| Objective: By retrospecting and analyzing clinical data systematically, we mainly discussed the related factors of postoperative adjuvant treatment of gastrointestinal stromal tumors,which to provide theoretical and clinical guidance.Methods: There are 128 people which has received adjuvant therapy in GIST in the Fourth Hospital of Hebei Medical University during April 2004 to December 2013,and we has recorded the related information of 120 people through outpatient records and telephone follow-up.To analyze the gastrointestinal stromal tumor in gender, age, primary tumor site, tumor diameter size, mitoses, the first operation risk classification, treatment time and other factors on the prognosis by using SPSS21.0 in statistics, Kaplan-Meier in Multiplication of survival rate, Log-rank in the the effects of single factor in survival rate. Among them, the single factor analysis which had statistical significance used Cox regression model.All the data processing results has a statistically significance in P<0.05.Results:1 The general statistical results 1.1 There are 128 people which has received adjuvant therapy in GIST in the Fourth Hospital of Hebei Medical University during April 2004 to December 2013,and there were 120 people through outpatient records and telephone follow-up,the follow-up rate was 93.8%. 1.2 Gender:Among the adjuvant treatment of patients of 120 in Imatinib Mesylate,the males were 57 and females were 63. The retio of males and females was 1:1.11,then the female was more than males. 1.3 Age:Among the age 26 to 78,the median age was 57 and the average agewas 60.58±10.31,there were 77 patients below 60 years of age,which 21 patients has recurrence or metastasis and 20 patients has died.,There were 43 patients more than 60 years,which 16 patients has recurrence or metastasis and 13 patients has died. 1.4 Clinical manifestations: The clinical manifestations,which had abdominal pain, abdominaldistension,tumor,bleeding-hematemesis, melena,is lack of specificity. 1.5 The region:The primary site in stomach had 75 patients, which including 16 patients has recurrence or metastasis and 15 patients has died. The primary site in jejunoileum had 16 patients, which including 1 patients has recurrence or metastasis and 1 patients has died. The primary site in duodenum had 5 patients,which including 1 patients has recurrence or metastasis and 1 patients has died. The primary site in colorectal had 2 patients, which including 2 patients has recurrence or metastasis and 2 patients has died. The primary site in others had 22 patients, which including 13 patients has recurrence or metastasis and 11 patients has died. 2 Morbid state 2.1 Diameter of the tumor size:The maximum diameter of the tumour in the Postoperative pathology specimen of first GIST case:there were 32 patient’s tumour follow the 5cm,the percent is 27.7%,which including 6 patients has recurrence or metastasis and 6 patients has died.There were 55 patients’ in between 5cm and 10 cm, the percent is 45.8%,which including 15 patients has recurrence or metastasis and 13 patients has died.There were 37 patients’ above the 10 cm,the percent is 26.5%,which including 16 patients has recurrence or metastasis and 14 patients has died. 2.2 Mitoses: By pathological diagnosis,there were 33 patients follow the 5/50 HPF,the percent is 27.5%,which including 11 patients has recurrence or metastasis and 10 patients has died.There were 64 patients’ in between 5-10/50 HPF, the percent is 53.3%,which including 18 patients has recurrence or metastasis and 15 patients has died.There were 23 patients above the10/50 HPF,the percent is 19.2%,which including 8 patients has recurrence or metastasis and 8 patients has died. 2.3 Immunohistochemical: All the patients were immunohistochemical, CD117:120 cases of positive, positive rate was 100%, CD34:93 cases of positive, positive rate is 77.5%, 81 cases of detection of S-100, 4 cases were positive, the positive rate is:4.9%, 44 cases of detection DOG-1, 44 cases were positive, positive rate is 100%. 3 NIH classification in 2008: There were 8 patients had recurrence or metastasis and 8 patients died in 42 intermediate-risk patients.There were 29 patients had recurrence or metastasis and 25 patients died in 78 high-risk patients. 4 Surgical methods: There were 107 cases with simple resection of the primary lesion,which 30 patients had recurrence or metastasis and 27 patients died. There were 13 cases with organ resection,which 7 patients had recurrence or metastasis and 6 patients died. 5 Follow-up:Lifetime of tumour-free was 10-121 months,the median disease-free survival is 42.5 months.The percent of survival in 1year,3 year or 5 years was 97.0%,80.0%,67.0%. Survival time from 15 to 121 month, median survival time was: 48 months.1, 3, 5years survival rate was respectively: 100%,91.0%、,68.0%. 6 Survival analysis: 6.1 Single factor analysis:It has statistical significance that the primary tumor site, tumor diameter, NIH grade 3 are the related factors of postoperative Imatinib Mesylate therapy(log-rankχ2= 28.072,9.414,3.893 P=0.000,0.009,0.048). 6.2 Multiplicity:It has statistical significance whether the tumor originating in the stomach is a high-risk factor of adjuvant treatment of imatinib mesylate(P=0.006). 7 Time to take medication:Intermediate risk taking imatinib mesylate in the case of taking the number of less than 1 year of 20 people, of which 8 cases of recurrence, 8 cases of death; The medicine of the 22 cases of patients, morethan 1 year; there were no transfer and death. High-risk groups taked imatinib mesylate medicine cases less than 1 year for the number of 25 people, of which 13 cases of recurrence, 13 cases were died; 53 patients with medication is greater than 1 year, 16 cases of recurrence, 12 cases were died. High-risk groups taking imatinib mesylate the number of cases is less than 2 years for 27 cases, 15 cases of recurrence, 13 cases were died; Taking more than 2 years of 51 cases patients, 14 cases of recurrence, 12 cases were died.Conclusions:In the fourth hospital, hebei medical university from April 2004 to December 2004 in hospital or outpatient service during admitted after radical surgery and adjuvant therapy in patients with intermediate and high-risk GIST cases data analysis, can draw the following conclusions: 1 The cases onset age was 26 to 78 and median age was 57 and the average age was 60.58±10.31. Primary site of tumor in 75 cases of stomach(62.5%)and small intestine in 16 cases(13.3%), duodenum in 5 cases(4.2%), 2 cases of colorectal(1.7%)and other parts of the 22 cases(18.3%). The main clinical manifestations were abdominal pain、 abdominal distension、 tumor、bleeding-hematemesis, melena. 2 Lifetime of tumour-free was 10-121 months,the median disease-free survival is 42.5 months.The percent of survival in 1 year,3years or 5years was 97.0%,83.0%,71.0%. Survival time from 15 to 121 month, median survival time was: 48 months. 1,3,5 years survival rate was respectively: 100%,91.0%,68.0%. 3 Gender,age,Mitotic figures,whether for combined organ resection were not the related factors of postoperative Imatinib Mesylate therapy,but for the primary tumor site、tumor diameter, NIH grading were the related factors of postoperative Imatinib Mesylate therapy. 4 Whether the tumor originating in the stomach is a Independent factor for adjuvant treatment of imatinib mesylate postoperative application. 5 Intermediate,high-risk GIST patients taking imatinib mesylate time more than one year after the operation, the prognosis is better. High-risk GISTpatients taking imatinib mesylate time more than two years after the operation, the prognosis is better. |
PDF Full Text Request