Systematic Review Of Clinical Research In 2007 Chinese Patients With Gastrointestinal Stromal Tumor

Objective: To summarize the current situation of diagnosis and therapy in Chinese patients with gastrointestinal stromal tumor.Methords: Taken"gastrointestinal stromal tumor or gastral stromal tumor or small intestinal stromal tumor or colorectal stromal tumor or rectal stromal tumor or duodenalstromal tumor"as docuterm. Retrieve Chinese literature pubulished in 2007 from CJFD, the obtained data were systematically evaluated.Results: Fifty-five literatures were selected and 2208 cases were included. (1) The medium onset age of GIST was 50-60 and the average onset age was 43-62. The incidence of male to female was 1.3:1. (2) GIST could invasion any part of alimentary tract, the most common part was stomach(51.8%) and intestine(33.6%), about 7.4% in colon-rectum and 6.8% in other parts of the alimentary tract(esophagus, omenta, mesenterium et al.). (3) The most commmon symptoms were abdominal pain,alimentary tract hemorrhage and abdominal mass which accounted for 41.4%,36.6%,22.6%,respectivily. Imageology examination could assist the preliminary diagnosis of GIST, the examine rate of type-B ultrasonic was 51.1% and tumor detection rate was 63.2%, the examine rate of endoscopic ultrasonography was 9.8% and and tumor detection rate was 97.1%, the examine rate of endoscope 52.8% and tumor detection rate was 70.0%, the examine rate of CT was 49.7% and tumor detection rate was 86.0%, the examine rate of DSA was 3.3% and tumor detection rate was 78.3%. The examine rate of biopsy was 16.1%. (4) The most common cell type was spindle cells which accounted for 78.9%, the epithelial cell type accounted for 11.5% and mixed cell type accounted for 9.6%. Immunohistochemistry staining examination: 93.7% CD117 positive cells, 69.3% CD34 positive cells, 16.4% SMA positive cells, 8.5% S-100 positive cells, 2.0% Desmin positive cells, 11.6% Vimentin positive cells, 1.2% NSE positive cells. Classification of benign and malignant tumors: benign tumors accounted for 28.6%, malignant tumors accounted for 46.1%, borderline tumors accounted for 23.7%. The risk classification: very low risk accounted for 8.2%, low risk accounted for 25.1%,middle risk accounted for 25.8% and high risk accounted for 40.7%. (5) Eight point nine percent preoperative diagnosed as GIST, 84.3% preoperative diagnosed as abdominal mass and others 6.8%. Ninety-one point five patients were completely resected, 6.5% were carried out palliative operation, 4.9% of lymphonode scavenge were positive. Seven percent patients were taken imatinib mesylate. Treatment effectiveness evaluation: CR accounted for 3.2%, PR accounted for 56.1%, SD accounted for 19.4%, PD accounted for 4.5%. Side effect: edema accounted for 12.9%, debilitation accounted for 3.9%, abdominal pain and diarrhea accounted for 3.2%, nausea and vomitting accounted for 4.5%, erythra accounted for 4.5%, auditory decrease accounted for 0.6%, conjunctivitis accounted for 0.6%. Post- operative lymphonode detection: lymphonode metastasis accounted for 2.4%. Hepatic metastasis accounted for 7.8% in preliminary diagnosed patients. 20.4% relapsed after surgery, 15.7% had metastasis. Among the total, abdominal cavity metastasis accounted for 13.9%, hepatic metastasis accounted for 9.1%, pulmonary metastasis accounted for 2.8%. Postoperative survival rate was 52.9%-100% in one year,19.5%-87.6% in two years, 42.8%-86.7% in three years and 32.6%-69.2% in five years.Conclusion: GIST lacks specific clinical manifestation. The main manifestations include alimentary tract hemorrhage, abdominal pain, abdominal mass and so forth. Clinical diagnosis mainly depends on endoscopy, CT and operations research. Pathological diagnosis relies on histological characteristics and immunohistochemistry detection of tumor markers. Complete resection is still the first choice for GIST diseases. Imatinib mesylate is the first choice for relapsing and metastatic GIST. Detection of GIST gene mutation can instruct the application of target therapy. Whether can be radically excised and risk classification are two factors that independently affect prognostic survival.