Zhao Bochao, Zhang Jingting, Mei Di, Zhang Jiale, Luo Rui, Xu Huimian, Huang Baojun
a Department of Surgical Oncology , First Affiliated Hospital of China Medical University , Shenyang , P.R. China.
Scand J Gastroenterol. 2018 Oct-Nov;53(10-11):1319-1327. doi: 10.1080/00365521.2018.1515319. Epub 2018 Oct 24.
Although various risk classification systems for GISTs have been proposed, the optimum one remains uncertain. In the present study, we compared the prognostic stratification of different risk classification systems for GIST patients.
We reviewed those patients who were pathologically diagnosed with GISTs in the SEER database between 2009 and 2014. All patients were classified into different risk groups according to the NIH criteria, AFIP criteria and AJCC staging system, respectively. The prognostic differences between different risk groups were compared and clinicopathologic features were analyzed.
The prognosis of small intestinal GISTs was not significantly different from that of gastric GISTs. For gastric GIST patients, there was no significant prognostic difference between very low risk and low risk group according to the NIH and AFIP criteria. However, the prognostic stratification for two groups could be improved by the AJCC staging system. For small intestinal GIST patients, the prognostic difference between low risk and intermediate risk group was not stratified properly by the NIH and AFIP criteria. However, the prognostic difference between two groups could reach statistical significance according to the AJCC staging system. Unlike gastric GISTs, tumor size was not identified as an independent factor influencing the prognosis of small intestinal GISTs.
The AJCC staging system could provide a better prognostic stratification for GIST patients compared with the NIH and AFIP criteria, regardless of gastric or small intestinal tumor. However, primary tumor location and tumor size may be reconsidered and revised in the risk classification system.
尽管已提出多种胃肠道间质瘤（GIST）的风险分类系统，但最佳的分类系统仍不明确。在本研究中，我们比较了不同风险分类系统对GIST患者的预后分层。
我们回顾了2009年至2014年间在监测、流行病学与最终结果（SEER）数据库中经病理诊断为GIST的患者。所有患者分别根据美国国立卫生研究院（NIH）标准、武装部队病理研究所（AFIP）标准和美国癌症联合委员会（AJCC）分期系统分为不同风险组。比较不同风险组之间的预后差异并分析临床病理特征。
小肠GIST的预后与胃GIST的预后无显著差异。对于胃GIST患者，根据NIH和AFIP标准，极低风险组和低风险组之间的预后无显著差异。然而，AJCC分期系统可改善两组的预后分层。对于小肠GIST患者，NIH和AFIP标准未正确分层低风险组和中风险组之间的预后差异。然而，根据AJCC分期系统，两组之间的预后差异具有统计学意义。与胃GIST不同，肿瘤大小未被确定为影响小肠GIST预后的独立因素。
与NIH和AFIP标准相比，AJCC分期系统可为GIST患者提供更好的预后分层，无论肿瘤位于胃还是小肠。然而，在风险分类系统中可能需要重新考虑和修订原发肿瘤部位和肿瘤大小。
