| ObjectiveTo retrospectively analyze the clinical data of 470 patients with gastrointestinal stromal tumor(GIST)who underwent surgery in our hospital,discuss the clinical characteristics and diagnosis and treatment of GIST,analyze the related factors affecting the prognosis,so as to provide scientific theoretical basis for the diagnosis and treatment of GIST in the future.MethodsWe retrospectively analysed 470 patients with gastrointestinal stromal tumor in the first affiliated hospital of Zhengzhou University by postoperative pathological diagnosis from August 2011 to August 2018.Date analysed included gender,age,preoperative CT,operation method,risk of NIH classification,tumor site,tumor size,diameter of fission,genetic testing,relevant immunohistochemical,transfer target therapy and postoperative recurrence following surgery.Statistical software SPSS22.0 was used to explore the relationship between clinicopathological factors and prognosis of gastrointestinal stromal tumors,and P<0.05 was defined as statistically significant difference.Results1.Among the 470 patients with gastrointestinal stromal tumor,there were 222 males(47.23%)and 248 females(52.77%).The age of onset was 15-86(57.96±11.74)years old.293 cases(62.34%)of primary tumors were located in the stomach,106 cases(22.55%)in the small intestine,and 71 cases(15.11%)in other sites.Significant tumor enhancement was observed in 321 cases(68.30%),no obvious tumor enhancement in 149 cases(31.70%),and obvious cystic changes in 353 cases(75,11%).There were 117 cases(24.89%)without obvious cystic changes,and the mean CT value was 10-67(36.53±9.54)HU.2.470 patients received Endoscopic ESD(EndosCopic Submucosed Dissection)surgery or surgical treatment,among which 35(7.45%)underwent ESD,133(28.30%)underwent laparoscopic surgery,and 302(64.25%)underwent open surgery.Postoperative tumor diameter was 0.4-29(7.08±4.07)cm.According to the NIH modified risk classification in 2008,there were 31 cases(6.60%)in the very low risk group,87 cases(18.51%)in the low risk group,144 cases(30.64%)in the medium risk group,and 208 cases(44.25%)in the high risk group.3.According to the postoperative pathology of 470 patients with gastrointestinal stromal tumor,263 cases(55.96%)with Ki-67 proliferation index<5%and 207 cases(44.04%)with>5%were observed.Mitotic images were<5/50HPF301(64.04%),6-10/50HPF116(24.68%),and greater than 10/50HPF53(11.28%).CD117 was positive in 444 cases(94.47%),DOG-1 was positive in 437 cases(92.98%),and CD34 was positive in 399 cases(84.89%).A total of 165 patients were tested for gene mutation of gastrointestinal stromal tumor after surgery.There were 143 cases(86.67%)with c-kit gene mutation,7 cases(4.24%)with PDGFRA gene mutation,and 15 cases(9.09%)with wild-type mutation.4.128 patients received imatinib mesylate 400mg/day as adjuvant therapy after surgery,very low risk and low risk did not receive postoperative adjuvant therapy,35 cases(27.34%)had moderate risk,and 93 cases(72.66%)had high risk;The last follow-up was conducted in August 2019.A total of 470 patients with gastrointestinal stromal tumor were followed up by telephone and outpatient service.Thirty-six patients were found to have recurred,including 2 patients with low risk(5.56%),patients with moderate risk(13.88),and 29 patients with high risk(80.56%).5.Spearman rank correlation analysis showed that risk grade had strong positive correlation with tumor diameter(r=0.78),mitotic image(r=0.59),cystic degeneration(r=0.42),surgical method(r=0.37),primary site of tumor(r=0.31)and Ki-67 proliferation index(r=0.30)(P<0.05).6.The single factor analysis found that gender,operation method,risk classification,the primary site of tumor,tumor size,diameter of fission,Ki-67 proliferation index,outline of tumor,targeted therapy after surgery,these factors and prognosis of tumor have statistical significance(P<0.05),the multi-factor analysis found that risk classification,tumor site,tumor size,diameter of fission,tumor outline independent risk factors for the prognosis of tumor(P<0.05).Conclusion1.There is no significant difference in the incidence of gastrointestinal stromal tumor between men and women.The onset of age is wide,and there is no specific onset age.Most of the patients were found in the stomach,followed by the small intestine,colorectum and extragastrointestinal tract.2.Preoperative enhanced CT can effectively diagnose gastrointestinal stromal tumors;postoperative routine pathology and immunohistochemistry can confirm the diagnosis;gene testing can improve the tumor pathological data and guide the subsequent adjuvant treatment and prognosis.3.There was a strong correlation between tumor diameter,mitotic index,cystic degeneration,surgical method,primary tumor site,Ki-67 proliferation index and risk grade.4.Gender,operation method,risk classification and tumor primary site,tumor size,diameter of fission,Ki-67 proliferation index,,tumor outline,targeted therapy after surgery is of decisive role in the gastrointestinal tract tumor surgery,risk classification,tumor site,tumor size,diameter of fission,tumor outline independent risk factors for the prognosis of gastrointestinal stromal tumor. |
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