| Objective:1.To analyze the clinical characteristics of small intestinal stromal tumors,such as age of onset,gender,clinical symptoms,and imaging detection rate,to provide a basis for early diagnosis by clinicians.2.To analyze the characteristics of pathological histology,immunohistochemistry and molecular alterations of small intestinal stromal tumors.3.To analyze a number of clinicopathologic factors affecting the prognosis of small intestinal stromal tumors,to find indicators that accurately and scientifically reflect their prognosis,and to improve the prognostic level of patients.Methods:This paper collected and retrospectively analyzed the clinical,pathological and follow-up data of 370 patients with surgically resected and pathologically confirmed primary small intestinal stromal tumors at the First Hospital of Jilin University from January 2014 to July 2021;and used statistical software SPSS 25.0 for analysis.The statistical data were expressed as percentages（%）,and this paper used the X2 test to compare the distribution of the number of patients’ 5-year deaths between groups and further analyzed factors affecting the 5-year survival of patients by multifactorial analysis using COX regression model.Results:1.In this study,370 patients with SIST were included,201 males and 169females;the median age of onset was 56 years;there were 203 cases with primary origin in the jejunum,122 cases in the ileum and 45 cases in the duodenum.The first clinical symptom was gastrointestinal bleeding in 152 cases and abdominal pain in 75 cases.270 cases underwent CT plain scan examination before surgery,and lesions were found in 175 cases;349 cases underwent CT enhanced scan examination,and the detection rate was 88.8%.2.There were 150 cases with maximum tumor diameter ≤5.0cm and 220 cases with >5.0cm.There were 221 cases with mitotic count ≤5/50 HPF and 149 cases with >5/50 HPF.More than half of the tumors grew in the submucosa（214/370,57.8%）.Histocytologically,there were 289 cases（78.1%）of spindle cell type,32cases（8.7%）of epithelioid cell type,and 49 cases（13.2%）of mixed type.Tumor rupture and tumor necrosis were respectively present in 39 and 192 cases.According to the NIH risk classification criteria（2008 modified version）,very low risk,low risk,intermediate risk and high risk contained 46,90,17 and 217 cases,respectively.The positive expression rates of CD117,CD34 and DOG-1 in immunohistochemically detected SIST specimens were 97.8%（362/370）,71.1%（263/370）and 98.4%（364/370）,respectively.234 cases had Ki-67 proliferation index ≤5.0% and 113 cases >5%.212 patients performed postoperative genetic testing,including 80.7%with C-KIT mutation,6.1% with PDGFRA mutation,and 13.2% with C-KIT/PDGFRA wild type.370 patients with SIST underwent surgical treatment,including 295 cases with open surgery and the remaining 75 cases with laparoscopic surgery.Of the 45 cases duodenal mesenchymal tumors,11 cases underwent pancreaticoduodenectomy and the remaining 34 cases were limited resections.314 cases of the 325 cases jejunoileal stromal tumors were radical small bowel segment resections and only 11 cases were palliative resections.There were 197 cases of postoperative imatinib adjuvant treatment therapy.3.In this study,there were 329 cases observed in the follow-up endpoint,with a follow-up rate of 88.92%.Because of the different surgical types of jejunal stromal tumors and duodenal stromal tumors,they were analyzed in groups.For jejunoileal stromal tumors,univariate analysis showed that age,type of surgery,maximum tumor diameter,mitotic count,and NIH risk classification had a significant effect on 5-year overall survival in patients with jejunoileal stromal tumors（P < 0.05）.The results of multifactorial prognostic analysis showed that age,type of surgery and NIH risk class were independent risk factors affecting 5-year overall survival in patients with jejunoileal stromal tumor（P < 0.05）.For duodenal stromal tumors,univariate analysis showed that the maximum tumor diameter was statistically associated with 5-year overall survival for duodenal stromal tumors（P < 0.05）.There was no statistical significance in 5-year OS of patients with jejunoileal stromal tumors and duodenal stromal tumors（P > 0.05）.Conclusion:1.Small intestinal stromal tumors can occur in all age groups,mostly in middle-aged and elderly people around 60 years old,with slightly more men than women.About half of them originate in the jejunum,followed by the ileum and duodenum.2.The first clinical symptoms of small intestine stromal tumor are non-specific,most of them start with gastrointestinal bleeding and abdominal pain,and the positive detection rate of CT scan/enhancement scan is high.C-KIT exon 11 mutation is still the most common type of mutation.3.Radical surgical resection is currently first choice of the treatment for small bowel stromal tumors.The use of laparoscopic surgery in small bowel stromal tumors is gradually increasing.For patients in the NIH risk classification group of moderate to high risk,the writer recommended postoperative molecular targeting adjuvant therapy.4.Age,type of surgery and NIH risk classification are independent risk factors affecting the 5-year overall survival of patients with jejunoileal stromal tumor.Maximum tumor diameter was be concerned to 5-year overall survival in duodenal stromal tumor.The prognosis of duodenal stromal tumors is similar to that of jejunoileal stromal tumor. |
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