The Diagnosis And Treatment Of Gastronintestinal Stromal Tumor

Objective To study the clinical presentation,diagnosis and treatment, prognostic factors of gastroinstestinal stromal tumor(GIST). It may provide references for diagnosis and treatment of GIST.Methods The clinical and clinicopathologic data of 54patients with GIST treated at the 1st affiliated hospital of GuangXi Medical University from April 2000 to April 2006 were analyzed retrospectively. The diagnosis of all patients was confirmed with surgery and pathology,Routine pathology and immunohistochemical examinations (marker such as CD117,CD34, Desmin, SMA, S-100, NSE,p53, Ki-67) were performed on 46 patients whose file were complete,they were all followed up for period ranging between 4-72 months, analyzed for clinical and clinicopathologic data and survival correlation. Investigate the prognostic factors of GIST. Kaplan-Meier method,Log-lang test were used to analyse the prognostic variables of GIST by SPSS 13.0 softwares .P<0.05 was considered statistically significant.Results Among the 54 patients there were 35 males and 19 females. Their age ranging between 22-82 years, The mean age of patients was 53 years. Clinical symptoms of GIST included abdominal pain (40.3%),gastrointestinal bleeding (40.7%), palpable mass (27.8%) , anemia (24%) and abdominal discomfort (20.4%) . The stomach was the most common site of origin of the disease (55.56%), followed by the small intestine (27.78%),colon (3.7%) ,rectal region (11.11%), esophagus (1.9%).44 case were perform complete resection ,10case were perform incomplete resection, 12 patients were given adjuvant therapy with Imatinib. Immunohistochemical staining positive rates of CD117,CD34, Desmin, SMA, S-100,NSE,p53, Ki-67 were 82.6%,82.6%, 10.8%, 37%,4.3%,32.6%,54.3%,37% respectively. 24 patients are alive free of disease. 1patient are alive with disease and 21 patients died amond 46 patients whose file were complete. Survival analyes show the overall median survival in this study was 29 months, Overall survival is significantly affected by tumor size,mitotic ,metastatic, incomplete resection,Ki-67 express.Conclusions (1) Most patients of GIST are more than 40 years ,Clinical symptoms of GIST have no specific,The diagnosis of GIST is made by normal pathology and immunohistochemical examination after laparatomy, most GIST are generally Kit (CD117)-positive and it is the specific diagnosis marker. (2) Surgery remains the primary treatment and complete surgical resection remains the ainstay of treatment, special care need to be taken to avoid intraoperative rupture, Prognosis of GIST can be improve by Imatinib . (3) Unfavorable prognostic factors were tumor size, mitotic, metastatic, incompleteresection , Ki-67 express, p53 mutation relative to high risk of GIST.