Department of Abdominal and Pediatric Surgery, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway.
Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway.
Ann Surg Oncol. 2018 May;25(5):1133-1139. doi: 10.1245/s10434-018-6353-5. Epub 2018 Feb 12.
In gastrointestinal stromal tumors (GISTs), rupture is a high-risk feature and an indication for adjuvant treatment; however, the independent impact of rupture on prognosis is uncertain and the term is inconsistently defined. In the present study, a previously proposed definition of 'tumor rupture' was applied on a population-based cohort of gastric GISTs.
Patients undergoing surgery for non-metastatic gastric GISTs from 2000 to 2015 were identified in the regional sarcoma database of Oslo University Hospital. Tumor rupture included spillage or fracture, piecemeal resection, incisional biopsy, blood-tinged ascites, gastric perforation, and microscopic adjacent infiltration. Minor defects of tumor integrity were not considered rupture, i.e. core needle biopsy, peritoneal tumor penetration, superficial peritoneal rupture, and R1 resection. Risk was assessed according to the modified National Institutes of Health consensus criteria.
Among 242 patients, tumor rupture occurred in 22 patients and minor defects of tumor integrity occurred in 81 patients. Five-year recurrence-free survival (RFS) for patients with tumor rupture, minor defects of tumor integrity, and no defect was 37, 91, and 96%, respectively (p < 0.001). In the high-risk group, 5 year RFS for patients with rupture was 37%, versus 77% without rupture (hazard ratio 3.56, 95% confidence interval 1.57-8.08, p = 0.001). On multivariable analysis, tumor rupture and mitotic index were independently associated with recurrence. Of 13 patients who received adjuvant imatinib after tumor rupture, 11 relapsed.
Tumor rupture according to the present definition was independently associated with recurrence. With tumor rupture, patients relapsed despite adjuvant treatment. Without rupture, prognosis was good, even in the high-risk group.
在胃肠道间质瘤（GIST）中，破裂是一个高风险特征，也是辅助治疗的指征；然而，破裂对预后的独立影响尚不确定，且该术语的定义也不一致。本研究应用了一种先前提出的“肿瘤破裂”定义，对一个基于人群的胃 GIST 队列进行了分析。
在奥斯陆大学医院的区域肉瘤数据库中，确定了 2000 年至 2015 年期间接受非转移性胃 GIST 手术的患者。肿瘤破裂包括溢出或破裂、分片切除、切开活检、血性腹水、胃穿孔和显微镜下相邻浸润。较小的肿瘤完整性缺陷不被认为是破裂，如芯针活检、腹膜肿瘤穿透、浅表腹膜破裂和 R1 切除。根据改良的美国国立卫生研究院共识标准评估风险。
在 242 例患者中，22 例患者发生肿瘤破裂，81 例患者发生肿瘤完整性缺陷。肿瘤破裂、肿瘤完整性缺陷和无缺陷的患者 5 年无复发生存率（RFS）分别为 37%、91%和 96%（p<0.001）。在高危组中，破裂患者的 5 年 RFS 为 37%，无破裂患者为 77%（危险比 3.56，95%置信区间 1.57-8.08，p=0.001）。多变量分析显示，肿瘤破裂和有丝分裂指数与复发独立相关。在 13 例因肿瘤破裂而接受辅助伊马替尼治疗的患者中，有 11 例复发。
根据本定义，肿瘤破裂与复发独立相关。尽管进行了辅助治疗，但有肿瘤破裂的患者仍会复发。无破裂时，即使在高危组，预后也良好。
