| Backgrounds:Gastrointestinal stromal tumor(GIST)is a malignant neoplasm originating from gastrointestinal stromal stem cells.As it is reported,GIST is the most common mesenchymal tumor of the gastrointestinal tract,and its incidence is increasing year by year.Previous Studies demonstrated that many factors were associated with the prognosis of this disease,such as the lesion location,tumor size,nuclear fission number,operation,metastasis and the treatment of imatinib mesylate.However,until now,few studies has been reported about the relationship between the histocytology type and the prognosis of GIST.Objective: To explore the relationship between the histocytology type and the prognosis of GIST by analyzing the the prognosis of GIST with different histocytology types retrospectively.Methods:One hundred and twelve GIST cases who had been underwent surgical treatment were collected in the Second Affiliated Hospital of Guangzhou Medical University from January 1st,2006 to December 31 st,2016.Among them,109 GIST patientswhose were treated with routine radical resection,were followed up with regard to their survival condition and the relapse and metastasis of tumor.Meanwhile,Kaplan-Meier single factor analysis and Cox risk model complex factor analysis were also conducted to analyzethe prognostic factors,and investigate the relationship between histocytology type and prognosis.Results: 1.The complete data of 112 cases of patients with GIST were collected,including 53 cases of male patients(47.3%),59 cases of the female(52.7%),the ratio: 0.9:1;The range age was 38~82,there were 4 people(3.6%)younger than 38,there were 42 people(37.5%)between 41~60,there were 66 people(58.9%)between 61~82,the average age was 63 years old,median age was 64 years old;2.Clinical manifestations:there were 37 cases(33%)with abdominal pain,there were 13 cases(11.6%)by abdominal examination,t 3 cases(2.7%)by nausea and vomiting,3 cases(0.9%)by constipation and diarrhea,34 cases(30.4%)by gastrointestinal bleeding,cases(21.4%)by other manifestations;3.All 112 cases of cases of patients with GIST were underwent with surgical treatment,there were 67(59.8%)cases by open surgery,45(40.2%)cases by endoscopic surgery;among them there were 109 cases(97.3%)with radical resection(R0),3 cases(2.7%)were taken in the palliative excision;there were 4 cases(3.6%)with a new adjuvant treatment of imatinib mesylate,76 cases(67.8%)were taken in surgery only.There were 32 cases(28.6%)by taking imatinib mesylate after surgery,28 patients got 400 mg QD,4 patients got 600 mg QD;4.Tumor size,there were 25 cases(22.3%),which diameter were ? 2cm,37 cases(33.0%),2cm< diameter ? 5cm;35 cases(31.3%),5cm< diameter ? 10cm;15 cases(13.4%),diameter >10cm;About nuclear fission number(/50HP),there were 80 cases(71.4%),which fissions were ? 5/50 HP,32 cases(28.6%),>5/50HP;there were 73 cases(65.2%)located in the stomach,5 cases(4.5%)located in the duodenum,5 cases(4.5%)located in the jejunoileum,28 case(25%)located in the colorectum,1 cases(0.9%)in the other part;About NIH(2008)Hazard grading,there were 28 cases(25%)in extremely low risk degree,26(23.2%)cases in low-risk degree,20(17.9%)cases in moderate-risk degree,38(33.9%)cases in high-risk degree;5.Histocytology types: there were 84 cases of spindle cell type(75%),16 cases of epithelial.cell.type(14.3%),12.case.of.mixed.cell.type(10.7%);immunohistochemic al staining About CD117,there were 9 cases(8%)with Negative expression,103 cases(92.0%)with positive expression;CD34,there were 19 cases(17%)with Negative expression,93 case(83.0%)with positive expression;DOG1,there were 38 cases(33.9%)with Negative expression,74 cases(66.1%)with positive expression;Desmin,there were 110 cases(98.2%)with Negative expression,2 cases(1.8%)with positive expression;SMA,there were 87 cases(77.7%)with Negative expression,25 cases(22.3%)with positive expression;S100,there 107 cases(95.5%)with Negative expression,5 cases(4.5%)with positive expression;6.Postoperative follow-up: there were 5 patients discovered with metastasis(4.6%),which were all from the stomach GIST,among them there were 4 cases of patients whose metastasis siteswere the liver,1 cases of omentum planting;104 patients have not discoveried any signs of metastasis(95.4%);There were 3 patients died(2.7%),109 patients were still survival(97.3%);7.The cumulative survival rate(5-year)of Spindle cell type,epithelial cell type and mixed cell type GIST,which were calculated by Kapla n-meier survival analysis were 96%,93%,100%,c2 =2.17,P=0.33,the difference has no statistically significant;but we get c2=16.85,P=0.00 by the Kaplan-Meier survival analysis of metastasis after postoperation,the difference got statistically significant.Continue to do Cox complexfactorssurvival analysis,P=0.00,Histocytology types were the factor of prognosis,which was intimated with metastasis in these GIST patients with radical resection.Meanwhile,we found that there were 13 cases(86.6%)of patients belong to the high-risk degree of the epithelial cells,34(41.4%)of patients belong to the high risk degree of the spindle cell type,8(66.7%)of patients belong to the high risk degree of the mixed cell type.We gotc2 =9.9,P=0.007 by the non-parametric test of three kinds of cell types with NIH:.Conclusion: 1,Surgical operation is the main therapeutic style of GIST;2,Imatinib mesylate is the first choice topatients who are in the preoperativeor postoperative period for GIST;3,Tumor size,location,nuclear fission number,NIH grading,surgery,metastasis,those are all prognostic factors of GIST,the difference of Histocytology types can affect its metastasis,it showed that the epithelial cell-type is partial to themedium and high risk by NIH get poor prognosis. |
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