国际指南推荐胃肠道间质瘤（GIST）随访，但缺乏关于低复发风险患者随访作用的数据。对于这些患者，应在成本和辐射暴露方面权衡预测复发检测的潜在益处与心理负担和放射学检查负荷。评估低风险 GIST 中基于指南的随访结果。这项多机构研究意大利肉瘤组织参考机构参与的回顾性队列研究评估了 2001 年 1 月至 2019 年 6 月期间接受手术的 GIST 患者。中位随访时间为 69.2 个月。数据分析于2022年12月15日至2023年3月20日进行。根据武装部队病理学研究所标准，纳入低风险GIST患者，前提是提供足够的临床信息：原发部位、大小、有丝分裂指数、手术切缘、以及 2 年或以上的随访。所有患者均根据欧洲肿瘤内科学会 (ESMO) 指南进行随访。主要结局是根据 ESMO 指南随访计划确定复发所需的测试数量。次要结局包括复发率、复发时间、无病生存期 (DFS)、总生存期 (OS)、GIST 特异性生存期 (GIST-SS)、复发后 OS、继发性肿瘤发生率和理论电离辐射暴露。还评估了一个探索性终点，即根据观察结果为低风险 GIST 患者制定新的随访计划建议。总共 737 名患者（377 名男性 [51.2%]；诊断时的中位年龄为 63 岁[范围， 18-86]岁）患有低风险GIST的人被纳入其中。 DFS 的估计 5 年生存率为 95.5%，GIST-SS 的估计 5 年生存率为 99.8%，OS 为 96.1%。 DFS 的估计 10 年生存率为 93.4%，GIST-SS 的估计 10 年生存率为 98.1%，OS 为 91.0%。 42 名患者（5.7%）在随访期间出现疾病复发（9 名局部患者，31 名远处患者，2 名两者皆有），其中 9 名患者在 10 年后或以上才被发现。这意味着每进行 170 次计算机断层扫描，就会检测到约 1 例复发，每位患者的中位辐射暴露量为 80 (IQR，32-112) mSv。非胃原发性肿瘤（风险比 [HR]，2.09；95% CI，1.14-3.83；P = .02）和 KIT 突变（HR，2.77；95% CI，1.05-7.27；P = .04）与复发的风险较高。 737 名患者中，有 187 名患者出现第二肿瘤 (25%)，其中 56 名患者在随访期间检测到，这是这些患者的主要原因。 在这项针对低风险 GIST 患者的队列研究中，复发风险为尽管进行了 10 年或更长时间的随访，但仍较低。这些数据表明需要修改随访计划，以减少当前推荐的随访策略的焦虑、费用和辐射暴露。

Gastrointestinal stromal tumor (GIST) follow-up is recommended by international guidelines, but data on the role of follow-up in patients with low relapse risk are missing. For these patients, the potential benefit of anticipating recurrence detection should be weighed against psychological burden and radiologic examination loads in terms of costs and radiation exposure.To evaluate the outcomes of guideline-based follow-up in low-risk GIST.This multi-institutional retrospective cohort study involving Italian Sarcoma Group reference institutions evaluated patients with GIST who underwent surgery between January 2001 and June 2019. Median follow-up time was 69.2 months. Data analysis was performed from December 15, 2022, to March 20, 2023. Patients with GIST at low risk according to Armed Forces Institute of Pathology criteria were included provided adequate clinical information was available: primary site, size, mitotic index, surgical margins, and 2 or more years of follow-up.All patients underwent follow-up according to European Society for Medical Oncology (ESMO) guidelines.The primary outcome was the number of tests needed to identify a relapse according to ESMO guidelines follow-up plan. Secondary outcomes included relapse rate, relapse timing, disease-free survival (DFS), overall survival (OS), GIST-specific survival (GIST-SS), postrelapse OS, secondary tumor rates, and theoretical ionizing radiation exposure. An exploratory end point, new follow-up schedule proposal for patients with low-risk GIST according to the observed results, was also assessed.A total of 737 patients (377 men [51.2%]; median age at diagnosis, 63 [range, 18-86] years) with low-risk GIST were included. Estimated 5-year survival rates were 95.5% for DFS, 99.8% for GIST-SS, and 96.1% for OS. Estimated 10-year survival rates were 93.4% for DFS, 98.1% for GIST-SS, and 91.0% for OS. Forty-two patients (5.7%) experienced disease relapse during follow-up (9 local, 31 distant, 2 both), of which 9 were detected after 10 or more years. This translated into approximately 1 relapse detected for every 170 computed tomography scans performed, with a median radiation exposure of 80 (IQR, 32-112) mSv per patient. Nongastric primary tumor (hazard ratio [HR], 2.09; 95% CI, 1.14-3.83; P = .02), and KIT mutation (HR, 2.77; 95% CI, 1.05-7.27; P = .04) were associated with a higher risk of relapse. Second tumors affected 187 of 737 patients (25%), of which 56 were detected during follow-up and represented the primary cause of death in these patients.In this cohort study on patients affected by low-risk GISTs, the risk of relapse was low despite a follow-up across 10 or more years. These data suggest the need to revise follow-up schedules to reduce the anxiety, costs, and radiation exposure of currently recommended follow-up strategy.