Study Of The Clinical Biological Behavior And Analysis On Prognosis Related Factors Of Gastrointestinal Stromal Tumor

Objective: To study the clinical biological behavior and analysis prognosisrelated factors of gastrointestinal stromal tumor.Methods:Retrospective analysis of223cases of gastrointestinal stromaltumor(sGISTs) thought the surgical treatment and confirmed by pathology inthe Fourth Hospital of Hebei Medical University during the period fromJanuary2000to December2010, and223cases of GIST clinical data followedup by the telephone and letters. Analysis the clinical biological behavior andprognosis related factors (such as gender, age, first symptom, tumor location,tumor size, mitotic index, surgical procedure, preoperative metastasis,preoperative anemia, the Immunohistochemistry signs, risk stratification,postoperative adjuvant therapy or not, et al). The data analysis use SPSS13.0software processing, univariate analysis and drawing survival curves using theKaplan-Meier method, the group differences using the Log-Rank test.Multivariate analysis using Cox model, all data processing results, P <0.05was considered statistically significant.Raultes:1General statistical results1.1Gender: The research shows that115males and108females patients,males and females in a proportion is1.06:1.1.2Age: The age of this group of patients was21~81years old, high-riskage were50~69years old.1.3The number of patients treated distribution with each passing year: Thisgroup of patients with GIST were treated in the11passing years were8,7,6,4,10,17,16,30,27,47,51cases, the number of cases of overall upward trend.2Clinical manifestation: Presented with abdominal distention discomfortas the main clinical performance,followed by stomach ache, gastrointestinal bleeding and gastrointestinal mass.3Auxiliary examinationThe detection rate of B ultrasonic examination for GIST was71.43%. Thedetection rate of endoscopic examination for GIST was84.21%.Thedetection rate of endoscopic ultrasonography examination for GIST was92.31%. The detection rate of CT examination for GIST was88.24%.4Preoperative metastasis and anemia4.1Preoperative metastasis: This group of preoperative metastasis in22cases accounted for9.87%, and11cases with liver metastasis accounted for4.93%, abdominal and pelvic metastases in6cases accounted for2.69%, liverand abdominal pelvic metastases in5cases accounted for2.25%.4.2Preoperative anemia: This group of preoperative anemia in60cases,accounting for26.91%; without anemia in163cases, accounting for73.09%.5Surgical procedure: R0resection in201cases, accounting for90.13%; R1~2resection in22cases, accounting for9.87%.6GIST pathological features6.1Tumor location: Tumor occurs in the stomach in141cases, accountingfor63.23%; The small intestine41cases, accounting for18.39%; The28casesof gastric bowel, accounted for12.56%; Colorectal in13patients accountingfor5.83%.6.2Tumor size: The diameter <2cm in14cases, accounting for6.28%;2~5cm in67cases, accounting for30.04%;5~10cm in63cases, accounting for28.25%;>10cm in79cases, accounting for35.43%.6.3Tumor rupture: Tumor rupture in15cases, accounting for6.73%;Without tumor rupture in208cases, accounting for93.27%.6.4The pathological and histological observation: Basic cell types forspindle cells and epithelioid macrophages under the microscope, and recordedthe mitotic index,<5/50HPF in113cases, accounting for50.67%;5~10/50HPF in41cases, accounting for18.39%;>10/50HPF in69cases,accounting for30.94%.6.5Risk stratification: The very low risk in14cases, accounting for6.28%; Low risk in62cases, accounting for27.80%; The moderate risk in40cases,accounting for17.94%; Highly risk in107cases, accounting for47.98%.6.6Immunohistochemical: All the patients were immunohistochemical,CD117positive in214cases, accounting for96.96%; CD34positive in198cases, accounting for84.75%; DOG1positive in34cases, accounting for100%.7Postoperative have targeted therapy or notTargeted therapy of moderate and high risk patients in34cases, accounting for15.25%; Without targeted therapy in189cases, accounting for84.75%.8Prognosis analysis8.1Overall survival (OS): In this group,1-,3-,5-years overall survival ratewere95.92%,83.23%,66.50%.8.2Univariate analysis: In this group, univeriate analysis results were: Theprognosis of male was poor than felmale (χ2=4.182,P=0.041); The prognosisof preoperative metastasis patients were poor than without metastasispatients(χ2=37.249,P=0.000); The R0resection patients have better prognosisthan R1~2resection patients(χ2=27.127,P=0.000); The primary site is locatedin the stomach have better prognosis than intestine and colorectal, and theworse prognosis was extre-gastrointestinal stromal tumor(χ2=58.728,P=0.000);The bigger tumor size the worse prognosis(χ2=15.828,P=0.001); The moremitotic index the worse prognosis(χ2=33.422,P=0.000); Tumor rupture withpoor prognosis(χ2=40.088,P=0.000); The higher risk stratification the worseprognosis(χ2=15.828,P=0.001).8.3Multivariate analysis: In this group, multivariate Cox regression analysisshows that preoperative metastasis, tumor rupture, mitotic index, tumorlocation were independent factors influence prognosis.Conclusion:1Analysis of patients with GIST in this group, male to female ratio is1.06:1, male slightly more than female. The age of onset up to50to69years, median age57years old. The major clinical manifestation wasabdominal distension and discomfort, followed by abdominal pain, gastrointestinal bleeding and abdominal mass, the clinical specificity is notobvious.2Liver is the most common site of the transfer, followed by abdominal andpelvic.3Endoscopic ultrasonography check the highest rate in stomach stromaltumor, the CT detection rate is high in small intestinal stromal tumor andextra-gastrointestinal stromal tumors.4GIST common in the stomach, followed by the small intestine,extra-gastrointestinal and colorectal. Radical resection rate was92.83%51-,3-,5-years overall survival rate were95.92%,83.23%,66.50%.6Male, preoperative metastasis, R1~2resection, tumor rupture and tumorlocated in extra-gastrointestinal have poor prognosis. And with tumor sizeincrease, mitotic index increases, risk stratification increase the more poorprognosis. Age, preoperative anemia, postoperative targeted therapy,CD117and CD34expression for patients had no effect on the overallsurvival.7Preoperative metastasis, tumor rupture, mitotic index, tumor location wereindependent factors influence the prognosis.