AbstractCurrently, due to limited long-term evidence, there remains some controversy surrounding the recommended postoperative monitoring strategy for primary low-risk gastrointestinal stromal tumors (GISTs). This study recruited a total of 532 patients diagnosed with very low-risk and low-risk GISTs who underwent endoscopic resection from 2015 to 2021, including 460 very low-risk patients and 72 low-risk patients.

摘要目前，由于长期证据有限，关于原发性低风险胃肠道间质瘤（GIST）的推荐术后监测策略仍存在一些争议。这项研究共招募了532名诊断为极低风险和低风险GIST的患者，这些患者在2015年至2021年期间接受了内镜切除术，其中包括460名极低风险患者和72名低风险患者。

Descriptive statistical analysis was used to evaluate the clinical and pathological characteristics of GIST patients, and Kaplan–Meier methods were employed for survival analysis. The results showed that the 5-year recurrence-free survival rates for very low-risk and low-risk patients were 98.5% and 95.9%, respectively.

。结果显示，极低风险和低风险患者的5年无复发生存率分别为98.5%和95.9%。

The 5-year disease-specific survival rates for both groups were 100%. Additionally, the 5-year overall survival rates were 99.7% for very low-risk patients and 100% for low-risk patients (P = 0.69). Therefore, it is suggested that routine follow-up monitoring, including endoscopic surveillance and imaging, may not be necessary for very low-risk and low-risk GISTs after endoscopic resection..

两组的5年疾病特异性生存率均为100%。此外，极低风险患者的5年总生存率为99.7%，低风险患者为100%（P=0.69）。。。

IntroductionGastrointestinal stromal tumors (GISTs) are considered to be the most common mesenchymally derived tumors of the digestive tract and are mainly derived from Cajal cells or their precursor cells, the biological behavior of GIST is diverse, manifests as benign, potentially malignant or malignant to varying degrees, and the majority of GIST have either KIT or platelet derived growth factor receptor alpha (PDGFRA) as the mutation type1,2,3.

引言胃肠道间质瘤（GIST）被认为是消化道最常见的间充质来源的肿瘤，主要来源于Cajal细胞或其前体细胞，GIST的生物学行为多种多样，表现为良性，潜在恶性或恶性程度不同，大多数GIST以KIT或血小板衍生生长因子受体α（PDGFRA）为突变类型1,2,3。

GIST can occur anywhere in the gastrointestinal tract but most commonly in the stomach (60–65%), followed by the small intestine (20–25%), and less commonly the colorectum, esophagus and other areas3,4,5. At present, The most commonly used classification system is the modified NIH risk classification criteria, which classifies the risk of GIST recurrence into very low-risk, low-risk, intermediate-risk and high-risk groups according to the tumor size, mitotic rate, tumor location and tumor rupture6.

GIST可以发生在胃肠道的任何地方，但最常见于胃（60-65%），其次是小肠（20-25%），结直肠，食道和其他区域较少见3,4,5。目前，最常用的分类系统是修改后的NIH风险分类标准，该标准根据肿瘤大小，有丝分裂率，将GIST复发风险分为极低风险，低风险，中等风险和高风险组。肿瘤位置和肿瘤破裂6。

For localized GIST, the standard therapeutic approach is complete surgical resection2,3. Particularly for GIST with a diameter > 2 cm, given their inherent malignant potential, surgical intervention is recommended7. Although small GISTs with a diameter of < 2 cm can be followed up according to the patient's wishes, there is now a view that surgical resection of small GISTs is recommended to avoid unnecessary follow-up8,9.

对于局部GIST，标准的治疗方法是完全手术切除2,3。特别是对于直径>2 cm的GIST，鉴于其固有的恶性潜能，建议进行手术干预7。虽然直径小于2厘米的小GIST可以根据患者的意愿进行随访，但现在有一种观点认为，建议手术切除小GIST以避免不必要的随访8,9。

With the continuous advancements in endoscopic techniques, endoscopic resection has become widely incorporated into the therapeutic landscape of GISTs. Research indicates that the overall survival of GIST patients post-ER is comparable to that of those treated with surgical intervention10,11,12. Despite the expanding application of endoscopic resection in GIST management, our understanding of its long-term prognos.

随着内镜技术的不断进步，内镜切除术已被广泛纳入GIST的治疗领域。研究表明，ER后GIST患者的总生存率与接受手术干预的患者相当[10,11,12]。尽管内镜切除术在GIST管理中的应用不断扩大，但我们对其长期预后的理解。

Table 1 Consensus criteria revised by the National Institutes of Health (NIH) in 2008. Reference to Joensuu et al.6 Full size tableStatistical analysisCategorical variables were expressed as frequencies and percentages, while continuous variables were presented as mean ± standard deviation (SD) or median and interquartile range (IQR).

表1美国国立卫生研究院（NIH）于2008年修订的共识标准。参考Joensuu等[6]。全尺寸表统计分析分类变量表示为频率和百分比，而连续变量表示为平均±标准差（SD）或中位数和四分位间距（IQR）。

The Kaplan–Meier method was employed to estimate the recurrence-free survival (RFS) and disease-specific survival (DSS) of patients with very low-risk and low-risk GISTs. Group comparisons were conducted using the Log-Rank test. Statistical analyses were performed using SPSS version 25.0 and R version 4.3.0.

Kaplan–Meier方法用于估计极低风险和低风险GIST患者的无复发生存期（RFS）和疾病特异性生存期（DSS）。使用对数秩检验进行组比较。使用SPSS 25.0版和R 4.3.0版进行统计分析。

P < 0.05 was considered statistically significant.Ethical approvalWe confirm that all methods were carried out in accordance with relevant guidelines, and all included cases were recorded in the Human Genetic Resources Center of the First Affiliated Hospital of Nanchang University. This study protocol has been approved by the Medical Ethics Committee of the First Affiliated Hospital of Nanchang University.

P<0.05被认为具有统计学意义。伦理认可我们确认所有方法均按照相关指南进行，所有纳入病例均记录在南昌大学第一附属医院人类遗传资源中心。该研究方案已获得南昌大学第一附属医院医学伦理委员会的批准。

Given the retrospective nature of the study, the need for informed consent was waived by the institutional review boards.ResultsPatient characteristicsBased on the established inclusion and exclusion criteria, we ultimately included 532 cases for study analysis, comprising 460 cases in the very low-risk group and 72 cases in the low-risk group (Fig. 1).

鉴于该研究的回顾性，机构审查委员会放弃了知情同意的必要性。结果患者特征根据既定的纳入和排除标准，我们最终纳入532例进行研究分析，其中极低风险组460例，低风险组72例（图1）。

Basic information and tumor characteristics are summarized in Table 2. The average age of the entire cohort was 55.50 (± 9.55) years, with a median tumor size of 1.00 (IQR: 0.70–1.5) cm. Regarding the primary tumor locations, there were 2 cases in the esophagus, 313 cases in the cardia and gastric fundus, 206 cases in the gastric body, angle, and antrum, 7 cases in the duodenum, and 4.

表2总结了基本信息和肿瘤特征。整个队列的平均年龄为55.50（±9.55）岁，中位肿瘤大小为1.00（IQR:0.70-1.5）cm。关于原发肿瘤的位置，食管2例，贲门和胃底313例，胃体，角度和胃窦206例，十二指肠7例，4例。

Data availability

数据可用性

The datasets used and/or analyzed during the current study available from the corresponding author on reasonable request.

本研究中使用和/或分析的数据集可根据合理要求从通讯作者处获得。

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Download referencesAcknowledgementsThis work was supported by the Key Laboratory Project of Digestive Diseases in Jiangxi Province (2024SSY06101) and Jiangxi Clinical Research Center for Gastroenterology (20223BCG74011).FundingThe study was supported by grants of Jiangxi Clinical Research Center for Gastroenterology (grant No.

下载参考文献致谢这项工作得到了江西省消化系统疾病重点实验室项目（2024SSY06101）和江西省胃肠病学临床研究中心（20223BCG74011）的支持。资助该研究得到了江西省胃肠病学临床研究中心（批准号：。

20223BCG74011, PI: Youxiang Chen); This study was supported by grants from the National Natural Science Foundation of China (Grant No. 82060448 and 82360112, PI: Youxiang Chen) and 2023 clinical research program of the first affiliated hospital of Nanchang University (PI: Chunyan Zeng).Author informationAuthor notesThese authors contributed equally: Jiaxin Gao and Zide Liu.Authors and AffiliationsDepartment of Gastroenterology, Jiangxi Provincial Key Laboratory of Digestive Diseases, Jiangxi Clinical Research Center for Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, ChinaJiaxin Gao, Zide Liu, Xingxing Liu, Xu Shu, Yin Zhu, Youxiang Chen & Chunyan ZengAuthorsJiaxin GaoView author publicationsYou can also search for this author in.

20223BCG74011，PI：陈友祥）；这项研究得到了国家自然科学基金（批准号82060448和82360112，PI:Youxiang Chen）和南昌大学第一附属医院2023临床研究计划（PI:Chunyan Zeng）的资助。作者信息作者注意到这些作者做出了同样的贡献：高加欣和刘子德。作者和所属单位江西省消化疾病重点实验室消化内科，江西省消化疾病临床研究中心，消化疾病医院，江西省南昌大学江西医学院第一附属医院，江西南昌，中国高加新，刘子德，刘兴兴，许曙，朱寅，陈友祥，陈春燕曾高加新观点作者出版物您也可以在中搜索这位作者。

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PubMed Google ScholarContributionsCZ and JG conceptualized the study. JG, ZL, and XL collected and analyzed the data. JG and ZL drafted the manuscript. XL, XS, YZ, and CZ contributed to manuscript revisions and proofreading. YC and CZ managed the project and secured funding. All authors consented to the publication of this manuscript.

PubMed谷歌学术贡献SCZ和JG对这项研究进行了概念化。JG，ZL和XL收集并分析了数据。JG和ZL起草了手稿。四十、 XS，YZ和CZ为稿件修订和校对做出了贡献。YC和CZ管理该项目并获得资金。所有作者都同意发表这份手稿。

JG and ZL have contributed equally to this work.Corresponding authorsCorrespondence to.

JG和ZL对这项工作做出了同样的贡献。通讯作者通讯。

Youxiang Chen or Chunyan Zeng.Ethics declarations

陈友祥或曾春燕。道德宣言

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Reprints and permissionsAbout this articleCite this articleGao, J., Liu, Z., Liu, X. et al. Follow-up analysis and research of very low-risk and low-risk gastrointestinal stromal tumors after endoscopic resection.

转载和许可本文引用本文Gao，J.，Liu，Z.，Liu，X。等人。内镜切除术后极低风险和低风险胃肠道间质瘤的随访分析和研究。

Sci Rep 14, 17872 (2024). https://doi.org/10.1038/s41598-024-68460-1Download citationReceived: 01 May 2024Accepted: 24 July 2024Published: 02 August 2024DOI: https://doi.org/10.1038/s41598-024-68460-1Share this articleAnyone you share the following link with will be able to read this content:Get shareable linkSorry, a shareable link is not currently available for this article.Copy to clipboard.

Sci Rep 1417872（2024）。https://doi.org/10.1038/s41598-024-68460-1Download引文接收日期：2024年5月1日接受日期：2024年7月24日发布日期：2024年8月2日OI：https://doi.org/10.1038/s41598-024-68460-1Share本文与您共享以下链接的任何人都可以阅读此内容：获取可共享链接对不起，本文目前没有可共享的链接。复制到剪贴板。

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KeywordsGastroenterologyGastrointestinal stromal tumorEndoscopic resectionRecurrenceLong-term outcomes

关键词胃肠病学胃肠道间质瘤内镜切除术近期长期疗效

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