| Objective: We collected and reviewed the clinical characteristics,diagnosis and therapy of gastrointestinal stromal tumor admitted in FourthHospital Of Hebei Medicial University. The follow-up date for patients wasrecorded. Recurrence or metastasis after surgery and prognostic factors wascomprehensive analyzed to provide the scientific basis for clinical treatment.Methods: The clinical date of389cases of GIST admitted betweenSeptember2003and June2013in Fourth Hospital Of Hebei MedicialUniversity was retrospectively reviewed. We analyzed the diseasecharacteristics,clinical manifestations, preoperative diagnosis, pathologicalfeatures, treatment of patients and recorded the follow-up date. The recurrencerate and survival rate was used to evaluate the prognosis. Univariate analysisand unconditional logistic regression analysis were used to evaluate the factorsof recurrence or metastasis after surgery. Kaplan-meier survival rate curve andcox regression model were used to explore the Survival factors.Results:1General statistical results1.1Gender: Male197cases,192cases of female, male to female ratio was1.03:1.1.2Age: The patient age of this group was14～82years old. The mean agewas (57.35±11.78) years old. Onset age mainly focus on50to70yearsold.1.3Tumor histology:15cases of patients with previous history of cancer,374cases of patients with no history of cancer.2Clinical manifestations: There was no specific clinical symptom for GISTand mainly including abdominal mass, abdominal pain,bloating.The proportion was33.54%、24.76%、14.73%.3Preoperative diagnosis:Preoperative examination mainly included CT,abdominal ultrasound, electronic endoscope, ultrasonic endoscope. Positivediagnosis rate was58.43%,46.67%,74.44%,87.27%.4Pathological features4.1Tumor location: Primary tumor in the stomach238cases (61.2%),duodenum14cases (3.6%), colorectal14cases (3.6%), ileum46cases(11.8%),77cases of extragastrointestinal stromal tumors (19.8%).4.2Tumor size: Diameter range0.5cm-40cm, with a median of6.5cm. Thediameter <5cm group of142cases (36.5%),5～10cm group of159cases(40.9%),>10cm group of88cases (22.6%).4.3Mitotic counts: Mitotic counts <5/50HPF group of167cases (42.9%),5～10/50HPF group of170cases (43.70%),>10/50HPF group of52cases(13.37%).4.4Risk classification: Extremely low risk and low risk group95cases（24.4%），the moderate risk group of96cases（24.7%），high risk group of198cases(50.9%).4.5Immunohistochemical: CD117, CD34, DOG-1the positive rate was92.2%(358/389),68.3%(266/389),97.3%(73/75).5Treatment5.1Surgical procedure: R0resection group of371cases (95.4%), non-R0resection group of18patients (4.6%).5.2Lymph node dissection: lymph node dissection group of20cases (5.1%),and no lymph node dissection group of369cases (94.9%).5.3Tumor rupture: Intraoperative tumor rupture group of15cases (3.9%),non-ruptured group of374cases (96.1%).5.4Invading the surrounding organs or tissue: Intraoperative explorationinvading surrounding organs or tissue group of21cases (5.4%), and noinvading the surrounding organs or tissue group of368cases (94.6%).5.5Molecular targeting treatment: Among moderate and high risk patients,accepting imatinib treatment after surgery group of112cases (42.1%), no imatinib treatment group of154cases (57.9%).6Prognostic analysis6.1Analysis of recurrence and metastasis after surgery: There were354patients getting successful follow-up, and119patients with postoperativerecurrence and metastasis. The1,3,5,7,10-year cumulative recurrence rateswere8.1%,26.0%,35.6%,38.3%,41.6%.6.1.1Univariate analysis：Compared with other sites, gastric stromal tumorhas a lower recurrence or metastasis rate（χ2=21.587，P=0.000）；Patients withlarge tumor size has a higher recurrence or metastasis rate（χ2=32.751，P=0.000）；High mitotic count was strongly associated with a high recurrenceor metastasis rate（χ2=40.098，P=0.000）；High risk classification was asignificant variable in worse prognosis for DFS rate（χ2=60.849，P=0.000）；Invading the surrounding tissue was strongly associated with a high recurrenceor metastasis rate(χ2=12.366，P=0.000)；R0resection was strongly associatedwith a better DFS rate （χ2=12.666，P=0.000）；Tumor rupture duringoperation was a significant variable in worse prognosis for DFS rate（χ2=4.715，P=0.030）；Imatinib treatment was a significant positive variablein recurrence or metastasis rate（χ2=6.824，P=0.009）。6.1.2Multivariate analysis: Tumor size, mitosis, risk classification, surgicalprocedure, imatinib treatment were independent factors of recurrence ormetastasis.6.2Analysis of survival rate after surgery: There were354patients gettingsuccessful follow-up, and98patients have died. The average survival timewas48.1months. The1,3,5,7,10-year survival rate rates were71.2%,63.1%,55.9%,54.8%,33.3%.6.2.1Univariate analysis: Compared with other sites, gastric stromal tumorhas a higer survival rate（χ2=30.463，P=0.000）；Large tumor size was asignificant variable in worse survival rate（χ2=37.598，P=0.000）；High mitoticcount was strongly associated with a worse survival rate（χ2=30.806，P=0.000）；High risk classification was a significant variable in worse survivalrate（χ2=52.147，P=0.000）；Invading the surrounding tissue was strongly associated with a worse survival rate（χ2=29.458，P=0.000）；R0resection wasstrongly associated with a higher survival rate （χ2=44.158，P=0.000）；Tumorrupture during operation was a significant variable in worse survival rate（χ2=5.092，P=0.024）；Imatinib treatment after surgery was a significantpositive variable in survival rate（χ2=12.937，P=0.000）。6.2.2Multivariate analysis: Tumor mitosis, risk classification, surgicalprocedure, imatinib treatment were independent prognostic factors.Conclusion:1GIST patients with male to female ratio is1.03:1, the incidence of male isslightly higher than female. The mean age was (57.35±11.78)years old. Onset age mainly focus on50to70years old. Clinicalmanifestations mainly include abdominal mass, abdominal pain, bloatingand the proportion was33.54%,24.76%,14.73%.2Gastric stromal tumor is the most common, followed by the order ofextragastrointestinal stromal tumor, ileum stromal tumor, duodenal stromaltumor, colorectal stromal tumor, which with the proportion of61.2%,19.8%,11.8%,3.6%,3.6%.3Recurrence rate after surgery: The1,3,5,7,10-year cumulative recurrencerates were8.1%,26.0%,35.6%,38.3%,41.6%.4Overall survival: The average survival time was48.1months. The1,3,5,7,10-year survival rate rates were71.2%,63.1%,55.9%,54.8%,33.3%.5Compared with other sites, gastric stromal tumor has a better prognosis.Large tumor size, high mitotic count, high risk classification and invading thesurrounding tissue are strongly associated with a worse prognosis.6Tumor size, mitotic count, risk classification, surgical procedure, imatinibtreatment is independent prognostic factor.7Gender sex, age, history of cancer, lymph node dissection could notinfluence on prognosis for patients with gastrointestinal stromal tumors.8Surgical resection is the main method for the treatment of primary GIST.The R0resection and preventing tumor repture could improve the prognosisafter surgery. 9Taking imatinib after surgery could improve the prognosis for patientswith gastrointestinal stromal tumors. |
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