| Objective:To investigate the clinical pathological features and prognostic factors in patients with intermediate or high risk gastrointestinal stromal tumors(GIST)who had undergone targeted agents,and summarize the clinical experience in the diagnosis and treatment for these patients.Materials and methods:From January 2010 to October 2015,the clinical pathological data and follow-up informations of patients with pathologically proven intermediate or high risk GISTs who had received target therapy were reviewed retrospectively.Statistical analyses were performed using the Statistical Package for Social Science(SPSS,version 17.0,Chicago,IL,USA).Kaplan-Meier method was used to estimate the overall survival(OS),relapse free survival(RFS)and progression free survival(PRF),and drawn the survival curves.Log-rank method was used to analysis the prognostic factors which affected the 5 years survival of pateinets,than Cox proportional hazard was used to the multivariate analysis for those meaningful results in the single factor analysis.A P value less than 0.05 was considered statistically significant.Results:The final study population consitsted of 276 intermediate or high risk GIST patients matched the qualifications,all of them had accepted target therapy.(1)Epidemiology characteristics: among of these patients,155 were male and 121 were female,and their age ranged from 17 to 83 years with an median age of (57.1±14.8) years.The primay tumors located at stomach in 110 cases,at duodenum in 15 cases,at small intestine in 117 cases,at colorectum in 17 cases and at extragastrointestinal in 17 cases.Their are 48 cases in the intermediate-risk group,and 228 cases in the high-risk group.(2)Clinical features: the most common presentations were abdominal distension,and discomfort and/or pain,followed by hematemesis,melena,abdominal mass or found by physical examination.(3)Immunohistochemical findings: the positive rate of CD117,DOG-1 and CD34 were 97.82%(270/276),98.37%(242/246)and 68.84%(190/276),respectively.(4)The treatment: 244 cases perfomed R0 rection with 234 of them started adjuvant therapy with targeted agents within 1 to 2 months after surgery,while the other 10 of them started target therapy after tumor recurrence or metastasis.6 cases performed R1 rection and 11 cases performed R2 rection,all of them started adjuvant therapy with targeted agents within 1 to 2 months after surgery.Besides,15 cases did not accept surgery,including one of them due to the tumor was gaint and located in duodenum,two of them due to the tumor located in lower rectal,and twelve of them due to hepatic multiple metastasis or peritoneal metastasis,all these patients started target therapy after the diagnosis was established.(5)Survival and prognosis: For the 276 cases involved in our study,the 1-year,3-year and 5-year OS were 99.6%,94.7% and 90.9%,respectively;The 5-year OS of patients who were diagnosed with tumor metastasis at the first time was significantly lower than that of those patients without tumor metastasis(74.8% vs 90.8%,P<0.05);The 5-year OS of patients who undergone R0 rection,non-R0 rection and non-operative treatment were 92.7%,64.3% and 92.3%(P<0.05),respectively;Their had no statistical significance in the difference of the OS or RFS between the cases who undergone R2 rection combine with imatinib therapy after surgery and the cases who only performed imatinib therapy(P>0.05).For the 251 cases who received adjuvant therapy after surgery,the 1-year,3-year and 5-year RFS were 98.7%,85.4% and 75.2%.And among of them,for the 234 cases who undergone adjuvant therapy after R0 rection,the 1-year,3-year and 5-year OS and RFS were 99.6%,96.6%,92.3% and 98.7%,87.3%,77.7%,respectively.The results of the single factor analysis suggested the sex,age,tumor size and location,mitotic index or risk classification did not related to the 5-year OS and RFS in this study(P>0.05).While,both the degree of surgical resection and whether metastatic tumor or not at the ftirst diagnosis were correlated with OS and RFS(P<0.05).Than the results of the multivariate analysis suggested whether metastatic tumor or not at the tirst diagnosis,whether performed surgery and its extent of resection were not independent prognostic factors for patients involved in our study(P>0.05).Conclusion:1.Intermediate or high risk GIST were middle-aged and elderly people predominant.The predominant localization of GIST were the stomach and small intestine,and the main sites of tumor recurrence or metastasis were liver,abdominal cavity and primary site.2.Radical(R0)rection combined with target therapy could significantly improve the survival and prognosis of patients with GIST.3.For the patients who had widley metastasis at the first diagnosis or non localed recurrence/metastasis,these patients colud be obtain more benefits from merely target therapy than the rection.4.For the patients with localed recurrence/metastasis,reoperation combined with target therapy will be improve the survival and prognosis of patients. |
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