Prognostic Analysis Of Clinicopathologic Characterization And Lymphangiogenesis And Angiogenesis In Gastrointestinal Stromal Tumors

Chapter One:Prognostic analysis of clinicopathologic characterization in173gastrointestinal stromal tumors patientsObject:In order to find out a more suitable risk classification in China, we evaluated prognosis factors of clinicopathologic characterization and risk classification of Fletcher score, Miettinen score and Joensuu score in gastrointestinal stromal tumors patients.Methods:The clinicopathological features and follow-up date of173patients with GISTs in three hospitals in Changsha were retrospectively reviewed. General conditions, symptoms and tumor size, mitotic index and other pathological parameters were tested as prognostic factors. Survival analysis of152primary disease were taken according to Fletcher score, Miettinen score and Joensuu score.Results:There was no significant difference in gender, age, disease course, tumor size and location in survival and recurrence-free survival analysis. The survival rates of RO resection patients were significant higher than partial resection. The survival rates of patients treated by endoscope were similar with patients of surgery. Among the three classification scores, Fletcher score showed significant differences in recurrence-free survival rates, but none in overall survival rates; Miettinen score showed significant differences both in recurrence-free and overall survival rates. Joensuu score showed no significant differences both in recurrence-free and overall survival rates. There were no significant differences among different tumor location in recurrence-free and overall survival rates according to three scores.Conclusion:Surgical resection is still the main treatment for GISTs. The survival rates of Endoscopic resection are equal to surgery in small GISTs. Single index is not suitable with primary GISTs prognostic evaluation. Miettinen score is more close to clinic in prognostic analysis, better than Fletcher score and Joensuu score. Chapter Two:Correlation between symptoms and tumor characterization in GISTsObject:In order to know more about clinical presentation in GISTs, we analysis the correlation between symptoms and tumor features. This may be helpful in diagnosis.Methods:The absent of symptoms and common symptoms in173GISTs patients were analyzed according to the tumor size, location, growth pattern and other features.Results:Abdominal pain and bleeding. were the most common symptoms, mainly occurred in gastric and intestinal GISTs. The present of symptoms in female is lower than in male. The present of symptoms is associated with tumor location, size, growth pattern, and structure, but none with the age, clinic course, metastasis, mitotic index and risk classification. The number of patients presented with bleeding and abdominal pain in esophageal, colon, rectal, omentum and liver GISTs is obviously less than the GISTs in stomach and small bowel. The incidence of abdominal pain in gastric GISTs of dumbbell-like growth pattern is obviously higher than the same pattern in intestinal GISTs. The incidence of abdominal pain in intestinal GISTs, whose growth pattern is out of the GI (gastric and intestinal) wall, is obviously higher than the same pattern of gastric GISTs and dumbbell-like intestinal GISTs. The incidence of bleeding in diameter≤5cm intestinal GISTs is significant higher than diameter>5cm intestinal GISTs. The incidence of bleeding in dumbbell-like intestinal GISTs is much higher than the outside pattern intestinal GISTs.Conclusion:Abdominal pain and bleeding were the most common symptoms, mainly occurred in gastric and intestinal GISTs. The present of symptoms in female is lower than in male. The present of symptoms is associated with tumor location, size, growth pattern, and structure. When a patient shows abdominal pain, the outside pattern GISTs should be excluded. When a patient shows bleeding of no reason, the present of small diameter of intestinal GISTs should be noticed. Chapter Three:The lymphangiogenesis and angiogenesis in GISTsObject:To investigate the mechanism of lymphangiogenesis and angiogenesis in GISTs, and their difference with gastric cancer.Methods:84GISTs and8gastric cancer patients were studied. Lymphatic and microvessel density as well as PROX1, VEGF-C, Syk and HIF-la expression in tumor tissues were analyzed by immunohistochemical(IHC) staining. The mRNA levels of PROX1, VEGF-C, Syk and HIF-1a were also tested.Results; The intratumoural lymphatics were rarely. detected in GISTs. The peritumoural lymphatics were very common in GISTs. The ITLs, PTLs and MVD in GISTs were obviously lower than in gastric cancer. The IHC staining of VEGF-C, Syk, and HIF-1a in GISTs showed no differences with in gastric cancer, but the PROX-1expression in IHC and mRNA level is obviously lower in GISTs than in gastric cancer. The mRNA levels of VEGF-C significant elevated in GISTs. The PTLs and MVD in GISTs were associated with tumor cell pattern. VEGF-C showed a high expression in younger patients (age<50y). HIF-1a showed a high expression in bleeding patients, accompany with a higher MVD.Conclusion:GISTs have a lower PTLs and MVD than gastric cancer. The depression of PROX-1protein and mRNA may related to lymphangiogenesis in GISTs, and have no effect with the mRNA level of VEGF-C. The elevated mRNA level of VEGF-C in younger patient may related to their high incidence of lymph node metastasis. Syk positive was first reported in GIST. The high expression of HIF-la is associated with bleeding.