From the Department of Radiology and Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115 (A.B.S., I.K.I., R.L., R.K.); Department of Radiology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Mass (A.B.S., N.H.R.); and Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Mass (S.G.).
Radiology. 2015 Feb;274(2):395-404. doi: 10.1148/radiol.14132456. Epub 2014 Sep 5.
To identify the frequency of and variables associated with thoracic metastasis in patients with gastrointestinal stromal tumor (GIST) to help optimize the use of cross-sectional chest imaging.
This retrospective institutional review board-approved study included 631 patients (343 men; mean age, 55 years; range, 19-94 years) with pathologically confirmed GIST who were identified with a natural language processing algorithm in a review of radiologic reports from January 2004 through October 2012, followed by manual confirmation. The requirement for informed consent was waived. Available imaging, pathologic, and clinical records were reviewed to confirm the presence of abdominal and thoracic metastases. The association of age; sex; size, location, mitotic count, and risk stratification of the primary tumor; initial treatment; presence of abdominal metastases; and bulky abdominal metastases (more than 10 lesions larger than 1 cm, or more than five lesions with at least one larger than 5 cm) with development of thoracic metastases, the primary outcome measure, was studied by using logistic regression.
During median follow-up of 61.4 months (interquartile range, 37.8-93 months), 401 of 631 (63.5%) patients developed metastatic disease (median interval, 6.9 months; interquartile range, 0-25.6 months), all with peritoneal (n = 324) and/or hepatic metastases (n = 303). Bulky abdominal metastases were found in 218 (34.5%) patients. Although 579 (91.8%) patients underwent chest imaging, only 64 of 631 (10.1%) developed thoracic metastases (median, 51.4 months; interquartile range, 36-78.7 months); all had bulky abdominal metastases except one patient who presented with symptomatic scapular metastasis. Only bulky abdominal metastasis was significantly associated with the development of thoracic metastasis (P < .0001; odds ratio, 42.6; range, 8.6-211.5).
Thoracic metastases are relatively uncommon in patients with GIST and are significantly associated only with presence of bulky abdominal metastases.
确定胃肠道间质瘤（GIST）患者发生胸部转移的频率和相关变量，以帮助优化横断面胸部成像的应用。
本回顾性机构审查委员会批准的研究纳入了 631 例（男 343 例；平均年龄 55 岁；范围 19-94 岁）经病理证实的 GIST 患者，这些患者是通过对 2004 年 1 月至 2012 年 10 月间放射学报告的自然语言处理算法进行识别的，随后进行了人工确认。豁免了知情同意的要求。回顾了可用的影像学、病理学和临床记录，以确认腹部和胸部转移的存在。研究了年龄、性别、原发肿瘤的大小、位置、有丝分裂计数和风险分层、初始治疗、腹部转移的存在以及腹部转移灶（>10 个直径大于 1cm 的病灶，或>5 个至少有一个大于 5cm 的病灶）与发生胸部转移（主要结局）的关系，采用 logistic 回归进行分析。
在 631 例患者的中位随访时间 61.4 个月（四分位距，37.8-93 个月）期间，401 例（63.5%）患者发生了转移性疾病（中位间隔 6.9 个月；四分位距，0-25.6 个月），均为腹膜（n = 324）和/或肝转移（n = 303）。218 例（34.5%）患者存在腹部转移灶。尽管 579 例（91.8%）患者进行了胸部成像，但仅有 64 例（10.1%）发生了胸部转移（中位时间 51.4 个月；四分位距，36-78.7 个月）；除了一名出现肩胛部症状性转移的患者外，所有患者均存在腹部转移灶。只有腹部转移灶且体积较大与发生胸部转移显著相关（P <.0001；优势比，42.6；范围，8.6-211.5）。
胃肠道间质瘤患者发生胸部转移相对少见，仅与存在体积较大的腹部转移灶显著相关。
