| Objective:Gastrointestinal stromal tumors(GIST)is mesenchymal tumors with multidirectional differentiation potential,which often occurs in the digestive tract.In the past 20 years,great progress has been made in diagnosis and treatment,and its prognosis has improved significantly.Especially,the emergence of targeted drugs such as imatinib has made the treatment of gastrointestinal stromal tumors a model of targeted treatment of solid tumors.However,about 15% of GIST patients will still have recurrence and metastasis after operation.This study reviewed the clinical features,postoperative pathological data and prognosis of 433 patients with GIST in our center,and discussed the expression of CD133 in GIST,as well as the relationship between clinical features and its expression.It provides guidance for the diagnosis,treatment and prognosis of GIST.Methods:The basic information,clinical manifestations,postoperative pathology and follow-up data of 433 patients with primary GIST who underwent surgery in Sichuan Provincial People’s Hospital from January 2018 to July 2021 were collected.The follow-up deadline was December 2022.The first part of this study retrospectively analyzed the clinical manifestations,pathological features,treatment,prognosis and the relationship between among 433 patients with GIST.The second part collected the postoperative pathological data of 346 patients with primary GIST diagnosed and treated in our hospital from January2018 to July 2021.The expression of CD133 in tumor tissue was detected by immunohistochemistry to explore the relationship between CD133 and clinical characteristics and prognosis.Results:1.Of the 433 GIST cases included in this study,222 patients were women,accounting for 51.27%,while 211 patients were men,accounting for 48.73%,and the ratio of women to men was 1.05:1.The age range is 20～87 years old,and the average age is(59.38 ± 11.72)years old.Patients are divided into groups by the age gap of 10.Those who are 20 to 29 accounts for 1.16%(5/433),the age of 30 to 39 accounts for 5.54%(24/433),the age of 40 to 49 accounts for 11.32%(49/433),the age of 50 to 59 accounts for 29.10%(126/433),the age of 60 to 69 accounts for 34.64%(150/433),the age of 70 to79 accounts for 15.24%(66/433),and the age of 80 to 89 accounts for 3.00%(13/433).In male patients,the average age of onset is 59.12 ± 11.45 years,while in female patients,the average age of onset is 59.63 ± 12.07 years,The peak onset age of male and female patients was 50～69 years old(male: 65.88%,139/211;female: 61.71%/222);There was no significant difference in average age of onset between different sexes(P=0.658).2.In 433 cases of GIST,according to the analysis of tumor site,the most common site was stomach and esophagus,301 cases(69.51%),followed by the small intestine in 90 cases(20.79%),duodenum in 19 cases(4.39%),abdominal cavity or primary unknown in 12 cases(2.77%),and colorectal in 11 cases(2.54%).Among the 443 patients with GIST,137 patients(27.94%)had recurrent abdominal pain;Next,87 cases(20.09%)had black stool,often accompanied by dizziness,fatigue and other anemia;Abdominal distension in73 cases(16.86%);There were 46 cases of systemic symptoms(fatigue,dizziness,anorexia,weight loss),including acid regurgitation,heartburn,bloody stool,hematemesis,changes in stool habits and other symptoms.3.Of the 433 cases of GIST in this study,121 cases(27.91%)had tumor size ≤ 2 cm,138 cases(31.87%)had tumor size between 2.1 and 5.0 cm,127cases(29.34%)had tumor size between 5.1 and 10 cm,and 47 cases(10.85%)had tumor size>10 cm.Through collecting preoperative imaging data,postoperative pathological examination and immune combination data of patients,426 patients in this study completed tumor risk staging.The positive rates of CD117,CD34,DOG-1,SAM,Desmin,S-100,CK,SDHB,and Ki-67 were 98.85%,85.91%,98.84%,30.03%,5.83%,1.41%,1.88%,97.69%,respectively,and Ki-67 > 5% accounted for 18.20%.The risk classification indicated that 116 cases were extremely low risk(27.23%),122 cases were low risk(28.64%),69 cases were moderate(16.20%),and 119 cases were high risk(27.93%).4.A total of 433 cases of GIST were included in this study,of which 22cases(5.08%)had tumor metastasis and 411 cases(94.92%)had no metastasis.433 cases were all treated in our hospital,and 418 cases(96.54%)underwent radical surgery.There were 98 cases of endoscopic surgery,101 cases of laparoscopic surgery and 219 cases of traditional open surgery.Among them,11cases(2.63%)underwent combined organ resection(including partial hepatectomy,pancreatectomy,splenectomy,partial cystectomy,hysterectomy).13 cases(3.11%)underwent complete resection of the greater omentum.No lymph node dissection was performed during the operation,and no lymph node metastasis was detected by pathology after the operation.5.12 cases(2.77%)of primary GIST patients received imatinib neoadjuvant therapy,the dose of which was 400mg/d or 600mg/d,and the duration of treatment was 6 to 40 months.Among them,8 cases underwent radical surgery,2 cases continued to maintain imatinib treatment,1 case changed to regafinil treatment after disease progression,and 1 case continued to receive imatinib treatment after disease progression.In this group,423 patients(radical surgery+palliative surgery)received imatinib adjuvant treatment in 160patients(37.83%)after GIST,including 48 patients(30.0%)who took the medicine within 12 months,37 patients(23.13%)who took the medicine within12 months,45 patients(28.12%)who took the medicine within 24 to 36 months,and 30 patients(18.75%)who took the medicine more than 36 months.6.As of December 2022,a total of 433 patients were followed up,including 10 patients who underwent targeted treatment after puncture biopsy(4 patients were stable,3 patients were progressing,and 3 patients died of disease progression),and 423 patients underwent radical or palliative surgery.During the survival analysis,367 cases without radical surgery were effectively followed up and 51 cases were lost,with a loss of follow-up rate of 12.20%.The follow-up time was 8～59 months,and the median follow-up time was36.78 months(95% CI: 35.52～38.05).In the effective follow-up,23 cases(6.27%)had terminal events,including 17 cases of postoperative recurrence,3cases of death due to disease progression,and 3 cases of death due to other diseases.The deleted data accounted for 93.73%.There were 344 cases without recurrence but the follow-up was terminated.7.The 418 patients with GIST undergoing radical surgery were divided into groups according to age,sex,tumor risk classification,surgical method and other factors.The univariate prognostic analysis using Kaplan-Meier found that gender,surgical method,tumor location,tumor size,mitosis,risk classification,tumor metastasis,targeted treatment after surgery,and the expression of CD117,SMA and Ki-67 were the factors to judge the prognosis of the tumor;The results of Cox regression analysis showed that non gastric tumors and Ki-67>5% were independent risk factors for primary GIST.8.CD133 is mainly expressed in the cell membrane and can be expressed in a small amount in the cytoplasm in GIST sections.The expression level of CD133 varies among different tumor diameters,risk scores,mitotic figures,and tumor sites,and has statistical significance(P<0.05);Patients with high expression of CD133 in GIST may have a worse prognosis.Conclusion:1.The incidence of GIST in women is more than that in men,and the ratio of women to men is 1.05:1.The average age is(59.38 ± 11.72),and it is mainly in the stomach and small intestine.2.The most common clinical manifestation of GIST is recurrent abdominal pain,followed by abdominal distension and black stool.The most common is GIST in extremely low risk group and low risk group.3.The most common adverse reactions of using imatinib are gastrointestinal symptoms(nausea,vomiting,diarrhea),followed by eye symptoms(eye congestion,swelling,tears),as well as abnormal blood test results(leucopenia,thrombocytopenia,abnormal coagulation function),facial edema,itching,rash,etc.4.CD117 、 CD34 and DOG-1 are all highly expressed in immunohistochemistry,which is of great significance to improve the detection rate of GIST.5.The factors that affect the prognosis of GIST include surgical method,tumor location,tumor size,mitotic image,risk classification,whether the tumor is metastatic,whether the tumor is targeted after surgery,and the expression of CD117,SMA and Ki-67.Non-gastric tumors and Ki-67>5% are independent prognostic factors of GIST.6.The expression level of CD133 in GIST varies with tumor diameter,risk classification,mitotic figures,and tumor site,indicating that it may have a regulatory effect on the proliferation and progression of GIST;CD133overexpression in GIST may lead to poorer prognosis. |
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