The Surgical And Molecular Target Therapy Of Gastrointestinal Stromal Tumor In Huashan Hospital

Purpose:Planned to investigate the clinical characteristics,surgical treatment,molecular target therapy and prognostic factors of gastrointestinal stromal tumors(GISTs).Methods:The clinical records of 68 patients with GISTs in Huashan hospital between Jan.2005 and Dec.2007 were reviewed retrospectively.Clinical follow-up was performed up to April 1^st 2009.We used the SPSS 15.0 to perform our statistical analysis.Table was used for case analysis.Survival analysis was performed by using the Kaplan-Meier method.The independent prognostic factors that affect survival were evaluated by univariate analysis using log-rank test.Multivariate analysis was performed with the Cox proportional hazards model.Results:Sixty-eight patients with GISTs were consistent with our study.All the patients underwent surgical treatment.The median age was 57.0 years,the female:male ratio was 26:42.The stomach was the most common site of origin (n=50,73.5%).Of the stomach,body was the most common anatomic origin(n=29,58.0%).The most common GIST symptoms and signs were gastrointestinal bleeding(27.9%) and palpable mass(20.6%).CT was the most commonly used methods for diagnosis(n=57,83.8%) before surgery,the sensibility to find mass was 89.5%.The median greatest tumor diameter was 6.0 cm.Exophytic(66.2%) growth was the main growth pattern.CD117 was positive in 92.6%patients,CD34 in 86.8%.Thirteen(19.1%) patients were benign,fifty-five(80.9%) were malignant or malignant potential based on postoperative pathology.Fifty-four localized GIST and six locally advanced patients all obtained complete resection.One multiple,seven metastatic tumors were detected.Four underwent complete resection,four incomplete.Lympha-denectomy was performed in 11(16.2%) patients,with 1(1.5%) having lymph node metastasis.No patients received molecular target therapy before surgery.Three localized,one locally advanced and four metastatic patients took Imatinib therapy after surgery.The median follow-up period was 25.9 months. We detected recurrence in 5(7.8%)patients after complete resection.There was no death in the early postoperative peroid.Four patients died due to tumor-related reasons during postoperative follow-up.The survival rate at 36 months was 91%.Univariate analyses revealed size less than 5 cm(p=0.044) enhanced survival rate.But Cox proportional hazards model revealed that there was no factor to increase survival rate.Conclusion:Surgical treatment remains the fundamental treatment for all GISTs in Huanshan hospital.But some operative methods don't keep up with the times,for example,wedge resection and laparoscopic surgery.For economical reason,most patients couldn't receive relatively standard molecular target therapy.Since the inpatients were random,the sample was small,the incidence rate of events was low and the follow-up peroid wasn't long enough,we didn't discover prognostic factors that significantly affect the survival of gastrointestinal stromal tumors(GISTs).