Peitgen K, Walz M K, Schmidt U, Hoederath A, Wilke H, Eigler F W
Abteilung für Allgemeine Chirurgie, Universitätsklinikum Essen.
Med Klin (Munich). 1996 Mar 15;91(3):123-30.
Due to the rarity of gastric leiomyosarcomas, only little is known on the results of diagnostics and therapy of these tumors. According to literature, the problem of suitable criteria in determining malignancy of these neoplasms is unsettled.
21 patients (10 male, 11 female; aged 13 to 74 [53 +/- 13,9] years) with leiomyosarcomas of the stomach were treated from 1978 to 1993. In a retrospective study, the diagnostic and therapeutic results and the pathologic features of these patients are compared with the results of literature.
Diagnosis was rarely confined preoperatively. Potentially curative resection was possible in 13/21 cases. Five year survival was 44% overall (R0-resections: 60%, R1/2-resections 22%) with a wide spread of individual cases. Pathologic examination of the tumors showed only half of the tumors classifiable according to the system of McGrath. Some well differentiated tumors revealed unclear malignancy criteria. Analysis of prognostic factors showed no statistically significant influence of surgical radicality but a significant influence of tumor size, mitotic activity and nuclear grading on survival and recurrence.
Because of their rare incidence, the treatment of gastric leiomyosarcomas remains non-standardized. Surgical radical removal of the tumor seems to promise the largest benefit. The treatment of patients with residual or recurrent tumors remains individual, no adjuvant radio- or chemotherapeutical treatment can be generally recommended.
由于胃平滑肌肉瘤罕见，关于这些肿瘤的诊断和治疗结果所知甚少。根据文献，确定这些肿瘤恶性程度的合适标准问题尚未解决。
1978年至1993年期间，对21例胃平滑肌肉瘤患者（10例男性，11例女性；年龄13至74岁[53±13.9]岁）进行了治疗。在一项回顾性研究中，将这些患者的诊断和治疗结果以及病理特征与文献结果进行了比较。
术前很少能确诊。21例中有13例可行潜在根治性切除。总体五年生存率为44%（R0切除：60%，R1/2切除：22%），个体差异较大。肿瘤的病理检查显示，根据麦格拉思系统，只有一半的肿瘤可分类。一些高分化肿瘤的恶性标准不明确。预后因素分析显示，手术根治程度对生存和复发无统计学显著影响，但肿瘤大小、有丝分裂活性和核分级对生存和复发有显著影响。
由于其发病率低，胃平滑肌肉瘤的治疗仍未标准化。手术彻底切除肿瘤似乎有望带来最大益处。对残留或复发性肿瘤患者的治疗仍需个体化，一般不建议进行辅助放疗或化疗。
