| Objective: Gastrointestinal stromal tumor is a potential malignant mesenchymal tumor,the current incidence increased year by year,more and more attention,this article systematically review the Fourth Hospital of Hebei Medical University,Department of Pathology diagnosis of 1260 cases Gastrointestinal stromal tumor cases,to explore the diagnosis and treatment of gastrointestinal stromal tumors,gastrointestinal stromal tumor to understand the biological laws,to provide the basis for the selection of appropriate treatment measures.Methods:Collected from the Fourth Hospital of Hebei Medical University from September 2003 to July 2016 diagnosed as gastrointestinal stromal tumors 1260 cases of data.Follow-up of high incidence of primary cases,the diagnosis of gastrointestinal stromal tumors,treatment and prognosis for retrospective analysis.Statistical analysis was performed using SPSS21.0 software.The chi-square test was used to compare the count data.The t-test was used for the comparison of the data.The Kaplan-Meier method was used to analyze the single factor that affected the survival by using the Log-rank test.Multivariate analysis was performed using the Cox regression model(forward stepwise-likelihood ratio).All data were treated with P <0.05 as statistically significant.Results:1 General statistical results1.1 Sex: 1260 cases of GIST patients in 643 cases of male,female 617 cases.1.2 Age: The age range of the study was 13-83 years old,with a median age of 60 years.1.3 The incidence of the site: the main part of the stomach is 748 cases,accounting for 59.4%(748/1260);empty ileal 106 cases,accounting for8.4%(106/1260);duodenal 43 cases,3.4%(43/1260);Colorectal in 26 cases,accounting for 2.0%(26/1260);esophageal 14 cases,accounting for 1.1%(14/1260);gastrointestinal patients 323 cases(70 cases of abdominal cavity,annex and uterine 64 cases,39 cases,mesentery in 5cases,pancreas in 4 cases,the other 141 cases),accounting for 25.6%(323/1260).1.4 Clinical manifestations: Stromal tumors as a primary disease in the clinical manifestations of their own non-specific,including physical examination found 244 cases(28.0% 244/871),94 cases of abdominal discomfort(10.8% 94/871),51 cases of abdominal pain(8.6% 51/871),abdominal distension in 33 cases(3.8% 33/871),abdominal mass in 71cases(8.2% 71/871),hematemesis in 66 cases(7.6% in 66/871),219cases(25.1% 871),anemia in 35 cases(4.0% 35/871),the other 58 cases(6.7% 58/871)and so on.2 pathology results2.1 The diameter of the tumor diameter of the tumor in the largest diameter: ≤ 2cm: 545 cases,accounting for 43.2%(545/1260);> 2cm and≤ 5cm: 219 cases,accounting for 17.4%(219/1260);> 5cm <10cm: 177 cases,accounting for 14.0%(177/1260);≥ 10cm: 150 cases,accounting for 11.9%(150/1260),data incomplete 169 cases,accounting for 13.4%(169/1260).2.2 fractures were less than 5 / 50HPF: 574 cases,accounting for 45.6%(574/1260);in 5-10 / 50HPF: 246 cases,accounting for 19.5%(246/1260);greater than 10 / 50HPF: 53 cases,Accounting for 4.2%(53/1260),and another 387 cases of incomplete information,accounting for 30.7%(387/1260).2.3 positive for immunohistochemical CD117: 1067 cases,the positive rate was 91.3%(1067/1169),CD34: 1043 cases were positive,the positive rate was 89.2%(1043/1169),752 cases were positive for DOG-1,The positive rate was 98.0%(752/737).(54.51260);156 cases of low-risk patients,accounting for 12.4%(156/1260);126 cases of intermediate-risk patients,accounting for 10.0%(126)/ 1260);286 cases of high-risk patients,accounting for 22.7%(286/1260);data can not be graded in 147 cases,accounting for 11.7%(147/1260).2.5 GIST Pathological analysis: A total of 616 cases of complete GIST were analyzed.The results showed that there were 399 cases of gastric disease,including tumor size,≤2cm: 70 cases,accounting for 17.5%,>2cm and ≤5cm: 161 cases,accounting for 40.4%;> 5cm and <10cm: 101 cases,accounting for 25.3%;≥ 10cm: 67 cases,accounting for 16.8%.Calcium mitotic like less than 5 / 50HPF: 238 cases,accounting for59.7%;between 5-10 / 50HPF: 142 cases,accounting for 35.6%;greater than 10 / 50HPF: 19 cases,accounting for 4.7%.(2)occurred in the small intestine in 73 cases,including tumor size,≤ 2cm: 1 case,accounting for1.4%;> 2cm and ≤ 5cm: 9 cases,accounting for 12.3%;> 5cm and <10cm:30 cases,accounting for 41.1% 33 cases,accounting for 45.2%.Calcium mitotic like less than 5 / 50HPF: 30 cases,accounting for 41.1%;between5-10 / 50HPF: 33 cases,accounting for 45.2%;greater than 10 / 50HPF:10 cases,accounting for 13.7%.(3)occurred in the duodenum 41 cases,including tumor size,≤ 2cm: 3 cases,accounting for 7.3%;> 2cm and ≤5cm: 22 cases,accounting for 53.6%;> 5cm and <10cm: 11 cases,accounting for 26.9% ≥ 10cm: 5 cases,accounting for 12.1%.Mitotic like less than 5 / 50HPF: 20 cases,accounting for 48.8%;between 5-10 /50HPF: 20 cases,accounting for 48.8%;greater than 10 / 50HPF: 1 case,accounting for 2.4%.(4)occurred in colorectal 26 cases,including tumor size,≤ 2cm: 3 cases,3.9%;> 2cm and ≤ 5cm: 7 cases,accounting for12.9%;> 5cm and <10cm: 10 cases,accounting for 25.9%;≥ 10 cm : 6cases,accounting for 12.3%.Mitotic like less than 5 / 50HPF: 13 cases,accounting for 24.7%;between 5-10 / 50HPF: 8 cases,accounting for44.1%;greater than 10 / 50HPF: 5 cases,accounting for 31.3%.(5)occurred in 77 cases of gastrointestinal tract,including tumor size,≤ 2cm:3 cases,accounting for 12.9%;> 2cm and ≤ 5cm: 10 cases,accounting for33.9%;> 5cm and <10cm: 20 cases,accounting for 27.9% 10cm: 44 cases,accounting for 25.3%.Calculated mitotic like less than 5 / 50HPF: 19 cases,accounting for 51.9%;between 5-10 / 50HPF: 34 cases,accounting for 38.4%;greater than 10 / 50HPF: 24 cases,accounting for 9.7%.3 treatment situation3.1 Surgical treatment3.1.1 cases of mesothelioma as a primary disease resection cases were871 cases,stromal tumors as associated with the disease cases were 389cases(167 cases of gastric cancer,combined with esophageal cancer 149 cases,combined with other malignant tumors in 73 cases).Stromal tumors as associated with the disease occurred in the stomach 278 cases,39 cases of gastric lymph nodes,18 cases of empty ileal,esophageal 9cases,2 cases of colorectal,other parts of 43 cases.Tumor mostly nodular,diameter 0.6-5.5cm,the average size of about 1.8cm,mitotic figures are less than 5 / 50 HPF.3.1.2 interstitial tumor as a primary disease in primary lesions only 830 cases of resection,combined with organ resection of 41 cases(resection of the main spleen,pancreas,liver,etc.),which combined with the highest probability of resection For the spleen(68.3% 28/41),due to extensive intravascular metastasis can not be removed by simple exploration of 2 cases;1 case found lymph node metastasis,lymph node metastasis tumor size of 8cm,mitotic> 10 / 50 HPF.844 cases were radical resection,27 cases of palliative resection(2 cases of tumor rupture).3.1.3 interstitial tumor open surgery 1125 cases,125 cases underwent laparoscopic resection(laparoscopic resection of gastroscopy in 4 cases),laparoscopic open laparotomy in 1 case.Laparoscopic resection of the case,the incidence of 119 cases in the stomach,accounting for 95.2%;small intestine in 1 case,0.8%;duodenum in 1 case,0.8%;abdominal 2cases,1.6%;rectum 2 cases 1.6%.Tumor size 0.3-10 cm,≤2cm: 46 cases,accounting for 36.8%;> 2cm and ≤ 5cm: 63 cases,accounting for50.4%;> 5cm and <10cm: 13 cases,10.4%;no ≥ 10 cm cases.Calcium mitotic less than 5 / 50HPF: 101 cases,accounting for 80.8%;between5-10 / 50HPF: 22 cases,accounting for 17.6%;greater than 10 / 50HPF: 2cases,accounting for 1.6%.Very low risk patients in 28 cases,accounting for 22.4%;60 cases of low-risk patients,accounting for 48.0%;29 cases of intermediate-risk patients,accounting for 13.2%;high-risk patients in8 cases,6.4%.Of which 114 cases of local resection,gastric resection in9 cases,pancreaticoduodenectomy in 1 case.3.2 endoscopic treatment of endoscopic diagnosis of mesothelioma and resection of 9 cases,postoperative pathological return: gastrointestinal stromal tumors in 9 cases,are very low risk,follow-up without recurrence and metastasis.3.3 taking targeted drug treatment of preoperative medication adjuvant therapy in 9 cases,after treatment assessment: 8 cases of partial remission,1 case of stability,the final 6 cases were surgical treatment,3 cases can not be removed to continue medication;initial postoperative oral methanesulfonate(236/364)of the high-risk group were followed up,34 cases were not taken,28 cases were not taken from the target drug and 28 cases died.After the recurrence and metastasis,the treatment was treated with imatinib mesylate 66 cases,31 cases died;did not take methotrexate methotrexate treatment in 18 cases,17 cases of death;turn sunolinate treatment of sunitinib in 4 cases,stable condition.4 follow-up results: very low risk of low-risk patients due to incomplete information and loss of follow-up cases were not fully followed up,high-risk patients were followed up.Follow-up of 412 cases of high-risk patients were followed up for 364 cases(follow-up rate of 88.3%364/412).The follow-up period ranged from 1 to 124 months(median time was 36 months).Of the 364 patients,84 had recurrence or metastasis,8 had local recurrence and 76 had distant metastases,including 1 in the stomach,2 in the small intestine,1 in the colorectal,4 in the gastrointestinal tract,Including 18 cases of metastatic liver metastasis,46 cases of intraperitoneal transfer and metastasis,9 cases of liver and abdominal transmission and metastasis,1 case of bone metastasis,1 case of lung metastasis,1 case of lung and liver metastasis.Metastasis in the stomach before the recurrence of 20 cases in the stomach,accounting for 23.8%;in the small intestine in 19 cases,accounting for 22.6%;in duodenum in 3cases,3.6%;in colorectal 8 cases,9.5%;located outside the gastrointestinal 2% and ≤ 5cm: 3 cases,accounting for 3.6%;> 5cm and<10cm: 25 cases,accounting for 29.8%;≥ 10cm: 1%,2% 56 cases,accounting for 66.7%.Calcium mitotic less than 5 / 50HPF: 15 cases,accounting for 17.9%;between 5-10 / 50HPF: 42 cases,accounting for50.0%;greater than 10 / 50HPF: 27 cases,accounting for 32.1%.4 cases of critically ill patients;4.8%,80 cases of high-risk patients,accounting for 95.2%.Of the 364 successful follow-up patients,63 patients died of interstitial tumor recurrence and metastasis associated with organ failure.Other died of interstitial tumors: 1 died of cirrhosis,1 died of heart disease,1 died of bone cancer,2 died of pulmonary heart disease caused by lung failure.4.1 follow-up in high-risk patients without recurrence and metastasis of survival from January to 124 months,the median recurrence-free survival:31 months.1,3,5,7,and 10 years were 93.8%,78.5%,67.5%,61.0%and 60.9% respectively.4.2 The survival time of high-risk patients during follow-up from 3 to 124 months,the median survival time was 37 months.The cumulativesurvival rates were 97.5%,83.0%,74.6%,72.9% and 72.9% respectively at 1,3,5,7 and 10 years respectively.5 in high-risk patients5.1 single factor analysis(1)primary survival in the duodenal GIST the highest survival rate,followed by the stomach,parenteral GIST survival rate after the lowest(log-rankχ2 = 22.572,P = 0.000);(2)tumor diameter(Log-rankχ2 = 32.627,P = 0.000).(3)The postoperative survival rate was relatively low(log-rankχ2 = 10.016,P = 0.007);(4)(Log-rankχ2 =14.326,P = 0.000);(5)Postoperative administration of imatinib mesylate could improve postoperative survival(log-rankχ2 = 5.484,P = 0.019);(6)High-risk group of patients taking time is greater than 3 years was statistically significant(log-rankχ2 = 29.379,P = 0.000).(7)metastatic site,simple liver metastasis patients with better prognosis(log-rankχ2 =16.019,P = 0.001).(8)The treatment of imatinib was best treated with different therapy(log-rankχ2 = 27.048,P = 0.000).Analysis of tumor size,pathogenesis and imatinib is an independent factor affecting the recurrence of postoperative metastasis.The tumor size,pathogenesis and mitosis are independent factors that affect postoperative survival.Conclusion:1 The proportion of men and women in this group: 1.04: 1.Male more than female,median age 60 years old.2 GIST of the primary site from more to less in the stomach,gastrointestinal tract,small intestine and duodenum,colorectal,esophageal,distant metastasis site is the most common for the liver and abdominal cavity.3 No recurrence of the survival of 1-124 months.1,3,5,7,and 10 years were 93.8%,78.5%,67.5%,61.0% and 60.9% respectively.4 The survival time from 3-124 months.The cumulative survival rates were 97.5%,83.0%,74.6%,72.9% and 72.9% respectively at 1,3,5,7 and 10 years respectively.5 Duodenal GIST prognosis is the best,followed by the stomach,small intestine,colorectal,parenteral GIST prognosis is the worst;with the tumor diameter increases,increased nuclear division,increased risk,GIST malignant degree higher.6 Tumor size,tumor location,mitosis is an independent factor affecting the prognosis of patients.7 High-risk patients taking methotrexate mesylate treatment than taking imatinib mesylate treatment can reduce postoperative recurrence and metastasis rate,improve patient survival,improve patient prognosis.8 The risk of GIST patients with postoperative use of imatinib mesylate treatment time for more than 1 year and no difference within 1year,high risk GIST patients with methotrexate methicillin treatment time for more than 3 years when the prognosis is lower 3 years good9 Combined surgery combined with targeted drug treatment is the best way to treat metastatic stromal tumors. |
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