Kim Min-Chan, Yook Jeong-Hwan, Yang Han-Kwang, Lee Hyuk-Joon, Sohn Tae-Sung, Hyung Woo-Jin, Ryu Seung-Wan, Kurokawa Yukinori, Kim Young-Woo, Han Sang-Uk, Kim Hyung-Ho, Park Do-Joong, Kim Wook, Lee Sang-Il, Cho Haruhiko, Cho Gyu-Seok, Kim Jin-Jo, Kim Ki-Han, Yoo Moon-Won
From the Department of Surgery, Dong-A University College of Medicine, Seoul, Korea (M-CK, K-HK); Department of Surgery, University of Ulsan College of Medicine, Seoul, Korea (J-HY, M-WY); Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea (H-KY, H-JL); Department of Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea (T-SS); Department of Surgery, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Korea (W-JH); Department of Surgery, Keimyung University School of Medicine, Seoul, Korea (S-WR); Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Seoul, Korea (YK); Center for Gastric Cancer, National Cancer Center, Seoul, Korea (Y-WK); Department of Surgery, School of Medicine, Ajou University, Seoul, Korea (S-UH); Department of Surgery, Seoul National University Bundang Hospital, Seoul, Korea (H-HK, D-JP); Department of Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Cathoilc University of Korea, Seoul, Korea (WK); Department of Surgery, Chungnam National University Hospital, Seoul, Korea (S-IL); Department of Gastrointestinal Surgery, Kanagawa Cancer center, Seoul, Korea (HC); Department of Surgery, Soonchunhyang University College of Medicine, Seoul, Korea (G-SC); and Division of Gastrointestinal Surgery, Department of Surgery, Incheon St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea (J-JK).
Medicine (Baltimore). 2015 Oct;94(41):e1526. doi: 10.1097/MD.0000000000001526.
The aim of this study was to evaluate the treatment and prognosis of gastric gastrointestinal stromal tumors (GISTs) according to the 7th UICC/AJCC tumor-node-metastasis (TNM) system and the modified National Institutes of Health (NIH) risk classification. The study cohort consisted of 1057 patients with gastric GIST who underwent surgery between January 2000 and December 2007 from 13 institutions in Korea and 2 in Japan. Clinicopathologic characteristics, surgical outcomes, recurrence, and 5-year recurrence-free survival were evaluated.The mean age of the patients was 58.6 years. Thirty patients (2.8%) had distant metastasis preoperatively. Median tumor size was 4.0 cm. Complete resection (R0 resection) was achieved in 1018 patients (96.3%). Eighty-six patients (8.1%) had postoperative complications, and 2 patients (0.2%) died within 30 days after surgery. According to the 7th UICC/AJCC TNM system, 5-year recurrence-free survival rates were 95% to 99% in stage I, 94.1% in stage II, 74.1% in stage IIIA, 48.6% in stage IIIB, and 50.0% in stage IV patients. On survival analysis of high-risk patients according to the TNM system, the 5-year recurrence-free survival rates were 91.6% in stage II, 74.1% in stage IIIA, and 48.6% in stage IIIB patients. Independent factors of recurrence following surgery for gastric GIST were gender, tumor size, mitotic count, and radicality on multivariate analysis.The treatment outcome and prognosis of gastric GIST in Korea and Japan seem more favorable compared to those in Western countries. Compared to the modified NIH risk classification, the 7th UICC/AJCC TNM system is more reflective of the 5-year recurrence-free survival of patients with gastric GIST.
本研究旨在根据第7版国际抗癌联盟（UICC）/美国癌症联合委员会（AJCC）肿瘤-淋巴结-转移（TNM）系统和改良的美国国立卫生研究院（NIH）风险分类，评估胃胃肠道间质瘤（GIST）的治疗及预后情况。研究队列包括2000年1月至2007年12月期间在韩国13家机构和日本2家机构接受手术的1057例胃GIST患者。对其临床病理特征、手术结果、复发情况及5年无复发生存率进行了评估。患者的平均年龄为58.6岁。30例患者（2.8%）术前有远处转移。肿瘤中位大小为4.0厘米。1018例患者（96.3%）实现了根治性切除（R0切除）。86例患者（8.1%）有术后并发症，2例患者（0.2%）在术后30天内死亡。根据第7版UICC/AJCC TNM系统，I期患者的5年无复发生存率为95%至99%，II期为94.1%，IIIA期为74.1%，IIIB期为48.6%，IV期为50.0%。在根据TNM系统对高危患者进行生存分析时，II期患者的5年无复发生存率为91.6%，IIIA期为74.1%，IIIB期为48.6%。多因素分析显示，胃GIST术后复发的独立因素为性别、肿瘤大小、核分裂象计数和根治程度。与西方国家相比，韩国和日本胃GIST的治疗结果及预后似乎更理想。与改良的NIH风险分类相比，第7版UICC/AJCC TNM系统更能反映胃GIST患者的5年无复发生存情况。
