Analysis Of The Diagnosis And Treatment Of Rectal Stromal Tumors In Xi'An Area

ObjectiveBy looking at patients of rectal stromal tumor of the medical record information from three hospitals in xi 'an,collect the pathological diagnosis,treatment and prognosis of clinical data,analysis the current status of diagnosis and treatment of rectal stromal tumor in xi 'an region of and existing problems,combine with literature review the standardization of clinical diagnosis and treatment of rectal stromal tumor,promote the diagnosis and treatment of rectal stromal tumor.MethodsA retrospective analysis of 42 cases of rectal stromal tumors from 2008 to 2018 which were admitted to Shanxi Provincial People's Hospital,Tangdu Hospital and Xijing Hospital.Including general data,pathologic and immunohistochemical detection results,tumor recurrence risk classification,clinical diagnosis and treatment,in patients with multiple hospital data and telephone return visit to the patients' follow-up data;Survival analysis of prognostic factors related to rectal stromal tumor was performed by Kaplan-Meier test,and survival curves were plotted.Log-rank test was used to conduct univariate analysis on the influencing factors of prognosis,and variables with P < 0.05 were included in Cox proportional hazard regression model for multi-factor analysis.ResultsAmong the 42 patients,32 were male and 10 were female.With the average age58.19 and the median age was 61.All the primary tumor sites were located in the middle and lower rectum,1~7cm away from the anal border,with an average distance of 3.48 cm and a median distance of 3cm.The main clinical symptoms associated with the disease include changes of defecation habit,bloody stool,and discomfort in the perianal.Rectal digital examination played an important role in the diagnosis process,and the detection rate was 93%.The pathological morphology of rectal GISTs more common in spindle cells;immunohistochemistry showed that the positive rate of CD117,CD34 and DOG-1were significant.A total of 32 patients received surgical treatment,of which the abdominalperineal resection of 19 cases(19/32),the local excision of 11 cases(11/32),low anterior resection in 2 cases(2/32).Among the 32 surgical patients,a total of 16 patients received perioperative treatment of imatinib mesylate(IM),among which 7 patientsreceived preoperative IM treatment with median treatment duration of 6 months,and 13 patients received postoperative IM adjuvant treatment with median treatment duration of 7months.Follow-up time was 6~123 months(median time was 40 months).Of all patients,7developed disease progression,including 5 relapsed,2 metastasized,and 3 died.Among the 5 patients with recurrence,the median diameter of the tumor was 6cm(2-15cm),and the median distance from the anal border was 2cm(2-3cm).Among the 5 patients,1patient underwent local resection through the anus,and 4 patients underwent Miles surgery.The local recurrence rates in the local resection group and the radical resection group were 9% and 19% respectively.The median recurrence-free survival was 15 months(6~80 months)and 59 months(7~112 months)respectively.The results of statistical analysis showed that postoperative adjuvant therapy(P=0.022)was an influential factor in the prognosis of patients with rectal stromal tumor.Conclusion(1)Disease characteristics of rectal GISTs: it usually occurs in elderly men and is mostly located in the middle and lower rectum.The primary symptoms are perianal distention and fall pain and hematogenous stool.(2)Digital rectal examination is an important diagnostic method for rectal GIST,and anal biopsy is a key means to diagnose rectal GIST and check its genetic mutation status.(3)Radical resection of rectum is the main treatment method for this group of rectal GIST,and local resection is an important method for the treatment of rectal GIST.For patients whose tumor diameter and location meet the requirements of local resection and whose risk of recurrence is low,they can benefit from it.(4)In this group,the postoperative adjuvant therapy rate was 40.6%,and only 2patients underwent gene mutation detection,and postoperative standardized adjuvant therapy was not applied enough;According to the guidelines,standardized adjuvant treatment for rectal stromal tumor should be vigorously promoted,postoperative follow-up monitoring should be strengthened,recurrence and metastasis should be reduced,and postoperative survival time should be extended.(5)The detection rate of gene mutation in preoperative biopsy specimens of patients with rectal GIST in this group was very low(12.5%),making it difficult to effectively guide preoperative therapy.We should strengthen the understanding and individualized and accurate application of preoperative therapy under the guidance of gene mutation detection,so as to improve the anal preservation rate and the quality of life of patients.