| Objectives:Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tissue tumors in gastrointestine, and manifest various pathological type and poor prognosis. To investigate and analysis the clinical and pathological characteristic of GIST patients as well as the risk factors of prognosis for GIST patients, an retrospective clinical trial is performed.Method:　The clinical and pathological features and follow-up data of GIST patients who underwent surgery in Peking Union Medical College Hospital from May 2002 to December 2013 were analyzed retrospectively. The prognosis was evaluated by univariate and multivariate analysis. Kaplan-Meier curves for progression-free and overall survival were compared with the use of the log-rank test. Hazard ratios for survival were calculated with the use of a Cox regression model.Results:A total of 558 GIST patients were collected, including 284 males and 272 females, as well as 52 cases of less than 40 years old,98 cases of 40-49 years old,154 cases of 50-59 years old,151 cases of 60-69 years old and 103 cases of more than 70 years old. Abdominal pain, abdominal discomfort were observed in 240 cases,134 cases with the symptom of gastrointestinal bleeding,46 cases with abdominal mass,99 cases with asymptom and 39 cases with others of symptom were also captured. Tumor sites of 7 cases were found to be primary esophageal,303 cases were stomach,53 cases were duodenum,118 cases were small intestine,5 cases were colon,41 cases were rectum,31 cases were extra-gastrointestine.229 patients underwent surgery, including 517 cases with R0 resection,4 cases with R1 resection,4 cases with R1 resection and 37 cases with palliative surgery. The recurrence risk was very low in 102 cases, low in 156 cases, moderate in 67 cases and high in 233 cases. Of all the patients,495 cases completed the follow-up, the follow-up rate was 88.7%. Five year survival rate was 87.4%. Patients who took targeted therapy with moderate and high risk of recurrence had a better prognosis compared with the patients not taking the drug. Multivariate analysis showed that tumor size (P=0.01, RR=1.562,95%　CI:1.452 to 15.664), location (P=0.01, RR=1.552,95%　CI=1.324～12.225), mitotic figures (P<0.01, RR=1.415,95% CI:2.126 to 7.968) and tumor rupture (P=0.01, RR=1.578,95% CI:1.543 to 15.892) were independent prognostic factors.Conclusions:1. The high incidence of GIST is observed in the elderly with 50 to 70 years old.2. GIST occurs in stomach and gastrointestinal tract most commonly. Gastric GIST showed better prognosis than that of non-gastric GIST, the prognosis of GIST in gastrointestinal tract is significantly good compared with extra-gastrointestinal GIST.3. RO resection combined with targeted therapy is the most effective treatment for GIST.4. laparoscopy combined with endoscopy is suggestive to be promising in the treatment of GIST, Small GIST especially non-gastric small GIST should be treated positively5. Tumor size, mitotic index, primary site and integrity of tumor are independent prognostic factors for GIST... |
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