Lu Jun, Dai Yun, Zheng Hua-Long, Xie Jian-Wei, Wang Jia-Bin, Lin Jian-Xian, Chen Qi-Yue, Cao Long-Long, Lin Mi, Tu Ru-Hong, Huang Ze-Ning, Lin Ju-Li, Li Ping, Huang Chang-Ming, Zheng Chao-Hui
Department of Gastric Surgery, Fujian Medical University Union Hospital.
Department of General Surgery, Fujian Medical University Union Hospital.
Medicine (Baltimore). 2019 Jan;98(3):e14177. doi: 10.1097/MD.0000000000014177.
In gastrointestinal stromal tumors (GISTs), rupture is a high-risk feature; however, "tumor rupture" is inconsistently defined, and its prognostic value remains controversial.Six hundred ninety-one patients undergoing surgery for primary nonmetastatic GISTs from 2003 to 2015 at our institution were enrolled. The strict definitions of "tumor rupture" according to the Kinki GIST Study Group (KGSG) were used.The median follow-up time was 64 months. The 5-year recurrence-free survival (RFS) and overall survival (OS) rates in the entire group were 79.3% and 84.1%, respectively. According to the KGSG's definition, tumor rupture occurred only in 24 (3.5%) of 691 patients. For all 691 patients, multivariable analysis showed that tumor rupture, according to KGSG's definition, is one of the independently prognostic factors for both RFS and OS. Twenty-four patients with tumor rupture were further analyzed. Receiving IM for more than 3 years was significantly associated with improved RFS and OS in GISTs patients with tumor rupture.Tumor rupture according to KGSG's definition was an independent predictive factor associated with GIST patient prognosis. More importantly, for GISTs with tumor rupture according to the KGSG's strict definition, receiving IM treatment for ≥3 years should be considered.
在胃肠道间质瘤（GISTs）中，肿瘤破裂是一个高危特征；然而，“肿瘤破裂”的定义并不一致，其预后价值仍存在争议。我们纳入了2003年至2015年在本机构接受原发性非转移性GISTs手术的691例患者。采用了根据近畿胃肠道间质瘤研究组（KGSG）制定的“肿瘤破裂”的严格定义。中位随访时间为64个月。整个队列的5年无复发生存率（RFS）和总生存率（OS）分别为79.3%和84.1%。根据KGSG的定义，肿瘤破裂仅发生在691例患者中的24例（3.5%）。对所有691例患者进行多变量分析显示，根据KGSG的定义，肿瘤破裂是RFS和OS的独立预后因素之一。对24例肿瘤破裂患者进行了进一步分析。接受3年以上伊马替尼治疗与肿瘤破裂的GISTs患者的RFS和OS改善显著相关。根据KGSG的定义，肿瘤破裂是与GISTs患者预后相关的独立预测因素。更重要的是，对于根据KGSG严格定义发生肿瘤破裂的GISTs，应考虑接受≥3年的伊马替尼治疗。
