Peparini Nadia
Azienda Sanitaria Locale Roma 6, Ciampino, Rome 00043, Italy.
World J Gastrointest Surg. 2023 Aug 27;15(8):1559-1563. doi: 10.4240/wjgs.v15.i8.1559.
Tumour rupture of gastrointestinal stromal tumours (GISTs) has been considered to be a remarkable risk factor because of its unfavourable impact on the oncological outcome. Although tumour rupture has not yet been included in the current tumor-node-metastasis classification of GISTs as a prognostic factor, it may change the natural history of a low-risk GIST to a high-risk GIST. Originally, tumour rupture was defined as the spillage or fracture of a tumour into a body cavity, but recently, new definitions have been proposed. These definitions distinguished from the prognostic point of view between the major defects of tumour integrity, which are considered tumour rupture, and the minor defects of tumour integrity, which are not considered tumour rupture. Moreover, it has been demonstrated that the risk of disease recurrence in R1 patients is largely modulated by the presence of tumour rupture. Therefore, after excluding tumour rupture, R1 may not be an unfavourable prognostic factor for GISTs. Additionally, after the standard adjuvant treatment of imatinib for GIST with rupture, a high recurrence rate persists. This review highlights the prognostic value of tumour rupture in GISTs and emphasizes the need to carefully take into account and minimize the risk of tumour rupture when choosing surgical strategies for GISTs.
胃肠道间质瘤（GISTs）的肿瘤破裂一直被认为是一个显著的风险因素，因为它对肿瘤学结局有不利影响。尽管肿瘤破裂尚未作为预后因素纳入当前GISTs的肿瘤-淋巴结-转移分类中，但它可能会将低风险GIST的自然病程转变为高风险GIST。最初，肿瘤破裂被定义为肿瘤向体腔的溢出或破裂，但最近有人提出了新的定义。这些定义从预后角度区分了被视为肿瘤破裂的肿瘤完整性主要缺陷和不被视为肿瘤破裂的肿瘤完整性次要缺陷。此外，已经证明R1患者疾病复发的风险在很大程度上受肿瘤破裂的影响。因此，排除肿瘤破裂后，R1可能不是GISTs的不良预后因素。此外，在对破裂的GIST进行伊马替尼标准辅助治疗后，复发率仍然很高。本综述强调了肿瘤破裂在GISTs中的预后价值，并强调在为GISTs选择手术策略时，需要仔细考虑并尽量降低肿瘤破裂的风险。
