| Objective: This study is a retrospective analysis based on the clinical data of gastrointestinal stromal tumors(GIST)patients treated in our hospital.By summarizing the clinical characteristics,analyzing the factors that may affect the risk classification,and comparing the clinical and pathological characteristics of aged and non-aged patients,we aim to improve the understanding of the disease and complement scientific theories for clinical diagnosis and treatment.Methods:310 GIST patients in the past 15 years were enrolled in the study via the medical record retrieval system of our hospital.The data of gender,age,first symptoms,clinical manifestations,tumor location and characteristics,pathological diagnosis,immunohistochemical detection,risk classification and treatment were collected as the clinical characteristics.The patients were divided into the aged group(age≥60 years)and the non-aged group(age<60 years),then we compared the clinical characteristics of the two groups.Results:1.Clinical and pathological characteristics of 310 cases of GIST(1)In GIST patients,151 were male,159 were female,and the ratio of male to female was 1:1.05.The age of onset ranged from 20 to 87 years,the mean age is60.7±11.8 years.95 cases(30.6%)were in age of 50～59,93 cases(30.0%)were in age of 60～69,50～69 age group was the most common.The stomach is the most commonlocation(220 cases,71%),followed by small intestine(50 cases,16.1%),colorectum(17 cases,5.5%),duodenum(15 cases,4.8%).The abdominal pain is the most common symptom(94 cases,30.3%),followed by found abdominal mass(91 cases,29.4%),abdominal discomfort(66 cases,21.3%),gastrointestinal bleeding(56 cases,18%),had a choking feeling after eating(3 cases,1%).(2)Diagnostic test: CT positive rate was 83.5%,barium meal positive rate was62.3%,abdominal ultrasound positive rate was 29.5%,and MRI positive rate was 90%.The positive rates of gastroscopy and colonoscopy were 73.6% and 23.7% respectively,and the positive rates of pathological biopsies were 22.2% and 33.3% respectively.The positive rates of ultrasonic endoscope were 100%.(3)Pathological and histological classification: GIST tumor sizes ranged from0.2～22 cm(diameter),with an average of 5.47±4.10 cm.Among them,51 cases(16.8%)were <2cm,150 cases(49.3%)were 2～5cm,56 cases(18.4%)were 5～10cm,and 47cases(15.5%)were ≥10cm.290 cases(95.4%)were single GIST and 14 cases(4.6%)were multiple GISTs.14 cases(4.6%)were accompanied with necrosis,6 cases(2.0%)with bleeding,and 1 case(0.3%)with calcification;no tumor rupture was found.Cell morphology: 293 cases were spindle cell types(94.5%),3 cases are epithelial cell types(1%),and 14 cases are mixed cell types(4.5%).Mitotic images: 106 cases(83.5%)≤5/50 HP,14 cases(11%)between 5～10/50 HP,and 7 cases(5.5%)>10/50 HP.(4)Immunohistochemistry: The positive rates of DOG1,CDll7,CD34,actin,Desmin,and S-100 were: 95.3%,91.9%,85.5%,23.2%,12.5%,and 11.2%.The positive rates of CDll7,DOG l,and CD34 were significantly higher than those of actin,Desmin,and S-100(P<0.05).The positive rate of DOG1 was higher than that of CDll7 and CD34(P<0.05).(5)Metastasis: 20 cases(6.5%)were accompanied with metastasis.The primary tumor site was most commonly in stomach(65%),followed by the duodenum(15%),small intestine(15%),and colon(5%).Among them,5 cases <60 years old(25%),and15 cases ≥60 years old(75%).Tumor diameter was most commonly in 2～5cm(55%),followed by > 10cm(25%),5～10cm(15%),and ≤ 2cm(5%).(6)Treatment: Interstitial tumor resections were performed in 304 patients,laparotomy in 248 cases(80.0%),laparoscopic resection in 45 cases(14.5%),endoscopic mass dissection in 8 cases(2.6%),and 3 cases(1%)were treated with laparoscopic combined microscopy.6 patients were treated conservatively(1.9%).2.Risk assessment(1)The enrolled GIST patients including 65 patients with high risk(21.4%),97 patients with moderate risk(31.9%),106 patients with low risk(34.2%),and 36 patients with very low risk(11.8%).(2)The risk classification is correlated with gender and the tumor with hemorrhage and necrosis(P<0.05).There was no correlation with age,underlying disease and cell morphologies(P>0.05).Ki-67 index was positively correlated with the risk classification(P<0.001).Patients with Ki-67 index <3 were mainly at very low risk(20.7%)and low risk(40.5%).With the increase of Ki-67 index,the proportion of very low-risk patients is gradually decreasing,while the proportion of high-risk patients is gradually increasing,Patients with Ki-67 index >10 were mainly at high-risk(63.6%).However,CD117,CD34 and DOG1 were not related to the risk classification(P>0.05).3.Comparison of clinical characteristics between the aged group and non-aged groupThe sex ratio was no difference between the aged and non-aged groups(P>0.05).The proportion of stomach GIST(77%)in the aged group was more than the non-aged group(64.1%),and the number of patients with basic diseases was more in the aged group than in the non-aged group(P<0.05).The symptom of abdominal mass(33.9%)is more common in the aged group,and abdominal pain(37.9%)is more common in the non-aged group.There was no significant difference in accompaning gastrointestinal tumors,anemia,tumor markers,tumor diameter,cell morphology and mitotic figures between the two groups(P>0.05).28 of 165 cases(17%)in the aged group and 10 of145 cases(6.9%)in the non-aged group had serosal invasion;15 of 165 cases(9.1%)patients in the aged group and 5 of 145 cases in the non-aged group(3.4%)had metastasis.In terms of serosal invasion and metastasis,the proportion of aged group was more than the non-aged group(P<0.05).There was no difference in tumor hemorrhage and necrosis between the two groups(P>0.05).The Ki-67 indexes in the aged group were mainly ≤3,while the Ki-67 indexes in the non-aged group were ≥3,which has significant difference(P<0.05).There are no significant differences in the expression of CD117,CD34,DOG1,Actin,S100,or Desmin between the two groups(P>0.05).Conclusion:1.GIST lacks specific clinical symptoms,and can occur in any parts of the gastrointestinal tract,while abdominal pain can be the main clinical manifestation.2.The first symptoms of elderly GIST cases are mainly abdominal masses,which are more insidious and more commonly found in the stomach,these cases are more prone to have metastasis and serosa infiltration.3.Tumor markers are of little help in the diagnosis of GIST.The combination of endoscopy,endoscopic ultrasound,and enhanced abdominal CT or MRI is more helpful for early detection of GIST.The diagnosis depends mainly on histopathological and immunohistochemistry tests.The expression of DOG1,CD117,and CD34 have obvious advantages in the diagnosis of GIST and can be used as important indicators.4.In addition to tumor size,mitosis,and tumor location as risk factors for identifying prognosis,male patients and tumors with hemorrhagic necrosis may indicate a worse prognosis.Combining the risk classification with Ki-67 index is helpful to identify the prognosis and outcome of patients with GIST. |
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