Department of Gastroenterology, Japan Labour Health and Welfare Organization, Yokohama Rosai Hospital, Yokohama, Japan.
Department of Surgery, Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, Tokyo, Japan.
Jpn J Clin Oncol. 2022 Mar 3;52(3):237-243. doi: 10.1093/jjco/hyab200.
A gastrointestinal stromal tumor rupture entails a high risk of recurrence even after curative surgery. However, the definition of rupture is unclear, and the question of whether patients with a minor rupture should be treated with adjuvant imatinib remains controversial.
The present, retrospective, multicentric study enrolled 57 patients with gastrointestinal stromal tumor with a minor/major tumor rupture, of whom 46 were finally found to be eligible for analysis. Tumor ruptures were subclassified by their degree, timing and cause. Multivariate analysis was performed to identify the risk factors of all types of recurrence as well as of peritoneal recurrence only.
The study cohort included minor (n = 24), intraoperative (n = 19) and iatrogenic (n = 20) ruptures besides the typical types (major, preoperative and spontaneous). All intraoperative ruptures were iatrogenic. In total, 27 patients (58.7%) had a recurrence in the peritoneum (n = 17) and/or the liver (n = 13) during a median follow-up period of 5.8 years, but no recurrence was observed in patients with tumor rupture as a single, high-risk factor. Multivariate analysis found the timing of tumor rupture to be an independent risk factor of poor recurrence-free survival (hazard ratio: 2.37; 95% confidence interval: 1.02-5.49; P = 0.045).
Preoperative tumor rupture in patients with a ruptured gastrointestinal stromal tumor was associated with poor recurrence-free survival. Our results suggested that a distinction should be made between preoperative and intraoperative tumor ruptures when considering the indications for adjuvant imatinib therapy for gastrointestinal stromal tumor patients with tumor rupture as a single, high-risk factor of recurrence.
胃肠道间质瘤破裂即使在根治性手术后也有很高的复发风险。然而，破裂的定义并不明确，对于有轻微破裂的患者是否应该用辅助伊马替尼治疗仍存在争议。
本回顾性多中心研究纳入了 57 例有轻微/严重肿瘤破裂的胃肠道间质瘤患者，其中 46 例最终符合分析条件。肿瘤破裂按其程度、时间和原因进行分类。进行多变量分析以确定所有类型复发的危险因素，以及仅腹膜复发的危险因素。
研究队列包括轻微（n=24）、术中（n=19）和医源性（n=20）破裂，除了典型类型（主要、术前和自发性）外。所有术中破裂均为医源性。在中位随访 5.8 年期间，共有 27 例（58.7%）患者在腹膜（n=17）和/或肝脏（n=13）出现复发，但在肿瘤破裂为单一高危因素的患者中未观察到复发。多变量分析发现肿瘤破裂的时间是无复发生存率不良的独立危险因素（风险比：2.37；95%置信区间：1.02-5.49；P=0.045）。
对于破裂的胃肠道间质瘤患者，术前肿瘤破裂与无复发生存率不良相关。我们的结果表明，在考虑胃肠道间质瘤患者肿瘤破裂为单一高危因素时，辅助伊马替尼治疗的适应证时，应区分术前和术中肿瘤破裂。
