| Objective:1. To study the fact of pathological features, tumor location, clinical characteristics, surgical treatment and prognosis of gastrointestinal stromal tumors.2.To investigate the relationship between pathological characteristics and operation prognosis of gastrointestinal stromal tumor.Methods: 1. To analyse 149 cases of gastrointestinal materials of the pathological data and medical records from 2010 January to 2014 December in Wangnan Medical College affiliated Yi-jishan Hospital, including stromal tumors, including name, gender, age, weight, height, tumor location, tumor size, metastasis, mitotic count, cell type, operation type, postoperative treatment and survival time; 2. According to pathological diagnosis and immunohistochemical chemical results of GIST tumor tissue specimens of the 149 patients, the factors that might affect the prognosis were statistically analyzed. Screening out the independent prognostic factors for patients with GIST.Result: Among eligible inclusion criteria of 149 patients, the male to female ratio is about 1.1:1. The width of age from 28 to 82 years old, the median age was 61 years old. The first main symptoms was abdominal discomfort in 83 cases(55.7%), gastrointestinal hemorrhage in 30 cases(20.1%), body examination revealed abdominal mass in 29 cases(19.5%), abnormal defecation in 5 cases(3.4%), and other symptoms(such as chest tightness, fatigue) in 2 cases. Complete resection in 126 cases(about 84.6%), palliative resection in 23 cases(about 15.4%).The percentage of GIST primary site occurred in the stomach, duodenum, small intestine, colorectal and abdominal cavity were respectively 67.8%, 5.4%, 17.4%, 3.4%, 6%. Tumor volume between 0.5 ~ 28.5cm, tumor size, <2cm, 2-5cm, 5-10cm and >10cm constitute respectively 26.2%, 28.2%, 31.5%, 14.1%. The first diagnosis were found tumor metastasis in 7 cases, splenic metastasis in 1 cases, the spleen associated with peritoneal metastasis in 2 cases, eritoneal metastasis in 3 cases, orbital metastasis in 1 cases.Tumor cell type include spindle cell type in 127 cases(85.2%), epithelial cell type in 8 cases(5.4%), mixed cell type in 14 cases(9.4%). The mitoses number of GIST include less than 110 cases in 5/50 HPF group(73.8%), 5-10/50 HPF group of 24 cases(16.1%), more than 15 cases in 10/50 HPF group(10.1%). CD117, DOG-1, CD34, SMA, Desmin, S-100 expression and the number of patients with positive were 147 cases(98.7%), 142 cases(95.3%) of 135 cases(90.6%), 51 cases(34.2%), 13 cases(8.7%), 31 cases(20.8%).Statistical analysis revealed that differences between the expression of DOG1, CD117, SMA and Desmin in patient age, gender, tumor location, tumor size, mitotic count, cell type were statistically significant, the value of P was >0.05. The expression of CD34 in tumor size group with statistical difference, the value of x2 was 13.450, P<0.05. Expression of S100 in the tumor site group and mitotic count groups with statistical difference, the value of x2 were 18.543 and 7.662, P<0.05.The follow-up results of 149 cases of patients with GIST, patients with GIST relapse after operation in 35 cases(23.5%), NIH high risk / palliative resection in 79 patients, taking imatinib recurrence in 53 patients(35.6%), not taking imatinib relapsed in 26 patients(17.5%). Effects between tumor location and tumor recurrence had no statistical significance,(P>0.05). Correlation analysis between the tumor size, operation mode and without taking imatinib and recurrence rate has statistical difference(P<0.001). Different mitotic analysis suggested that the number of single factors of recurrence rate, mitotic count <5 /50 HPF group was significantly higher than that of mitotic count to >5 HPF group that has statistical significance, the value of x2 was 5.757, the value of P was 0.016.GIST primary site had no significant effects on the survival rate(P>0.05). 3 year survival rates of tumor size groups were 95%, 89%, 75% and 54%, with significant difference(x2=21.968, P<0.001). 3 year survival rates of the NIH risk between extremely low risk group to high risk group were 98%, 94%, 83% and 62%, with significant difference(x2 = 21.358, P<0.001). The 3 year survival rate of mitotic arrays were respectively 89%, 61%(x2 = 18.074, P<0.001). 3 year survival rates between Resection operation completely to palliative resection were 87%, 53%, with significant difference(x2 = 17.363, P<0.001). the survival rate in whether oral imatinib mesylate group had statistical difference(x2 = 5.857, P<0.005). Gender group, age group, tumor location, cell type and immunohistochemical expression correlated with survival analysis, there is no statistical difference(P>0.05).Conclusion:1.The clinical and pathological features of patients with GIST in our hospital were collected approximately consistent with foreign research. 2. The immunohistochemical results of CD117, DOG-1, CD34, SMA, S-100, Desmin can help GIST diagnosis. 3. That NIH risk, the diameter of tumor, tumor mitotic count smaller and tumor complete resection were smaller, was conducive to improving the prognosis of patients. |
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