Shen Chaoyong, Chen Haining, Yin Yuan, Chen Jiaju, Tang Sumin, Zhang Bo, Han Luyin, Chen Zhixin, Chen Jiaping
From the Department of Gastrointestinal Surgery (CS, HC, YY, JC, ST, BZ, ZC, JC); and Intensive Care Unit, West China Hospital, Sichuan University, Chengdu, China (LH).
Medicine (Baltimore). 2015 Jul;94(28):e1117. doi: 10.1097/MD.0000000000001117.
Data on treatments and specific outcomes of primary gastrointestinal stromal tumors (GISTs) ≥10 cm are limited. We here report the treatments and survival outcomes concerning a subgroup of primary giant GISTs. Data of 83 consecutive patients with primary GISTs ≥10 cm in a single institution were retrospectively collected. Fifty-eight patients underwent surgery before imatinib mesylate (IM) treatment (Group A), 10 underwent surgical resection following IM therapy (Group B), whereas 15 patients took IM as drug therapy alone (Group C). The baseline clinical characteristics were similar among the 3 groups. However, a lower proportion in Group A had metastatic disease at the time of diagnosis or surgery compared with Groups B and C (8.6% vs 40.0% vs 40.0%, P < 0.05). The median follow-up duration was 21.5 months. No statistically significant differences were observed on progression-free survival (PFS) among the groups. However, patients in Group B showed significantly better overall survival (OS) compared with those in Group C (P = 0.044). Multivariate analysis showed that patients treated with adjuvant IM were associated with better PFS (hazard ratio [HR] 3.01; 95% confidence interval [CI] 1.13-7.97; P = 0.027) and OS (HR 29.11; 95% CI 3.32-125.36; P = 0.004). The subgroup with mitotic count >10/50 high-power fields (HPF) showed worse PFS (HR 3.50; 95% CI 1.19-10.25; P = 0.022) and OS (HR 20.04; 95% CI 1.67-143.79; P = 0.018) than that of mitotic count ≤5/50 HPF. Clinical treatment patterns for primary giant GISTs are different, and the outcomes of different interventions vary. The optimal treatments for these subgroup of patients still require further long-term investigation. Moreover, mitotic count and adjuvant IM are closely associated with PFS and OS in giant GISTs.
关于直径≥10厘米的原发性胃肠道间质瘤（GIST）的治疗及特定结局的数据有限。我们在此报告一组原发性巨大GIST患者的治疗及生存结局。回顾性收集了某单一机构中83例连续的原发性GIST直径≥10厘米患者的数据。58例患者在甲磺酸伊马替尼（IM）治疗前行手术（A组），10例在IM治疗后行手术切除（B组），而15例患者仅接受IM药物治疗（C组）。3组患者的基线临床特征相似。然而，与B组和C组相比，A组在诊断或手术时发生转移疾病的比例更低（8.6%对40.0%对40.0%，P<0.05）。中位随访时间为21.5个月。各组间无进展生存期（PFS）差异无统计学意义。然而，B组患者的总生存期（OS）显著优于C组（P = 0.044）。多因素分析显示，接受辅助IM治疗的患者PFS更好（风险比[HR] 3.01；95%置信区间[CI] 1.13 - 7.97；P = 0.027）且OS更好（HR 29.11；95% CI 3.32 - 125.36；P = 0.004）。有丝分裂计数>10/50高倍视野（HPF）的亚组PFS（HR 3.50；95% CI 1.19 - 10.25；P = 0.022）和OS（HR 20.04；95% CI 1.67 - 143.79；P = 0.018）均较有丝分裂计数≤5/50 HPF的亚组更差。原发性巨大GIST的临床治疗模式不同，不同干预措施的结局各异。这些亚组患者的最佳治疗仍需进一步长期研究。此外，有丝分裂计数和辅助IM与巨大GIST的PFS和OS密切相关。
