Shi Xiaoxiao, Chen Zhou, Shou Chunhui, Bai Hao, Yang Weili, Zhang Qing, Liu Xiaosun, Yu Jiren
Department of Gastrointestinal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of Epidemiology and Biostatistics, School of Public Health, Zhejiang University, Hangzhou, China.
J Gastrointest Oncol. 2023 Oct 31;14(5):2028-2038. doi: 10.21037/jgo-22-1240. Epub 2023 Sep 11.
Gastrointestinal (GI) bleeding is one of the common symptoms of GI stromal tumor (GIST). Although several studies have highlighted its prognostic role, conclusions have been inconsistent. This study aimed to investigate the prognosis of GIST patients with GI bleeding.
Primary GIST patients who underwent complete resection and did not receive adjuvant imatinib therapy from January 2003 to December 2008 were reviewed. The Kaplan-Meier method was used to estimate recurrence-free survival (RFS), and multivariate analysis was performed using the Cox proportional hazard model. Propensity score matching (PSM) was conducted to reduce confounders. A systematic review of the published articles in the PubMed, Embase, Cochrane Collaboration, and Medline databases was also conducted, and the inclusion criteria were determined using PICOS (patients, intervention, comparison, outcomes, and study design) principles.
In total, 84 patients presenting with GI bleeding and 90 patients without GI bleeding were enrolled in this study. The median time of follow-up was 140 months (range, 10-196 months), and 38 patients developed tumor recurrence/metastasis. For all patients, the multivariate analysis indicated that tumor location [hazard ratio (HR) =3.48, 95% confidence interval (CI): 1.78-6.82, P<0.001], tumor size (HR =1.91, 95% CI: 1.05-3.47, P=0.035), mitotic index (MI; HR =5.69, 95% CI: 2.77-11.67, P<0.001), and age (HR =2.68, 95% CI: 1.49-4.82, P=0.001) were the independent prognostic factors for poor RFS. However, GI bleeding was not associated with RFS (HR =1.21, 95% CI: 0.68-2.14, P=0.518). After PSM, 45 patients from each group were included, and it was found that GI bleeding was still not the independent prognostic factor (HR =1.23, 95% CI: 0.51-2.97, P=0.642). Moreover, the pooled results of our study and six previously reported studies showed that GI bleeding was not the independent prognostic factor (HR =1.45, 95% CI: 0.73-2.86, P=0.287).
In this study, tumor location, tumor size, MI, and age were independent prognostic factors in primary GIST patients who underwent radical resection. However, GI bleeding was not associated with worse RFS.
胃肠道（GI）出血是胃肠道间质瘤（GIST）的常见症状之一。尽管多项研究强调了其预后作用，但结论并不一致。本研究旨在探讨发生胃肠道出血的GIST患者的预后情况。
回顾性分析2003年1月至2008年12月期间接受完整切除且未接受辅助伊马替尼治疗的原发性GIST患者。采用Kaplan-Meier法估计无复发生存期（RFS），并使用Cox比例风险模型进行多因素分析。进行倾向评分匹配（PSM）以减少混杂因素。还对PubMed、Embase、Cochrane协作网和Medline数据库中已发表的文章进行了系统评价，并使用PICOS（患者、干预措施、对照、结局和研究设计）原则确定纳入标准。
本研究共纳入84例出现胃肠道出血的患者和90例未出现胃肠道出血的患者。中位随访时间为140个月（范围10 - 196个月），38例患者出现肿瘤复发/转移。对所有患者而言，多因素分析表明肿瘤位置[风险比（HR）=3.48，95%置信区间（CI）：1.78 - 6.82，P<0.001]、肿瘤大小（HR =1.91，95%CI：1.05 - 3.47，P=0.035）、有丝分裂指数（MI；HR =5.69，95%CI：2.77 - 11.67，P<0.001）和年龄（HR =2.68，95%CI：1.49 - 4.82，P=0.001）是RFS较差的独立预后因素。然而，胃肠道出血与RFS无关（HR =1.21，95%CI：0.68 - 2.14，P=0.518）。PSM后，每组纳入45例患者，发现胃肠道出血仍不是独立预后因素（HR =1.23，95%CI：0.51 - 2.97，P=0.642）。此外，本研究与之前六项报道研究的汇总结果显示，胃肠道出血不是独立预后因素（HR =1.45，95%CI：0.73 - 2.86，P=0.287）。
在本研究中，肿瘤位置、肿瘤大小、MI和年龄是接受根治性切除的原发性GIST患者的独立预后因素。然而，胃肠道出血与较差的RFS无关。
