Analysis Of Clinical Diagnosis,Surgical Management And Prognosis From36Cases With Duodenal Stromal Tumors

Background Gastrointestinal stromal tumors(GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. The incidence is rare and only accounts for2%of all the gastrointestinal tumors. GISTs may occurred in any part of the digestive tract but are most common in the stomach (60%-70%), the small intestine (25%-35%), the duodenal stromal tumors only account for4.5%. The patients with primary localized duodenal stromal tumors may acquired a good prognosis if accecpted the surgery combined with the target therapy of imatinib mesylate (if necessary), the5year survival rate can reach to more than50%. No typical severe discomforts is the characteristic of the tumor, so missed diagnosis and misdiagnosis often happened. More evaluations about the prognostic factors were analysed while the tumos were recognized deeper and deeper these years.Objective To sum up the clinical features,surgical management and prognostic analysis of the duodenal gastrointestinal stromal tumors (GISTs) from36cases.Methods A data of36patients with duodenal GISTs treated in Provincial Hospital Affiliated to Shandong University from2006to2013were collected and retrospectively analyzed (including12patients who performed the surgery in other hospitals), the prognostic data was followed by telephone. SPSS17.0software was used for the statistical methods.Results Among36patients,20were men and16were women, the ratio is1.25:1. The average age was56.92±13.017years old, only2cases less than40years old. Clinical discomforts are not obvious and characteristic, mostly were intermittent melena repeatedly, as well as abdominal discomfort and abdominal pain, abdominal mass were palpated in some cases. Upper gastrointestinal barium meal, endoscopy, computed tomography were effective diagnostic methods and the endoscopic ultrasonography (EUS) has its unique advantages. The tumors most commonly occurred at the descending portion(52.8%) with abundant blood supply mostly. All patients received surgical resections, including pancreaticoduodenectomy, local resection and segmental duodenectomy. CD117(97.2%,35/36)、 CD34(86.1%,31/36) and Dog-1(96.2%,25/26) are positive in immunohistochemistry stain, no case occurred with CD117(-),CD34(-) and Dog-1(-).The average follow up was28.28±18.53months (range6-78months), the2year survival rate is83.0%.7cases died from liver and extensive enterocoelia metastasis. Method of single factor analysis indicated that tumor size, mitotic count, the risk degree classification and whether the tumor is fractured in the surgery are statistical significance. Application of COX regression model analysis indicated that the mitotic count was the independent prognostic risk factor.Conclusion Rare typical severe symptoms occurred in the patients with the duodenal stromal tumors. Upper gastrointestinal barium meal, endoscopy, computed tomography and endoscopic ultrasonography (EUS) were effective diagnostic methods. Complete resection is the mainstay therapy and the only chance for cure. The prognostic factors are associated with tumor size, mitotic count, the risk degree classification and whether the tumor is fractured in the surgery and the mitotic count is the independent risk factor.