Conservative surgery vs. duodeneopancreatectomy in primary duodenal gastrointestinal stromal tumors (GIST): A retrospective review of 114 patients from the French Sarcoma Group (FSG)
Conservative surgery vs. duodeneopancreatectomy in primary duodenal gastrointestinal stromal tumors (GIST): A retrospective review of 114 patients from the French Sarcoma Group (FSG)
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DOI：
10.1016/j.ejso.2014.04.011
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发表时间：
2014-10-01
期刊：
影响因子：
3.8
通讯作者：
Bonvalot, S.
中科院分区：
文献类型：
--
作者：
Duffaud, F.;Meeus, P.;Bonvalot, S.
背景：十二指肠胃肠道间质瘤占所有胃肠道间质瘤的3-5%，对患者预后的了解有限。我们对原发性十二指肠胃肠间质瘤进行回顾性分析。方法：通过来自16个FSG中心（n = 105）的调查确定患者，9名患者参加了BFR14试验。数据是从原始数据库和患者档案中收集的，符合法国法律。结果：纳入114例患者，中位年龄为57岁。肿瘤主要起源于D2（33%）或D3(24%)，中位大小为5 cm。109例患者切除了原发肿瘤；局部切除（LR, n = 82），胰十二指肠切除术（PD, n = 23）， 4例患者资料缺失。切除为RO (n = 87,79%), R1 (n = 8,7%), R2 （n = 6）。肿瘤特征：KIT+ (n = 104), CD34+ (n = 58)。Miettinen风险低（n = 43），高（n = 52）。术前（n = 11）和术后（n = 20）给予伊马替尼。中位随访36个月（2-250个月），98例患者存活，33例复发。5年OS和EFS分别为86.5%和54.5%。LR组和PD组患者的EFS相似（P < 0.05）。在多变量分析中，ECOG、PS和CD34表达是OS的独立预后因素。Miettinen风险和梭形细胞类型是复发的独立预测因素。结论：十二指肠间质瘤切除术患者预后良好。本研究倾向于在没有解剖限制的情况下保留胰腺。与PD相比，LR具有相似的生存率和较小的发病率。(C) 2014 Elsevier Ltd.版权所有。
Background: Duodenal GISTs represent 3-5% of all GISTs with limited understanding of patient outcomes. We conducted a retrospective analysis of primary localized duodenal GISTs.Methods: Patients were identified via a survey from 16 FSG centers (n = 105), and a group of 9 patients enrolled in the BFR14 trial. Data were collected from the original database and patient files, in agreement with French legislation.Results: 114 patients were included, with a median age of 57. Tumors originated mainly in D2 (33%), or D3 (24%), with a median size of 5 cm. 109 patients had resection of the primary tumor; with a Local Resection (LR, n = 82), a pancreaticoduodenectomy (PD, n = 23), and data were missing for 4 patients. Resections were RO (n = 87, 79%), R1 (n = 8, 7%), R2 (n = 6). Tumor characteristics were: KIT+ (n = 104), CD34+ (n = 58). Miettinen risk was low (n = 43), and high (n = 52). Imatinib was administered Preoperatively (n = 11) and post-operatively (n = 20). With a median follow-up of 36 months (2-250), 98 patients are alive, and 33 relapsed. The 5-year OS and EFS rates are 86.5% and 54.5%. EFS was similar for patients in the LR and the PD groups (P > 0.05). In multivariate analysis, ECOG PS, and CD34 expression are independent prognostic factors on OS. Miettinen risk and spindle cell type are independent predictive factors for relapse.Conclusions: Patients with resected duodenal GIST have a reasonably favorable prognosis. This study favors a preservation of pancreas when there are no anatomical constraints. LR exhibit similar survival and smaller morbidity then PD. (C) 2014 Elsevier Ltd. All rights reserved.