Analysis Of Clinical Pathological Features And The Prognostic Factors Of Gastrointestinal Stromal Tumors

Objective:The aim of this retrospective study is to evaluate the clinicopathologic features and analysis the common treatments of gastrointestinal stromal tumors.Figure out the relative factors which affect the prognosis in order to improve the diagnosis and treatment of GIST.Methods:240Patients with gastrointestinal stromal tumors were collected between January2006to July2013in Tian jin Medical University General Hospital. Analyzed all data including gender, age, clinical symptoms, imaging methods, treatment methods and pathology results. Using Kaplan-Meier method for survival analysis, Logistic regression analysis for single factor analysis. Cox regression for multivariate analysis. Compared the outcomes of perioperative situation and prognosis between laparoscopic surgery group and laparotomy group for gastrointestinal stromal tumors, discussed the efficacy of laparoscopic surgery.Results:1、Clinical results:240patients, including132male,108female. The average age is (56.5±13.0) years. The common clinical symptoms is Abdominal pain, gastrointestinal bleeding, abdominal mass. The Diseased regions,including144cases in stomach,15cases in duodenum,46cases in Jejunum and ileum,15cases in esophageal,8cases in rectum and Colon. All patients were treated by surgery, including61cases of endoscopic resection,13cases of laparoscopic surgery.2、Pathological results:the diameter range of Tumor was between1.5and25.0cm. The organizational Type of240GIST, including spindle cell type is155cases, the epithelioid cell type is62cases, the mixed type is23cases; using NIH grading standard to Classified the GIST in240cases of GIST, Followed-up:61cases with the lowest malignant group,51cases with the lower malignant group,66cases with moderate malignant group,62cases with high malignant group.3、Follow-up results:The1year,3years and5years survival rate of240patients were963%、87.5%、72.5%.Univariate analysis revealed that the tumor size,number of karyokinesis, tumor malignancy risk,tumors location, tumor hemorrhage and necrosis, metastasis were related to the survival rates. Multivariate analysis showed that tumor malignancy risk and radical surgical excision were the most important prognostic factors of the primary tumor resection group. The advanced GIST patients treated with Gleevec showed significant improvement in survival rate (P<0.05).Conclusions:1^GIST mainly occurs in older people and has a similar incidence among men and women. The presentations are always unspecific, such as abdominal pain, gastrointestinal bleeding and abdominal mass; and diagnosis can be difficult to make, as it can be asymptomatic in the early stages.2> As a new marker of GIST, DOG1protein has a similar sensitivity as CD117, and serves as a good complimentary indicant to CD117and CD34in the diagnosis of GISTs, especially of CD117-GISTs. Histological features along with immunochemical indicators such as CD117, DOG1, CD34, SMA and S-100can differentiate GIST from other mesenchymal-derived tumors and thus help with establishing the diagnosis.3、The radical surgery is still the best therapy to the primary gastrointestinal stromal tumor. Laparoscopic surgery is recommended for its safety and effectiveness.4、Imatinib mesylate can significantly improve the survival rate of patients with metastatic gastrointestinal stromal tumors.5、It is reasonable to use the NIH grading standard to predict the biological behavior and prognosis of GISTs and directing treatment.