Şenol Kazım, Dağlar Özdemir Gül, Akat Arif Zeki, Kama Nuri Aydın
Department of General Surgery, Uludag University School of Medicine, Bursa, Turkey.
Department of General Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey.
Turk J Surg. 2020 Jun 8;36(2):209-217. doi: 10.5578/turkjsurg.4389. eCollection 2020 Jun.
The aim of this study was to evaluate the prognostic factors effecting recurrence risk and disease-free survival of the patients who were diagnosed as gastrointestinal stromal tumor after complete resection of the tumor with or without adjuvant therapy.
Between the years 2005 and 2013, data of 71 patients including clinical and demographic features, tumor localizations, pathologic examinations, survival and recurrence rates were enrolled into this retrospective study.
Male/female ratio was 1.71, and mean age was 60.27 ± 14.65 years. Forty-two (59.2%) patients had tumor in stomach, 16 (22.5%) in small bowel, whereas 12 (16.9%) had extra-gastrointestinal system and one patient (%1.4) had rectal localization. Modified NIH risk stratification scheme categorized 9 (12.68%) patients in very low-, 12 (16.90%) in low-, 21 (29.58%) patients in moderate-and 29 (40.85%) patients in high-risk group. Twenty-four (33.8%) patients had a metastatic disease at follow-up while 13 (18.3%) patients were metastatic at admission. R0 resection was successfully performed in 51 (71.8%) patients, while R1 resection in 9 (12.7%) and R2 resection in 11 (15.5%) were achieved. Mean follow-up time was 47.12 ± 33.52 months (range, 1-171 months). Nineteen (26.8%) patients demonstrated recurrence with a mean time of 22.16 ± 15.89 months (range, 3-57 months). During follow-up 17 (23.9%) patients were deceased. In univariate analysis, high-risk group, small bowel and extra-gastrointestinal system localization, R1-2 resection, necrosis, positive resection margin and invasion of surrounding tissues, metastatic disease and adjuvant therapy were statistically significant in terms of recurrence. Multivariate analysis presented small bowel and extra-gastrointestinal system localization, R2 resection, mitoses count, invasion and adjuvant therapy as independent prognostic risk factors affecting disease-free survival rates. The 1, 3 and 5 years of disease-free survival rates of the patients were 89.6%, 75.4%, 64.3%, respectively.
As mentioned in the literature, the mainstay of curative therapy of gastrointestinal stromal tumor is surgery. In our study, not only small bowel, extra-gastrointestinal system localization and invasion of surrounding tissues by tumor, but also R2 resection that complicate the local control of the disease were represented as independent adverse prognostic factors for disease-free survival. Unfavourable clinical outcomes of adjuvant therapy over the disease-free survival was linked to higher tumor stage with metastatic disease and emphasized that prospective trials with more cases should be practiced.
本研究旨在评估经肿瘤完全切除（无论有无辅助治疗）后被诊断为胃肠道间质瘤的患者复发风险及无病生存期的预后因素。
2005年至2013年间，本回顾性研究纳入了71例患者的数据，包括临床和人口统计学特征、肿瘤定位、病理检查、生存率和复发率。
男女比例为1.71，平均年龄为60.27±14.65岁。42例（59.2%）患者肿瘤位于胃，16例（22.5%）位于小肠，12例（16.9%）位于胃肠道外系统，1例（1.4%）位于直肠。改良的美国国立卫生研究院（NIH）风险分层方案将9例（12.68%）患者归为极低风险组，12例（16.90%）归为低风险组，21例（29.58%）归为中度风险组，29例（40.85%）归为高风险组。24例（33.8%）患者在随访时有转移疾病，13例（18.3%）患者入院时即有转移。51例（71.8%）患者成功进行了R0切除，9例（12.7%）进行了R1切除，11例（15.5%）进行了R2切除。平均随访时间为47.12±33.52个月（范围1 - 171个月）。19例（26.8%）患者出现复发，平均复发时间为22.16±15.89个月（范围3 - 57个月）。随访期间17例（23.9%）患者死亡。单因素分析显示，高风险组、小肠和胃肠道外系统定位、R1 - 2切除、坏死、切缘阳性和周围组织侵犯、转移疾病及辅助治疗在复发方面具有统计学意义。多因素分析表明，小肠和胃肠道外系统定位、R2切除、核分裂象计数、侵犯及辅助治疗是影响无病生存率的独立预后风险因素。患者的1年、3年和5年无病生存率分别为89.6%、75.4%、64.3%。
如文献所述，胃肠道间质瘤的根治性治疗主要手段是手术。在我们的研究中，不仅小肠、胃肠道外系统定位及肿瘤对周围组织的侵犯，而且使疾病局部控制复杂化的R2切除均被视为无病生存的独立不良预后因素。辅助治疗对无病生存的不良临床结局与更高的伴有转移疾病的肿瘤分期相关，并强调应开展更多病例的前瞻性试验。
