Department of General Surgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China.
Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
Surg Endosc. 2019 Sep;33(9):2982-2990. doi: 10.1007/s00464-018-6564-7. Epub 2018 Nov 27.
Till present, there are still controversies over the epidemiology, pathological features, types of surgical treatment, and prognoses of primary small gastric GISTs (gGISTs).
From January 1998 to January 2015, patients with primary small gGIST admitted from four high-volume medical centers of the Southern China were enrolled and their data were analyzed to evaluate their clinicopathological features, treatment and prognostic factors to provide evidence-based medical experience for clinical practice.
A total of 276 primary small gGIST cases over a period of 18 years were investigated and had a median age of 60 years (range 27-91 years old). Regarding the tumor sites, 24 (8.7%) cases were in the cardia of the stomach, 107 (38.8%) in the fundus, 117 (42.4%) in the gastric body, and 28 (10.1%) in the gastric antrum. Eleven patients (4.0%) underwent a preoperative biopsy. A total of 137 (49.6%), 75 (27.2%), and 64 (23.2%) patients underwent laparoscopic, open resection, and endoscopic resection, respectively. Sixty-four patients (23.2%) had local endoscopic resection, 172 (62.3%) had wedge resection, 7 (2.5%) had proximal gastrectomy, 19 (6.9%) had distal gastrectomy, and 14 (5.1%) had total gastrectomy. Mitotic counts were ≤ 5/50, (5-10)/50, and > 10/50 per HPF in 259 (93.8%), 7 (2.5%), and 10 (3.6%) cases, respectively. There were 259 cases (97.1%) of spindle cell type, 7 (2.5%) epithelial cell types and one case (0.4%) of mixed type. Immunohistochemistry showed 74.6% (206/276), 98.2% (271/276), and 97.4% (269/276) of the patients had co-expression of CD34+, CD117+, and DOG-1+, respectively. Thirty-nine patients underwent genetic testing (39/276, 14.1%). Three patients (1.1%) had positive resection margin. Five high-risk patients received follow-up treatment with imatinib with a median follow-up time of 38 months (range 3-156 months). The overall 1-, 3-, and 5-year overall survival rates were 100%, 99.6%, and 99.1%, respectively.
Though the incidence of primary small gGISTs increased per annum, the overall survival prognoses were high. Surgery or endoscopic resection was the primary mode of treatment. Pathological features of primary small gGISTs were similar to large gGISTs, and to achieve a timely surgical intervention, the identification of intermediate- and high-risk cases should be a future focus of study.
目前，原发性胃小 GIST（gGIST）的流行病学、病理特征、手术治疗类型和预后仍存在争议。
本研究纳入了 1998 年 1 月至 2015 年 1 月期间，来自华南地区 4 家高容量医疗中心的原发性胃小 gGIST 患者，并对其临床病理特征、治疗和预后因素进行了分析，为临床实践提供了循证医学经验。
本研究共纳入了 276 例原发性胃小 gGIST 患者，中位年龄为 60 岁（27-91 岁）。肿瘤部位：贲门 24 例（8.7%），胃底 107 例（38.8%），胃体 117 例（42.4%），胃窦 28 例（10.1%）。11 例（4.0%）患者行术前活检。腹腔镜、开放和内镜下切除分别为 137 例（49.6%）、75 例（27.2%）和 64 例（23.2%）。64 例（23.2%）患者行局部内镜下切除，172 例（62.3%）行楔形切除，7 例（2.5%）行近端胃大部切除，19 例（6.9%）行远端胃大部切除，14 例（5.1%）行全胃切除。核分裂像计数<5/50、（5-10）/50 和>10/50 的患者分别为 259 例（93.8%）、7 例（2.5%）和 10 例（3.6%）。梭形细胞型 259 例（97.1%），上皮样细胞型 7 例（2.5%），混合细胞型 1 例（0.4%）。免疫组化显示，CD34+、CD117+和 DOG-1+共表达的患者分别为 206 例（74.6%）、271 例（98.2%）和 269 例（97.4%）。39 例患者接受了基因检测（39/276，14.1%）。3 例（1.1%）患者切缘阳性。5 例高危患者接受了伊马替尼的随访治疗，中位随访时间为 38 个月（3-156 个月）。总 1、3、5 年生存率分别为 100%、99.6%和 99.1%。
尽管原发性胃小 gGIST 的发病率逐年增加，但总体生存预后良好。手术或内镜下切除是主要的治疗方式。原发性胃小 gGIST 的病理特征与大 gGIST 相似，为实现及时的手术干预，识别中高危病例应成为未来的研究重点。
