接受手术联合或不联合 TKI 治疗的胃肠道间质瘤患者的临床特征和结局：一项回顾性真实世界研究。

Clinical characteristics and outcomes of gastrointestinal stromal tumor patients receiving surgery with or without TKI therapy: a retrospective real-world study.

机构信息

Department of General Surgery, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.

Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.

出版信息

World J Surg Oncol. 2023 Jan 23;21(1):21. doi: 10.1186/s12957-023-02897-y.

DOI:10.1186/s12957-023-02897-y

PMID:36691015

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9869533/

Abstract

PURPOSE

To retrospectively analyze the clinical characteristics of patients undergoing surgical treatment for gastrointestinal stromal tumors (GISTs) in Ruijin Hospital and explore the relevant prognosis clinical factors after surgical treatment.

METHODS

We screened out 1015 patients with GISTs diagnosed and treated during January 2010 to December 2019. We performed univariate analysis by the log-rank test and multivariate analysis by COX regression. The Kaplan-Meier method was used to estimate the disease-free survival (DFS) and overall survival (OS) of the whole group.

RESULTS

All 1015 patients in the whole group received radical surgery, and the proportion of patients with high, intermediate, and low risk was 31.1%, 21.7%, and 47.3%, respectively. Among the 480 low-risk patients, surgery could achieve radical therapy; only the Ki-67 index was related to DFS and OS (DFS: p = 0.032, OS: p = 0.009) among the 140 intermediate-risk patients with tumors located in the stomach, whether received Tyrosine kinase inhibitors (TKIs) therapy did not affect the prognosis of patients (DFS: p = 0.716, OS: p = 0.848). Among the 331 high-risk patients, those with non-gastric tumors (those outside the stomach, duodenum, and small intestine, HR 1.55, 95% CI 1.19-2.00, p < 0.001), tumor diameter > 10 cm (hazard ratio, HR 2.63, 95% confidence interval, CI 2.09-4.03, p < 0.001), as well as high-risk patients with mitotic rate > 10/50 HPF (HR 2.74, 95% CI 2.00-3.76, p < 0.001), the overall prognosis was obviously worse than that of other patients. For some high-risk patients, prolonged postoperative imatinib therapy could significantly improve the survival of patients (HR 0.43, 95% CI 0.15-0.66, p < 0.001).

CONCLUSIONS

For the vast majority of GIST patients, surgery can be curative; but in intermediate-risk patients, the Ki-67 index and postoperative TKI treatment are closely related to prognosis. For intermediate-risk patients whose primary tumor is the stomach, the value of TKI-targeted therapy after surgery seem be not necessary in our study. However, for some high-risk patients, the prognosis of patients can be improved by appropriately prolonging the treatment time of TKI.

摘要

目的

回顾性分析瑞金医院胃肠间质瘤（GISTs）患者的临床特征，并探讨手术治疗后相关的预后临床因素。

方法

我们筛选了 2010 年 1 月至 2019 年 12 月期间诊断和治疗的 1015 例 GIST 患者。采用对数秩检验进行单因素分析，采用 COX 回归进行多因素分析。Kaplan-Meier 法估计全组无病生存（DFS）和总生存（OS）。

结果

全组 1015 例患者均行根治性手术，高危、中危、低危患者的比例分别为 31.1%、21.7%和 47.3%。在 480 例低危患者中，手术可达到根治性治疗；仅 Ki-67 指数与 DFS 和 OS 相关（DFS：p=0.032，OS：p=0.009），胃内肿瘤的 140 例中危患者，是否接受酪氨酸激酶抑制剂（TKI）治疗并不影响患者的预后（DFS：p=0.716，OS：p=0.848）。在 331 例高危患者中，非胃肿瘤（胃、十二指肠和小肠以外，HR 1.55，95%CI 1.19-2.00，p<0.001）、肿瘤直径>10cm（HR 2.63，95%CI 2.09-4.03，p<0.001）以及高危患者核分裂率>10/50HPF（HR 2.74，95%CI 2.00-3.76，p<0.001）的总体预后明显差于其他患者。对于某些高危患者，延长术后伊马替尼治疗可显著改善患者的生存（HR 0.43，95%CI 0.15-0.66，p<0.001）。