An audit of surgical management of gastrointestinal stromal tumours (GIST)
An audit of surgical management of gastrointestinal stromal tumours (GIST)
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DOI：
10.1016/j.ejso.2005.11.021
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发表时间：
2006-04-01
期刊：
影响因子：
3.8
通讯作者：
Morel, P
中科院分区：
文献类型：
--
作者：
Bucher, P;Egger, JF;Morel, P
目的：分析原发性切除术后GIST的结果，并确定一个新的分级系统是否可以充分预测预后：方法：回顾性分析（1993年至2002年）确定了80例进行原发性手术切除，c-KIT阳性，GIST。所有患者均完成随访（中位随访42，范围1-132个月）。结果：GIST起源于胃（46例）、小肠（30例）、结直肠（2例）和肠系膜（2例），其中胃、小肠、肠系膜、结肠和直肠各2例。手术时，94%的病例表现为局限性病变，6%的病例表现为血行转移，伴或不伴淋巴结浸润。72例完全切除（R 0）。R 0切除与预后相关（p < 0.01）。60例GIST被归类为低级别（中位随访时间为60个月），20例被归类为高级别（中位随访时间为27个月）。低级别和高级别GIST患者的5年生存率分别为95%和21%（p < 0.001）。结论：GIST手术治疗的预后受原发肿瘤切除的完整性和肿瘤恶性潜能的影响。低级别GIST单独手术后预后良好，而高级别GIST初次切除后复发率高。对于高级别GIST或原发性胃肠道间质瘤切除不全的患者，应提倡辅助治疗。该分级系统可以可靠地预测GIST初次手术治疗后的预后，完全手术切除为低级别GIST提供了良好的治愈机会，而对于高级别GIST，仅手术是不够的。所提出的分级系统可用于识别GIST切除术后可能受益于甲磺酸伊马替尼辅助治疗的患者。(c)2005爱思唯尔有限公司保留所有权利。
Aim: To analyze GIST outcome after primary resection and to determine if a new grading system could adequately predict there prognosis.Methods: A retrospective review (1993-2002) identified 80 patients who underwent primary surgical resection for, c-KIT positive, GIST. Follow-up was complete for all patients (median follow-up 42, range 1-132, months). GIST were classified as low or high grade according to the following parameters: size, mitotic rate, mitotic index (MiB1), presence of necrosis, invasion of adjacent structure and presence of metastasis.Results: GIST originated from the stomach (46), small bowel (30), colon and rectum two and mesentery two. At surgery, 94% of cases presented with localized disease and 6% blood born metastasis with or without lymph node invasion. Resections were complete (R0) in 72 cases. R0 resection correlated with prognosis(p < 0.01). Sixty GIST were classified as low grade (median follow-up 60 months) and 20 as high grade (median follow-Lip 27 months). Five-year actuarial survival of patients with low or high grade GIST were of 95 and 21%, respectively, (p < 0.001).Conclusion: Prognosis of GIST after surgical treatment is influenced by completeness of primary resection and tumour malignant potential. Low grade GIST have an excellent prognosis after surgery alone, while high grade GIST have a high rate of recurrence after primary resection. Adjuvant treatment should be advocated for patient with either high grade GIST or after incomplete primary resection. The presented grading system can reliably predict GIST outcome after primary surgical treatment.Complete surgical resection offers good chance of cure for low grade GIST, while for high grade GIST surgery alone is not sufficient. The presented grading system could be used to identify patients who may benefit of adjuvant treatment with imatinib mesylate after GIST resection. (c) 2005 Elsevier Ltd. All rights reserved.