The Clinical Observation Of73Cases Of Gastrointestinal Stromal Tumors Treated With Imatinib

Background and Purpose: GIST (Gastrointestinal stromal tumors (GIST)) aremesenchymal tumors of the gastrointestinal tract, gastrointestinal cancer accounts forabout1-3%, the annual incidence of about1to2/10000. GISTs overall5-yearsurvival rate was35%, surgery is the treatment of choice, along with imatinib(imatinib (IM)) mainly targeted drugs are widely used in gastrointestinal stromaltumor adjuvant treatment, as well as first-line treatment, the patient survival rate wassignificantly improved. This paper aims to explore the local epidemiology of oralimatinib therapy and clinical pathological features of patients with gastrointestinalstromal tumors, the analysis of prognostic factors related to the evaluation of imatinib(IM) in the adjuvant treatment of GIST patients as well as first-line treatment Clinicalefficacy and treatment of GIST patients with adverse reactions.Methods:Collected from July2011to March2014in Dalian oral imatinib(IM): clinical data (trade name Gleevec)400mg/d treatment of73cases of GISTpatients. All patients were confirmed through pathology or cytology is GIST, andCD117(+), physical condition score ECOG≤2minutes, taking at least a monthbefore did not perform chemotherapy, biological therapy or other treatments; capableof first-line treatment of patients measurement of target lesions. After the first-linetreatment of oral treatment three months later, according to the new solid tumorevaluation criteria in1999the United States ASCO meeting (RECIST) for efficacy evaluation. Toxicity according to the U.S. National Cancer Institute CommonToxicity Criteria (NCI-CTC3.0) were evaluated. Using SPSS17.0statistical softwarefor data processing and statistical analysis accordingly. Count data X2test,calculated using the Kaplan-Meier method PFS and survival curves were plotted,Log-Rank method for first-line treatment prognosis univariate analysis andmultivariate analysis using COX regression. P values <0.05were consideredstatistically significant.Results:1.Patients1,73cases of oral imatinib therapy, a total of45cases of postoperativeadjuvant therapy, first-line treatment in28cases.36males (49.3%), womenaccounted for37cases (50.7%), age of onset between29-81years old, with a medianage of59.2years,69cases (94.5%) underwent surgical treatment,32cases of gastricprimary site (43.8%), small intestine34cases (46.6%), rectal three cases (4.1%),abdominal five cases (5.5%).28cases of first-line treatment of patients,24cases ofdistant recurrence and metastasis, including liver metastasis in15cases (62.5%), lungmetastasis in5patients (2.4%), peritoneal metastasis2cases (0.83%), other parts ofthe transfer of two cases (0.83%), four cases of unresectable primary tumor.Pathological and immunohistochemical results: CD117(+) accounted for100%(73/73), CD34(+) accounted for54.8%(40/73), s-100(+) accounted for4.7%(3/64),DOG-1(+)100%(12/12),49patients were detected desmin found no positive cases.2. First-line treatment of28patients, with an average follow-up time of11.4months, patients were treated with six cases of recurrence or unresectable Gleevectargeted therapy two months, less than three months, has not been efficacy evaluation.22cases of recurrence or unresectable patients, seven cases of recurrence, the medianPFS was21months,1year and2-year progression-free survival (PFS) were81.8%,68.2%. There are three cases in which CR (13.6%), PR3cases (13.6%), SD9patients(40.9%), PD7patients (31.9%), the total benefit (RR=CR+PR+SD) rate68.1%.Analysis of prognostic factors related to age, gender, disease location, and othermetastatic sites, tumor size, tumor necrosis and mitotic count is whether the relevantprognostic factors, and COX regression analysis showed that tumor size is thediameter of the line treatment of high-risk prognostic factors.The first-line treatmentof28patients, with an average follow-up time of11.4months, patients were treatedwith six cases of recurrence or unresectable Gleevec targeted therapy two months, less than three months, has not been efficacy evaluation.22cases of recurrence orunresectable patients, seven cases of recurrence, the median PFS was21months,1year and2-year progression-free survival (PFS) were81.8%,68.2%. There are threecases in which CR (13.6%), PR3cases (13.6%), SD9patients (40.9%), PD7patients(31.9%), the total benefit (RR=CR+PR+SD) rate68.1%.3. A total of45cases of postoperative adjuvant therapy in patients with anaverage follow-up time of15.7months,9patients with recurrence,1-year,2-yearrelapse-free survival (RFS) were97.8%,80%.21cases in the risk group, there is onecase of recurrence (4.8%),1-year recurrence-free survival rate of100%, andrelapse-free survival rate was95.2%within2years.24cases of high-risk group, thereare eight cases of recurrence and metastasis (33.3%),1-year relapse-free survival(95.8%), within2years of recurrence in8patients (66.7%). Intermediate-risk andhigh-risk group by group comparison found, RFS significant difference.4.73cases of patients with oral targeted therapy imatinib, there are seven casesof any side effects did not occur, and the remaining majority of adverse reactionswere mild. Toxicity ratio of8percent or greater, are listed below,41cases of varyingdegrees of edema and sodium retention (56.2%), Ⅰ°24cases, Ⅱ°14cases, Ⅲ°3cases;15cases of nausea and vomiting (20.5%), Ⅰ°10cases, Ⅱ°5cases;14casesof adverse reactions have abdominal pain and diarrhea (19.1%), Ⅰ°8cases, Ⅱ°6cases; decrease (12.3%)9cases of neutropenia, Ⅰ°5cases, Ⅱ°4cases; appearedeight cases of lower back and extremities rash (11.0%), Ⅰ°5cases, Ⅱ°2cases, Ⅲ°1case;8patients had fatigue symptoms (11.0%), Ⅰ°4cases, Ⅱ°4cases. Otheradverse reactions include liver and kidney damage, anemia, hair loss, muscle aches.1patient with severe grade3rash, short-term oral steroid treatment and return to normalafter stopping treatment.Conclusion:1. In the region of gastrointestinal stromal tumors, the incidence of the majorityof middle-aged patients, males slightly higher incidence rate than women. Theincidence of stomach and small intestine majority, mainly in liver metastasis andperitoneal metastasis based.2. First-line treatment in patients with imatinib, the median PFS21months, thetotal benefit rate of68.1%.1-year and2-year progression-free survival (PFS) were81.8%,68.2%. Tumor size, tumor necrosis and mitotic counts is whether the first-line treatment-related factors affecting prognosis. Tumor size is first-line treatment inpatients with risk factors for prognosis.3. Patients with postoperative adjuvant imatinib therapy, the1-year,2-yearrecurrence-free survival rates were97.8%,80%. Postoperative adjuvant therapy inpatients with risk factors for RFS low.4. Imatinib treatment of gastrointestinal stromal tumors mild toxicity, patientstolerated. Discontinuation due to adverse reactions in patients with less severe.