胃肠间质瘤破裂定义相关问题  

Definition of tumor rupture in gastrointestinal stromal tumor

作　　者：周岩冰[1] Zhou Yanbing(Department of Gastrointestinal Surgery,the Affiliated Hospital of Qingdao University,Qingdao 266003,China)

机构地区：[1]青岛大学附属医院胃肠外科,266003

出　　处：《中华胃肠外科杂志》2021年第9期762-768,共7页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金(81270449、81572314);山东省自然科学基金(2016GSF201109);青岛市民生科技计划项目(14235nsh)。

摘　　要：肿瘤破裂是胃肠间质瘤(GIST)发生、发展和诊疗过程中常见的临床事件,与肿瘤复发、转移及预后不良密切相关。其诱因包括腹腔压力升高、挤压、碰撞、不适当手术操作等;肿瘤巨大、小肠GIST、核分裂象高和KIT 11外显子557/558缺失突变等不良生物学行为以及伊马替尼新辅助治疗反应良好、迅速使肿瘤液化、坏死等为其高危因素。当前指南认为,肿瘤破裂是GIST完整切除后复发的一个重要风险因素,是确定服用伊马替尼时间、甚至终身辅助治疗的指征。然而,肿瘤破裂的界定尚未达成共识或缺乏公认的定义,因此,肿瘤破裂发生率的报道差异很大,缺少相应流行病学资料,也很难评估肿瘤破裂的临床意义。根据相关文献和国际指南,将肿瘤破裂分为自发性及医源性破裂,并根据Oslo criteria标准,将肿瘤破裂分为6类:(1)肿瘤破裂或破碎;(2)血性腹水;(3)肿瘤部位胃肠道穿孔;(4)邻近器官镜下肿瘤浸润;(5)经病灶切除或分块切除病灶;(6)切取活检。如下的肿瘤完整性轻微缺损不视为破裂,即(1)肿瘤引起的胃肠道黏膜缺损或肿瘤破溃到胃肠道;(2)镜下肿瘤穿透腹膜或肿瘤腹膜医源性损伤;(3)无并发症经腹腔穿刺活检;(4)R1切除。此外,我们进一步强调识别GIST破裂的高危因素、预防和积极干预肿瘤破裂的重要性。Tumor rupture is a common clinical event in the process of tumorigenesis,progression,diagnosis and treatment of gastrointestinal stromal tumor,which is closely associated with tumor recurrence,metastasis and poor prognosis.Tumor rupture may be associated with some intrinsic biological aggressiveness qualities,such as large tumor size,high mitotic count,and KIT exon 11 deletion mutations involving codons 557 and 558,and may be relatively more frequent with small intestine GIST and excellent response to imatinib neoadjuvant therapy resulting in tumor tissue rapid liquefacient and necrosis.The triggering factors involve sudden increase in abdominal pressure,external pressure,collision and improper surgical operation,etc.Tumor rupture is considered as an important risk factor of recurrence after macroscopically complete resection of tumor,and an indication for determining interval or even lifelong adjuvant therapy with imatinib according to guidelines.However,there is no consensus or universally accepted definition of tumor rupture,and,consequently,its incidence varies greatly across reported series and lacks detailed epidemiological data.Without pre⁃defi ned criteria,it is difficult to assess the clinical significance of rupture.We reviewed the relevant literature and international guidelines,and generally divided tumor rupture into spontaneous rupture and iatrogenic rupture.Based on the Oslo criteria,we proposed the following six definitions for tumor rupture:(1)tumor fracture or spillage;(2)blood⁃stained ascites;(3)gastrointestinal perforation at the tumor site;(4)microscopic infiltration of an adjacent organ;(5)intralesional dissection or piecemeal resection;(6)incisional biopsy.The following types of minor defects of tumor integrity should not be defined as rupture:(1)mucosal defects or spillage contained within the gastrointestinal lumen;(2)microscopic tumor penetration of the peritoneum or iatrogenic damage only to the serosa;(3)uncomplicated transperitoneal needle biopsy;(4)R1 resection.In addition,we fur

关 键 词：胃肠间质瘤 肿瘤破裂 定义 镜下切缘阳性 临床结局 

分 类 号：R735[医药卫生—肿瘤]