Clinical Analysis Of 173 Cases Of Gastrointestinal Stromal Tumors

Objective:Through the retrospective analysis of clinical cases of gastrointestinal stromal tumors in this unit,the clinical features,pathological features,diagnosis and treatment methods,and prognostic factors of gastrointestinal stromal tumors(GIST)were investigated to improve the unit’s gastrointestinal tract.The diagnosis and treatment of stromal tumors reduces the rate of misdiagnosis.Materials and methods:1.General condition of the patients:The clinical data of 204 patients confirmed as stromal tumors after surgical treatment of general surgery in our hospital were included from2012-01-01 to2016-12-31,including clinical manifestations,preoperative auxiliary examination,surgery 173 patients with successful follow-up were excluded from the follow-up data.The data were collected and analyzed retrospectively.2.Clinical treatmentThe successful follow-up of 173 patients underwent surgical treatment.One patient had severe pancreatitis and transverse colon adhesions,and the tumor ruptured with blunt dissection.Two patients underwent emergency surgery because of tumors leading to perforation of the digestive tract.Other patients reached R0 resection.Postoperative patients underwent pathological and immunehistochemical examination,some patients underwent genetic testing.Patients according to the risk of pathological test results grading,genetic test results and the patient’s economic situation,some patients targeted imatinib treatment,the initial dose of 400 mg / d.3.The observation indexesBy retrospective analysis,the single factor analysis of sex,age,tumor anatomy,tumor size,surgical approach,tumor metastasis,tumor R0 resection,pathologicalmitosis,whether targeted therapy,NIH risk classfication,Postoperative patients were treated with drugs,count data using the chi-square test,univariate survival analysis using Kaplan-merie method(Log-rank test),multivariate analysis using Cox regression analysis(P <0.05)analysis Its prognostic factors.Results:Totally 204 cases of gastrointestinal stromal tumors were included in the study.According to the primary anatomic sites of tumor,204 cases were found in153 cases(75.00%)with primary tumor in stomach,30 cases(14.71%)in primary small intestine,primary in the duodenum in 9 cases(4.41%),primary in the rectum in 6 cases(2.94%),primary in the colon in 2 cases(0.98%),primary esophagus in 3 cases(1.47%),primary in the appendix in 1 case(0.49%).97 cases of male patients(46.57%),107 cases of female patients(53.43%),male to female ratio of 1: 1.1.Aged 21-90 years(mean age 60.6±40.6),the median age of 60 years.Clinical manifestation:According to the clinical manifestations,74 cases(36.4%)of gastrointestinal bleeding,mainly manifested as blood in the stool,melena,hematemesis and simple anemia;physical examination found 62 cases(30.5%);manifested as abdominal discomfort in 23 cases(11.6%);Swallowing discomfort,intestinal obstruction,gastrointestinal perforation performance in 13 cases(6.4%);whole body fatigue,belching,hiccups,vomiting and other 10 cases were mainly complained of(6.4%),A variety of performance of the above symptoms in 3 cases.Auxiliary examination:204 patients were taken abdominal ultrasound,CT,electronic gastrointestinal endoscopy,ultrasound gastroscopy,MRI,digestive tract imaging in a few or all of the tests.The detection rate of gastrointestinal angiography was 60.98%,the detection rate of CT was 82.84%,the detection rate of MRI was 100%,the detection rate of electronic endoscopy was 80.46%,the detection rate of ultrasound endoscopy was 100% and the detection rate of ultrasound was 50.98 %.Treatment:All patients underwent surgical treatment,including 13 cases of endoscopic surgery,laparoscopic surgery in 107 cases(52.45%),84 cases of open surgery(47.55%).R0 resection of 201 cases(98.53%),R1 resection in 3 cases(1.47%).Forty-six patients underwent targeted drug therapy.Pathology and Immunohistochemistry:Postoperative pathology and immunohistochemical detection,according to NIH risk classification,30 cases were very low risk(14.5%),77 cases were low risk(37.8%),37 cases were moderate risk(18%)and 60 cases were high risk(29.7%).According to the size of the tumor,tumor diameter ≤5cm 145 cases(71.1%),> 5cm,and ≤10cm 39 cases(19.1%),>10cm 20 cases(9.8%).According to the immunohistochemical analysis,the percentage of patients with positive expression of CD34 in the total population was 89.7%,that of the patients with positive expression of CD117 in the total population was 95.1%,and that of the population with positive expression of DOG1 was 89.2%.Follow up:A total of 173 cases of all the researchers were followed up successfully,followed up for 1-55 months with an average of 25.4 months.During the follow-up period,12 patients relapsed(6.9%)and 10 patients died(5.8%).Conclusion:1.GIST incidence of the median age of 60 years old,the incidence of men and women is not much difference,any age can be disease.2.Surgical treatment is the main way.3.The prognosis of GIST and tumor size,complete tumor resection,tumor rupture,differences in mitotic figures,NIH risk classification,age of onset,whether it reached R0 resection,targeted drug therapy are statistically different.