Duodenal Gastrointestinal Stromal Tumor: A Multi-institutional Retrospective Analysis In Shandong Province(GISSG 1201Study)

Objective: To investigate the clinicopathological features and prognosis of patients with duodenal gastrointestinal stromal tumors(GIST) after surgery in Shandong Province.Methods: Clinicopathological data of duodenal GIST patients underwent different surgical procedures from July 2003 to November 2014 in 23 grade A tertiary hospitals in Shandong Province were reviewed retrospectively. Pathology results were rechecked. Patients were followed up. The prognostic factors were evaluated by univariate and multivariate analysis with Log-rank test and Cox proportional hazard model respectively.Results: A total of 203 duodenal GIST cases were enrolled, There were 101 males and 102 females. The median age was 55 years old. The 1-, 3-, 5-, and 10-year actuarial survival was 95%, 85%, 82%, and 82%, respectively. The 1-, 3-, 5-, and 10-year actuarial recurrence-free survival was 93%, 87%, 81%, and 75%, respectively. For patients with high risk of recurrence after surgery, the 5-year overall survival rate was significantly higher than those without medication(89% vs 62%, P <0.05). Multivariate analysis revealed that tumor size(P <0.05, RR=5.510,95%CI:1.170~5.719)), mitotic count(P <0.05, RR=6.849,95%CI:1.264~5.124), and the tumor rupture(P <0.05, RR=7.349,95%CI:1.608~18.196) were independent prognostic factors.Conclusions: Tumor size, mitotic count and the tumor rupture affect prognosis of patients after resection of primary duodenum GIST independently. Surgical methods was not associated with 5-year overall survival. Adjuvant imatinib therapy can improve overall survival of patients with high risk of recurrence after surgery.