评估结直肠胃肠道间质瘤手术后长期生存的预后因素。

Assessing prognostic factors of long-term survival after surgery for colorectal gastrointestinal stromal tumours.

机构信息

Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA.

Department of Surgery, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, South Korea.

出版信息

Colorectal Dis. 2023 Dec;25(12):2325-2334. doi: 10.1111/codi.16778. Epub 2023 Oct 24.

DOI:10.1111/codi.16778

PMID:37876119

Abstract

AIM

Due to their rarity, the management of colorectal gastrointestinal stromal tumours (CR GISTs) is still under debate. The aim of this study was to assess prognostic factors.

METHOD

We performed a retrospective review of patients who underwent surgery with curative intent for CR GIST at our centre from 2002 to 2019. Factors associated with overall (OS) and recurrence-free survival (RFS) were analysed.

RESULTS

Fifty-six patients were included [median age 63 years, 29 (52%) female, 30 (54%) Miettinen high-risk, 40 (71%) with rectal GIST]. Nineteen (34%) patients received perioperative (neoadjuvant and/or adjuvant) imatinib. All cases of colonic GIST had an R0 resection, compared with 28 (70%) of rectal GISTs. After a median follow-up of 97 months (interquartile range 48-155 months), 14 (25%) deaths and 14 (25%) recurrences occurred. In the high-risk cohort, factors associated with improved RFS were R0 resection (OR 0.19, 95% CI 0.1-0.5, p = 0.002) and perioperative imatinib (OR 0.33, 95% CI 0.42-0.97, p = 0.04). Patients who had received perioperative imatinib had longer RFS (60% vs. 11% at 5 years, p = 0.006) but not OS. In rectal GISTs, 5-year OS was 85% for R0 and 70% for R1 resections (p = 0.164) and 5-year RFS was 85% for R0 and 12% for R1 resection (p < 0.001). When stratifying patients by perioperative imatinib, there were no differences in OS or RFS in the R0 or R1 groups.

CONCLUSION

Perioperative imatinib and R0 resection were associated with improved RFS in high-risk patients with CR GIST. In patients with rectal GIST, R1 resection was associated with worse RFS irrespective of perioperative imatinib treatment.

摘要

目的

由于其罕见性，结直肠胃肠道间质瘤（CR GIST）的治疗仍存在争议。本研究旨在评估预后因素。

方法

我们对 2002 年至 2019 年在我们中心接受根治性手术治疗的 CR GIST 患者进行了回顾性分析。分析了与总生存（OS）和无复发生存（RFS）相关的因素。

结果

共纳入 56 例患者[中位年龄 63 岁，29 例（52%）为女性，30 例（54%）为 Miettinen 高危，40 例（71%）为直肠 GIST]。19 例（34%）患者接受了围手术期（新辅助和/或辅助）伊马替尼治疗。所有结肠 GIST 均行 R0 切除，而直肠 GIST 仅 28 例（70%）行 R0 切除。中位随访 97 个月（四分位距 48-155 个月）后，14 例（25%）死亡，14 例（25%）复发。在高危组中，与 RFS 改善相关的因素包括 R0 切除（OR 0.19，95%CI 0.1-0.5，p=0.002）和围手术期伊马替尼（OR 0.33，95%CI 0.42-0.97，p=0.04）。接受围手术期伊马替尼治疗的患者 RFS 更长（5 年时为 60% vs. 11%，p=0.006），但 OS 无差异。在直肠 GIST 中，R0 切除的 5 年 OS 为 85%，R1 切除的为 70%（p=0.164），R0 切除的 5 年 RFS 为 85%，R1 切除的为 12%（p<0.001）。当按围手术期伊马替尼对患者进行分层时，R0 或 R1 组的 OS 或 RFS 均无差异。