recurrence after a median follow-up period of 67.5 months (range, 3 to 118). The 1-year, 2-year, and 3-year rates of recurrence-free survival were 95%, 89.5%, and 86.7%, respectively. Kaplan-Meier analysis and log-rank tests showed that surgical pattern, mitosis, and risk grade were significantly associated with recurrence-free survival (P < .05 for all). However, only high mitosis was a significant predictive factor for adverse outcomes on multivariate analysis (hazard ratio, 16.414; 95% confidence interval, 1.914 to 140.756; P = .011).
Duodenal GIST is an unusual neoplasm with favorable survival after curative resection. Mitotic activity was more influential than tumor size and risk grade in predicting adverse outcomes. All patients with duodenal GISTs require long-term follow-up, because late relapse can occur even if the tumor has low malignant potential.
胃肠道间质瘤（GIST）在十二指肠中很少见。由于其发病率低，有关长期生存和预后因素的数据有限。本研究的目的是介绍作者在诊断和治疗这种疾病方面的经验，并评估长期手术结果。
回顾性研究了 1999 年 5 月至 2011 年 8 月期间连续 22 例接受手术治疗的十二指肠 GIST 患者的临床资料。通过系统回顾英文文献中的其他病例系列，进行了汇总分析。使用 Kaplan-Meier 方法和多变量 Cox 回归分析无复发生存率和不良结局的独立预测因素。
十二指肠 GIST 男性略多见（68.2%），主要发生于老年人（中位年龄 58 岁），占所有 GIST 的 7.49%。临床表现不特异，以胃肠道出血和腹痛或不适为最常见症状。肿瘤主要位于十二指肠第二段，14 例（63.6%），中位大小为 3.75cm（范围 1.4 至 14cm）。所有患者均行根治性手术切除，包括 9 例胰十二指肠切除术、3 例节段性十二指肠切除术和 10 例局部切除术。18 例患者在中位随访 67.5 个月（范围 3 至 118 个月）后无复发证据而存活。无复发生存率的 1 年、2 年和 3 年率分别为 95%、89.5%和 86.7%。Kaplan-Meier 分析和对数秩检验显示，手术方式、有丝分裂和危险分级与无复发生存率显著相关（均 P<.05）。然而，仅高有丝分裂是多因素分析中不良结局的显著预测因素（危险比 16.414；95%置信区间 1.914 至 140.756；P=.011）。
十二指肠 GIST 是一种罕见的肿瘤，根治性切除后生存良好。有丝分裂活性比肿瘤大小和危险分级更能预测不良结局。所有十二指肠 GIST 患者均需长期随访，因为即使肿瘤恶性潜能低，也可能发生晚期复发。
