An enhanced risk-group stratification system for more practical prognostication of clinically malignant gastrointestinal stromal tumors
An enhanced risk-group stratification system for more practical prognostication of clinically malignant gastrointestinal stromal tumors
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DOI：
10.1007/s10147-007-0705-7
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发表时间：
2007-10-01
影响因子：
3.3
通讯作者：
Nishida, Toshirou
中科院分区：
文献类型：
--
作者：
Takahashi, Tsuyoshi;Nakajima, Kiyokazu;Nishida, Toshirou
背景资料。最近在胃肠道间质瘤(GIST)致癌方面的突破导致了甲磺酸伊马替尼在晚期GIST治疗中的广泛使用。然而，伊马替尼在辅助环境中的作用尚未确定，主要是因为缺乏准确的系统来预测复发和/或转移。本研究的目的是找出影响术后不良预后的因素，并加强目前的NIH-Consensus危险组分层系统(Fletcher‘s系统)。对在研究期间(1987-2003)接受手术切除的303例原发胃肠道间质瘤患者进行了回顾性研究。除了Fletcher‘s系统，该系统基于形态变量(肿瘤大小和核分裂数)，分为四个风险组：极低风险组、低风险组、中风险组和高风险组，对任何主要的术前、术中或术后临床因素的预测潜力进行统计学评估。除了肿瘤大小和有丝分裂，有四个手术变量被发现影响无病生存：腹膜扩散、转移、侵袭和肿瘤破裂。出现这些“临床恶性因素”中至少一种的患者预后不佳(即，他们是辅助治疗的潜在候选者)。因此，我们修改了Fletcher的系统，增加了一个新的患者组，称为“临床恶性组”(至少有一种“临床恶性因素”的患者)。通过这一修改，“新”极低风险和低风险组患者的结果仍然是有利的，但“临床恶性组”和“新”高风险组患者的结果变得不利。这一改进的弗莱彻系统，通过增加“临床恶性因素”而得到加强，可以将结果可能不佳的患者与那些除了手术以外不需要治疗的患者区分开来。“临床恶性组”的患者可能是使用伊马替尼辅助治疗的潜在候选者。
Background. Recent breakthroughs regarding the oncogenesis of gastrointestinal stromal tumors (GISTs) have led to the wider use of imatinib mesylate in the treatment of advanced GISTs. However, the role of imatinib in an adjuvant setting has yet to be established, mainly owing to the lack of an accurate system to prognosticate recurrences and/or metastases. The aims of this study were to identify factors prognostic for an unfavorable postoperative outcome, and to enhance the current NIH-consensus risk-group stratification system (Fletcher's system).Methods. A retrospective review was conducted in 303 consecutive patients who had undergone surgical resection of primary GISTs during the study period (1987-2003). In addition to Fletcher's system, which is based on morphologic variables (tumor size and mitotic count), with four risk groups: very low risk, low risk, intermediate risk, and high risk, the predictive potential of any major preoperative, intraoperative, or postoperative clinical factor was statistically evaluated.Results. In addition to tumor size and mitosis, four operative variables were found to affect disease-free survival: peritoneal dissemination, metastasis, invasion, and tumor rupture. Patients presenting with at least one of these "clinically malignant factors" had an unfavorable outcome (i.e., they were potential candidates for adjuvant therapy). We therefore modified Fletcher's system by adding a new patient group, termed the "clinically malignant group," (patients having at least one of the "clinically malignant factors"). With this modification, the outcomes of patients in the "new" very-low-risk and low-risk groups remained favorable, but the outcomes of patients in the "clinically malignant group" and the "new" high-risk group became unfavorable.Conclusion. This modified Fletcher's system, enhanced by the addition of "clinically malignant factors," can distinguish patients with a possible unfavorable outcome from those who require no therapy other than surgery. Patients in the "clinically malignant group" could be potential candidates for adjuvant therapy using imatinib.