Department of Abdominal and Pediatric Surgery, Oslo University Hospital, The Norwegian Radium Hospital, Nydalen, Oslo, Norway.
Department of Radiology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway.
Ann Surg Oncol. 2021 Oct;28(11):6837-6845. doi: 10.1245/s10434-021-09605-8. Epub 2021 Mar 2.
Adjuvant imatinib for 3 years is recommended to patients with high-risk gastrointestinal stromal tumor (GIST). Risk stratification is inaccurate, and risk assessments are further complicated by the increased use of neoadjuvant treatment. Anatomical criteria for prognostication have not been investigated.
Clinical, molecular, and anatomical variables were retrospectively studied in a population-based cohort of 295 patients with gastric GIST resected between 2000 and 2018. Gastric subsite was divided into the upper, middle, and lower thirds. Growth pattern was classified as luminal, exophytic, or transmural based on imaging and surgical reports.
Of 113 tumors in the upper third of the stomach, 103 (91.2%) were KIT mutated, 7 (6.2%) were PDGFRA mutated, and 104 (92.0%) harbored genotypes sensitive to imatinib. Transmural tumors were strongly associated with a high mitotic index. Five-year recurrence-free survival (RFS) was 71% for patients with transmural tumors versus 96% with luminal or exophytic tumors (hazard ratio [HR] 8.45, 95% confidence interval [CI] 3.69-19.36; p < 0.001), and, in high-risk patients, 5-year RFS was 46% for patients with transmural tumors versus 83% with luminal or exophytic tumors (HR 4.47, 95% CI 1.71-11.66; p = 0.001). Among 134 patients with tumors > 5 cm, there were 29 recurrences. Only five patients with exophytic or luminal tumors had recurrent disease, of whom four had tumor rupture. Five-year RFS for patients with exophytic/luminal tumors >5 cm without rupture was 98%.
In the upper third, over 90% of tumors were sensitive to imatinib. Patients with exophytic or luminal tumors without rupture, irrespective of size, had an excellent prognosis and may not benefit from adjuvant therapy.
对于高危胃肠道间质瘤（GIST）患者，建议使用辅助伊马替尼治疗 3 年。风险分层不准确，新辅助治疗的应用进一步增加了风险评估的复杂性。目前尚未研究用于预后判断的解剖学标准。
对 2000 年至 2018 年间接受胃 GIST 切除术的 295 例患者进行了基于人群的回顾性临床、分子和解剖学变量研究。胃的亚部位分为上、中、下三分之一。根据影像学和手术报告，将生长模式分为腔内、外生或透壁。
在胃的上三分之一，113 个肿瘤中，103 个（91.2%）存在 KIT 突变，7 个（6.2%）存在 PDGFRA 突变，104 个（92.0%）存在对伊马替尼敏感的基因型。透壁肿瘤与高有丝分裂指数密切相关。5 年无复发生存率（RFS）为透壁肿瘤患者 71%，腔内或外生肿瘤患者 96%（危险比[HR]8.45，95%置信区间[CI]3.69-19.36；p<0.001），高危患者中，透壁肿瘤患者 5 年 RFS 为 46%，腔内或外生肿瘤患者为 83%（HR 4.47，95%CI 1.71-11.66；p=0.001）。在 134 例肿瘤>5cm 的患者中，有 29 例复发。仅有 5 例外生或腔内肿瘤患者出现复发病例，其中 4 例有肿瘤破裂。无破裂的>5cm 外生/腔内肿瘤患者 5 年 RFS 为 98%。
在上三分之一，超过 90%的肿瘤对伊马替尼敏感。无破裂的外生或腔内肿瘤患者，无论肿瘤大小，预后均较好，可能无需辅助治疗。
