| Objective: To investigate the clinical features and treatment of postoperative recurrence and metastasis of gastrointestinal stromal tumors,and to analyze the risk factors and prognosis of postoperative recurrence and metastasis,and provide guidance for prevention and treatment of postoperative recurrence and metastasis of gastrointestinal stromal tumors.Methods: The patients with gastrointestinal stromal tumors who underwent surgery from January 2008 to January 2018 in the Fourth Hospital of Hebei Medical University were selected.The general data(sex,age,family history)and pathological characteristics(tumor location,tumor size,mitotic figures,tissue type,immunohis-tochemistry)and gene mutation type,risk grading,preoperative treatment,surgical radicalization,postoperative targeted drug therapy,postoperative recurrence and metastasis,treatment after recurrence and metastasis were collected.The patients were followed up(outpatient review and telephone follow-up)to understand survival.Univariate and multivariate analysis were used to analyze risk factors for postoperative recurrence,metastasis and prognosis in patients with gastrointestinal stromal tumors.Results: 1 General dataA total of 287 patients with gastrointestinal stromal tumors underwent surgery and 94 patients had recurrence and metastasis.1.1 GenderThere were 153 males,accounting for 53.3%,and 134 females,accounting for 46.7%.1.2 AgeThe age range was 18-78 years old,and the average age was(55.41±9.64)years old.1.3 Family historyThere were 10 cases of family history of stromal tumors,accounting for 3.5%,and there were no family history of 277 cases,accounting for 96.5%.2 Pathological features 2.1 Primary siteThere were 127 cases of stomach,accounting for 44.3%,69 cases of jejunum,accounting for 24.0%,16 cases of duodenum,accounting for 5.6%,35 cases of colorectal,accounting for 12.2%,and 40 cases of other parts,accounting for 13.9%.2.2 Tumor sizeTumor diameter was ? 5cm in 75 cases,accounting for 26.1%,5.1-10 cm in 142 cases,accounting for 49.5%,> 10 cm in 70 cases,accounted for 24.4%.2.3 Nuclear fissionThe number of mitotic divisions was ?5/50 HPF in 62 cases,accounting for 21.6%,6-10/50 HPF in 139 cases,accounting for 48.4%,and >10/50 HPF in 86 cases,accounting for 30%.2.4 Organization typeThere were 207 cases of spindle cell type,accounting for 72.1%,and 43 cases of epithelioid cell type,accounting for 15.0% and mixed type,accounting for 12.9%.2.5 ImmunohistochemistryCD117 was positive in 261 cases,accounting for 90.9%,and CD34 was positive in 229 cases,accounting for 79.8% and D0G-1 positive in 252 cases,accounting for 87.8%.3 Gene mutation typeThere were C-kit gene mutation in 171 cases(9 exon mutations in 20 cases,11 exon mutations in 144 cases,13 exon mutations in 4 cases,17 exon mutations in 2 cases,and 18 exon mutations in 1 case),wild types in 22 cases,and no cases of PDGFRA mutation.4 Risk classificationThere were 72 cases in the very low-risk and low-risk groups,accounting for 25.1%,70 cases in the intermediate-risk group,accounting for 24.4%,and 145 cases in the high-risk group,accounting for 50.5%.5 Preoperative targeted drug treatment74 patients were treated with targeted drugs before operation,accounting for 25.8%.213 patients were not treated with targeted drugs before surgery,accounting for 74.2%.6 First surgery radical degreeThere were 236 patients with R0 resection,accounting for 82.2%,and 51 patients with non-R0 resection,accounting for 17.8%.7 Postoperative targeted drug treatment143 cases of targeted drugs were taken after operation,accounting for 49.8%,and 144 cases of targeted drugs were not taken after operation,accounting for 50.2%.8 Postoperative recurrence siteThere were 26 cases of simple recurrence(9 cases of stomach,7 cases of small intestine,3 cases of colorectal,7 cases of gastrointestinal tract),accounting for 27.7%: 41 cases of simple metastasis(27 cases of liver,8 cases of abdominal pelvic cavity,4 cases of retroperitoneum,bone metastasis 1 cases,1 cases of lung metastasis),accounting for 43.6%: 27 cases of recurrence and metastasis,accounting for 28.7%.9 Treatment after recurrence and metastasis24 cases were not treated,accounting for 25.5%;54 cases were treated with targeted drugs,accounting for 57.4%;4 cases were treated with surgery alone,accounting for 4.3%;and 12 cases were treated with surgery and targeted drugs,accounting for 12.8%.10 Follow-upAs of January 2019,201 patients survived and 86 died.11 Analysis of related factors of postoperative recurrence and metastasis 11.1 Univariate analysisThe primary site is located in the stomach with the lowest rate of recurrence and metastasis,and there is no significant difference between other sites;the larger the tumor diameter,the higher the recurrence and metastasis rate;the more mitotic numbers,the higher the recurrence and metastasis rate;the recurrence risk grade is higher,the higher the recurrence and metastasis rate;the degree of surgical radicalization is an important factor affecting recurrence and metastasis.The first operation of R0 resection can significantly reduce the rate of recurrence and metastasis;postoperative oral targeted drugs can significantly reduce the rate of recurrence and metastasis.Gender,age,family history,tissue type,immunohistochemistry,type of gene mutation,and preoperative targeted drug therapy were not associated with postoperative recurrence and metastasis.11.2 Multi-factor analysisTumor diameter,mitotic number,tumor risk grading,surgical radicalization,and postoperative targeted drug therapy are independent factors affecting postoperative recurrence and metastasis.12 Analysis of related factors of postoperative survival rate 12.1 Univariate analysisThe primary site has the highest survival rate after gastric surgery,and there is no significant difference between other sites;the survival rate of patients with small tumor diameter is higher;the fewer the number of mitotic division,the higher the postoperative survival rate;the higher the tumor risk classification The postoperative survival rate was lower;the survival rate of patients with R0 resection was higher than that of non-R0 patients;postoperative oral targeted drugs could significantly prolong the survival of patients.Postoperative recurrence and metastasis patients have shorter postoperative survival.Gender,age,family history,tissue type,immunohistochemistry,gene mutation types,and preoperative targeted drug therapy had no significant relationship with postoperative survival.12.2 Multi-factor analysisTumor diameter,mitotic number,tumor risk grading,surgical radicalization,postoperative targeted drug therapy and postoperative recurrence and metastasis were independent factors affecting postoperative survival.13 Analysis of related factors of prognosis in patients with recurrent metastasis 13.1 Univariate analysisThe survival rate of patients with simple recurrence was higher than that of patients with simple metastasis or recurrence and metastasis.The survival rate of patients with recurrence and metastasis combined with targeted drug therapy was significantly higher than that of patients with simple surgery,simple targeted drugs and untreated patients.13.2 Multi-factor analysisThe site of postoperative recurrence and metastasis,treatment after recurrence and metastasis are independent factors affecting the survival of patients with recurrence and metastasis.Conclusion:1.GIST tumor size,mitotic figures,risk grading,surgical radicalization,and postoperative targeted drug therapy are independent factors that affect postoperative recurrence and metastasis.2.GIST tumor size,mitotic figures,risk grading,surgical radicalization,and postoperative targeted drug therapy for recurrence and metastasis were independent factors influencing the prognosis of postoperative patients.3.GIST has a higher recurrence and metastasis rate and a short postoperative survival rate in primary site of non-stomach,but they are not independent factors affecting postoperative recurrence,metastasis and prognosis.4.Gender,age,family history,histological type,immunohistochemistry,gene mutation type,and preoperative targeted drug therapy were not related factors affecting postoperative recurrence,metastasis and prognosis.5.Patients with simple recurrence after surgery have a better prognosis than patients with metastasis and recurrence.6.Surgery combined with targeted drug therapy after recurrence and metastasis is better than simple surgery,simple targeted therapy and untreated patients.7.The site of postoperative recurrence and metastasis,treatment after recurrence and metastasis are independent factors affecting the prognosis of patients with recurrence and metastasis. |
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