The Clinical Characteristics And Prognostic Analysis In 375 Cases Of Gastrointestinal Stromal Tumors

Objective:To improve our understanding of the clinical characteristics and the level of diagnosis and treatment of gastrointestinal stromal tumors(GISTs))by analyzing the clinical manifestation,imaging performance,pathological feature,treatment and prognostic factors of 375 patients.Methods:The clinical data of 375 GISTs who were treated and manifested in Shanxi Provincial Tumor Hospital and our Hospital dating from January,2010 to August,2016 were retrospectively reviewed.Analyzing these patients clinical data include age,gender,clinical manifestation,imaging performance,tumor position,tumor size,invasion depth,pathomorphology,metastases,treatment and following up those patients helped us to realize the prognosis and analysis some relevant prognostic factors of GISTs.Results:(1)375 cases were included in our research,178 cases were males and 197 cases were females.Among the patients the median age was 58 years,the youngest was 23,the oldest was 85.(2)Most of the clinical symptoms of GISTs were non-typical,and the main clinical manifestations were abdominal discomfort,gastrointestinal bleeding,abdominal mass and the symptoms due to compression of the adjacent structures.Occasionally the patients with acute abdominal pain or infection were more likely to see their doctor.The ratio of accidental discovery was about 16.27%.(3)The disease was preliminarily understood through gastrointestinal radiography,abdominal ultrasound,CT,MRI and endoscopic ultrasonography.However its diagnosis depended on pathology.Under the microscope,the morphology difference of tumor cell was obvious.In addition,the high malignant tumors generally possessed unclear boundaries and could invade directly or adhere with surrounding tissues.(4)The tumors in this group varied in size and shape,the minimum size was 0.3cm,the maximum size was 33 cm.The rates of diameter more than 10 cm of tumors were19.2%,which were high degree malignant.(5)Most GISTs began in the gastrointestinal tract.The frequent sites of occurrence were successively stomach,small intestine,colorectum,esophageal.The tumors outside the gastrointestinal tract were rare.The difference were significant(P<0.05)in tumor site and biological behavior by analyzing and comparing the data of the group.The result showed that the ratios of invasion and metastases of stromal tumors in small intestine were significantly higher than in gastric stromal tumors(P<0.05),while there was not significant difference between the stromal tumors in esophageal and stomach(P>0.05).(6)All the patients with GISTs in the group,the number of the type of spindle cell was 272 cases(72.5%),the number of epithelium cell type was 61 cases(16.3%),42 cases(11.2%)were the mixed cell type under microscope.The number of mitotic count(≤5/50HPF)was 228 cases(60.8%),the number of mitotic count(>5/50HPF)was 147cases(39.2%).Immunohistochemistry(IHC)staining showed that the positive rates of CD117,CD34,DOG-1 were 95.73%,69.9%,93.6%respectively.(7)The differences were significant(P<0.05)in different position of tumor and NIH/Miettinen classification in the groups.In addition,the NIH classification might more precise than the Miettinen classification in evaluating the prognosis of GISTs.(8)The prognosis of GISTs was influenced by various factors.Univariate analysis indicated that tumor size,tumor position,metastases,Ki-67,mitotic count,NIH classification,grade of Miettinen and surgical approach were significantly relevant to the prognosis(P<0.05).Multivariate analysis revealed that metastases and surgical approach were the independent risk factors to the prognosis.Conclusions:GISTs mainly occurred in the elder,the clinical symptoms were not typical.The tumor has the activity of malignant transformation.Definite diagnosis depended on pathological examination.Clinical characteristics and risk classification could be anticipated the prognosis of disease.Early diagnosis and treatment was important points for improving prognosis,and radical surgery served as the preferred therapy after definite diagnosis.The survival rate could be effectively improved by using imatinib after recurrence or metastases.