| Objective: Gastrointestinal stromal tumor(GIST)is the most common mesenchymal tumor in the digestive tract,originated in the interstitial cells of Cajal or their precursors.Surgery remains the primary treatment for localized GIST.In 2010,NCCN guidelines for the first time suggested that the diameter less than or equal to 2cm of gastric stromal tumor was defined as SGST.With the progress of the society and the enhancement of people's consciousness of physical examination,as well as the popularization of endoscopy and imaging examination,the rate of detecting small gastric stromal tumor(SGST)is increasing.For the SGST is positive early surgery or regular follow-up observation,still controversial.This article retrospectively analyzed the general data,clinical pathology and prognosis follow-up data of 268 patients with gastric stromal tumors,aimed to analysis the clinical features,biological behavior of SGST and explore the significance of surgical treatment.Methods: We retrospective analyzed the clinical dates of 90 patients that underwent surgical treatment and the postoperative pathology was gastric stromal tumor from January 2009 to February 2016 in the General Surgery III of the Fourth Hospital of Hebei Medical University.According to the tumor diameter,they were divided into study group(d?2cm,a total of 90 patients)and the control group(d>2cm,a total of 178 patients).The inclusion criteria:(1)had the complete clinical data and complete follow-up information;(2)no other malignant tumors;(2)no circulatory system,respiratory system and other major diseases.We comparative analyzed the baseline characteristics(gender,age,clinical manifestation,tumor location),pathological datas(immunohistochemical results,gene mutation characteristics,mitotic,risk classification),treatment(surgical approach,intraoperative blood volume,postoperative exhaust time,postoperative hospitalization stay,hospitalization costs)and the recurrence and metastasis after surgery of the two groups.Results:1 Baseline characteristics: There were no no significant difference between the two groups in the gender ratio,age,clinical manifestations and tumor location(P> 0.05).2 Tumor diameter: The tumor diameter in the research group was from0.5cm to 2cm,the median diameter was 1.5cm,35 cases with d?1cm,55 cases with 1cm<d?2cm.The tumor diameter in control group was 2.5cm to 15 cm,the median diameter were 5cm.3 Immunohistochemical results: The positive rates of CD117,CD34 and DOG-1 in the research group were 98.89%(89/90),97.78%(88/90)and 100%(90/90)respectively.The positive rates of CD117,CD34 and DOG-1 in the control group were 97.19%(173/178),93.82%(167/178)and 96.07%(171/178)respectively.There was no significant difference between the two groups(P> 0.05).4 Gene test results: The total mutation rate of in the rsearch group was82.22%,the C-kit exon 11 mutation rate was 77.78%,the C-kit exon 9mutation rate was 4.44%,no PDGFRA gene mutation patients,wild type was17.78%.The total mutation rate of the gene was 89.89% in the control group,the C-kit exon 11 mutation rate was 84.27%,the C-kit exon 9 mutation rate was 3.93%,the PDGFRA exon 18 mutation rate was 1.69 %,wild type was10.11%.There was no significant difference between the two groups in the type and rate of gene mutation(P> 0.05).5 Mitotic count: The proportion of patients with mitotic count >5/50 HPF in the research group was lower than that in the control group.The proportion of patients with mitotic count >5/50 HPF in d?1cm group was lower than that in the 1cm<d?2cm group,the difference was statistically significant(P<0.05).6 The risk classification: The research group of middle and high-risk ratio was lower than the control group,d?1cm group of middle and high-risk ratiowas lower than 1cm<d?2cm group,the difference was statistically significant(P <0.05).7 Treatment: The research group in the proportion of laparoscopic surgery,intraoperative blood volume,postoperative exhaust time,postoperative hospitalization stay,hospitalization costs were better than those in the control group,the difference was statistically significant(P<0.05).There was no significant difference in the incidence of perioperative complications(P>0.05).8 Follow-up: The follow-up date was up to February 2017.The median follow-up time was 54.0 months,with no patients lost,the follow-up rate was100%.In the research group the 3-year recurrence and metastasis rate,5-year recurrence and metastasis rate were both 1.11%,and in the control group the3-year recurrence and metastasis rate,5-year recurrence and metastasis rate were 11.80% and 12.92% respectively.The 3-year recurrence and metastasis rate and 5-year recurrence and metastasis rate in the research group were lower than those in the control group,the difference was statistically significant(P <0.05).Conclusion:1 Most of the SGST were occurred in the crowd over the age of 50,the proportion of men and women was not different.Most of them were occurred in the gastric fundus and gastric body,and they were always asymptomatic or no special clinical manifestations.2 Of the SGST patients the proportion of mitotic count ? 5/50 HPF is relatively low,the ratio of middle and high-risk is relatively low,the recurrence and metastasis rate is relatively low,and the prognosis is relatively good.3 SGST of d?1cm can be considered benign and can regular follow-up.Although the majority of SGST that 1cm<d?2 show inert performance,but also has the potential to be malignant,should be early surgical intervention.4 SGST underwent early surgical intervention,has a high proportion of laparoscopic surgery,less trauma,quicker recovery. |
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