PROGNOSTIC FACTORS INFLUENCING SURVIVAL IN GASTROINTESTINAL LEIOMYOSARCOMAS - IMPLICATIONS FOR SURGICAL-MANAGEMENT AND STAGING
PROGNOSTIC FACTORS INFLUENCING SURVIVAL IN GASTROINTESTINAL LEIOMYOSARCOMAS - IMPLICATIONS FOR SURGICAL-MANAGEMENT AND STAGING
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DOI：
10.1097/00000658-199201000-00010
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发表时间：
1992-01-01
影响因子：
9
通讯作者：
ROMSDAHL, MM
中科院分区：
文献类型：
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作者：
NG, EH;POLLOCK, RE;ROMSDAHL, MM
胃肠平滑肌肉瘤患者的局部或更晚期疾病的适当手术治疗选择仍不清楚。这种疾病的分期分类尚未采用，也没有确定患者复发风险的危险因素。为了解决这些问题，本研究评估了各种临床病理变量对总生存率和无病生存率的影响。在一项涉及191例患者的总生存率的单因素分析中，Cox比例风险模型确定了四个与显著更好的结果相关的因素：完全切除而无肿瘤破裂（p < 0.001）、局部病变（p < 0.001）、肿瘤分级低（p = 0.02）和肿瘤小于5 cm （p = 0.03）。然而，当考虑到这些因素的相互作用时，肿瘤切除类型被选为多变量分析中唯一重要的预后因素。无肿瘤破裂的完全切除提高了局部疾病患者（中位，46个月）以及连续器官侵犯患者（中位，36个月）或腹膜植入患者（中位，36个月）的总生存期。相比之下，不完全切除的患者平均存活时间为21个月。肿瘤破裂的患者，尽管切除了所有的大体病变，其表现与不完全切除的患者相似；中位生存期仅为17个月。对于无病生存，从多变量分析中选择的重要决定因素是肿瘤破裂（p = 0.002）、邻近器官侵犯（p = 0.02）和高肿瘤分级（p = 0.02）。使用TGM系统评估结合这些预后因素的分期分类：T1 (< 5cm), T2（大于或等于5cm）， T3（邻近器官侵犯或腹膜植入物），T4（肿瘤破裂）；G: G1（低级），G2（高级）；M: M0（无转移），M1（有转移）。I期、II期、III期、IVA期和IVB期相应的5年总生存率分别为75%、52%、28%、12%和7%。手术后2年无病生存率分别为89%、57%和47%。总之，手术仍然是胃肠道平滑肌肉瘤患者的主要治疗方式，完全切除所有肿瘤而不破裂的疾病，即使是局部晚期疾病，也能提高总生存率和无病生存率。分期分类似乎是可行的，并被推荐用于确定胃肠道平滑肌肉瘤患者的预后。
The appropriate surgical therapeutic options for either localized or more advanced disease in patients with gastrointestinal leiomyosarcomas remain unclear. A staging classification for this disease has not been adopted nor risk factors identifying patients at risk for recurrence defined. To address these issues, this study evaluated the influence of various clinicopathologic variables on overall and disease-free survival. In an univariate analysis of overall survival involving 191 patients, the Cox proportional hazards model identified four factors that were associated with a significantly better outcome: complete resection without tumor rupture (p < 0.001), localized lesions (p < 0.001), low grade of tumor (p = 0.02), and tumors smaller than 5 cm (p = 0.03). When interactive effects of these factors were taken into account, however, type of resection of the tumor was selected as the only significant prognostic factor in a multivariate analysis. Complete resection without tumor rupture improved overall survival of patients with localized disease (median, 46 months) as well as those with contiguous organ invasion (median, 36 months) or peritoneal implants (median, 36 months). In contrast, patients with incomplete resections survived for a median of 21 months. Patients with tumor rupture, despite removal of all gross disease, behaved similarly to those with incomplete resections; median survival was only 17 months. For disease-free survival, important determinants selected from a multivariate analysis were tumor rupture (p = 0.002), contiguous organ invasion (p = 0.02) and high tumor grade (p = 0.02). A staging classification incorporating these prognostic factors of significance was evaluated using a TGM system: T1 (< 5 cm), T2 (greater-than-or-equal-to 5 cm, T3 (contiguous organ invasion or peritoneal implants), T4 (tumor rupture); G: G1 (low grade), G2 (high grade); M: M0 (no metastases), M1 (metastases present). The corresponding 5-year overall survivals for stages I, II, III, IVA, and IVB were 75%, 52%, 28%, 12%, and 7%. Disease-free survival at 2 years after surgery was 89%, 57%, and 47% for stages I, II, and III, respectively. In conclusion, surgery remains the primary modality of treatment for patients with gastrointestinal leiomyosarcomas, and complete resection of all disease without tumor rupture, even of locally advanced disease, improves overall and disease-free survival. A staging classification appears feasible and is recommended to determine outcome in patients with leiomyosarcomas arising from the gastrointestinal tract.