Clinicopathologic Features And Prognosis Of Gastrointestinal Stromal Tumor In Jiangxi Province

Purpose: By retrospective analysis of the clinicopathologic features and prognosis of patients with multi-center gastrointestinal stromal tumor in Jiangxi area,the diagnosis and treatment of gastrointestinal stromal tumor in Jiangxi area were improved,and the factors affecting the prognosis of gastrointestinal stromal tumor were further explored.Method: The clinicopathologic and prognostic data of 1594 patients with gastrointestinal stromal tumor diagnosed and treated by 10 public hospitals in Jiangxi from August 2006 to June 2022 were retrospectively collected and a database was established.IBM SPSS Statistics 26.0 and R version 3.5.3 software were used for statistical analysis.Parameter test or rank sum test was used for inter-group comparison of measurement data.Chi-square test or Fisher exact probability method of four-cell table was used for inter-group comparison of count data.logistic regression was used for correlation analysis,Kaplan-Meier curve was used for univariate prognostic analysis,and COX regression model was used for multivariate prognostic analysis.Results: 1.General information: A total of 1594 patients were included in the database,including 729 males and 865 females,with a male to female ratio of 1:1.19;The median age was 57(22-85)years old,and 85.8% of the population were 45 years old or above.The first three symptoms were abdominal pain,gastrointestinal bleeding,and asymptomatic physical examination.2.Preoperative biopsy : A total of 58 patients underwent preoperative biopsy,including 36 patients with endoscopic biopsy,17 patients with percutaneous fine needle puncture biopsy,3 patients with surgical biopsy,and 2 patients with unknown biopsy.3.Neoadjuvant therapy : A total of 45 patients were treated with neoadjuvant therapy,of which 27 patients underwent surgery after transformation,with 1 patient receiving complete response 、19 patients receiving partial response、17 patients receiving stable disease and 8 patients receiving progressive disease.4.Surgical treatment: There were 9 cases(0.7%)of esophageal GIST,and there was no significant difference in the proportion of endoscopic surgery and local resection between patients with tumor diameter ≤ 2cm and those with tumor diameter > 2cm(P>0.05).There were 868 cases(63.3%)of gastric GIST,of which the proportion of endoscopic surgery and local resection in the favorable site group was higher than that in the unfavorable site group(P<0.05),but there was no significant difference in the proportion of laparoscopic surgery between the two groups(P>0.05).The proportion of endoscopic surgery,laparoscopic surgery,and local resection in the tumor diameter ≤ 5cm group was higher than that in the tumor diameter>5cm group(P<0.05).A total of 109 cases(8%)of duodenal GIST underwent laparoscopic surgery and local resection in the group with a tumor diameter of ≤ 5cm compared to the group with a tumor diameter of>5cm(P<0.05).There was no significant difference in the proportion of laparoscopic surgery between the descending part of duodenum and the non-descending part of duodenum(P>0.05).The proportion of local resection in the non-descending part of duodenum was higher than that in the descending part of duodenum(P<0.05).There were 337 cases(24.6%)of GIST in the jejunum and ileum,and there was no significant difference in the proportion of laparoscopic surgery between the group with tumor diameter ≤ 5cm and the group with tumor diameter>5cm(P>0.05).However,the proportion of local resection in the group with tumor diameter ≤ 5cm was higher than that in the group with tumor diameter>5cm(P<0.05).There were 10 cases(0.7%)of GIST in the colon,and there was no significant difference in the proportion of laparoscopic surgery and local resection between the groups with tumor diameters ≤ 5cm and>5cm(P>0.05).There were 352 cases(25.7%)of small GIST,of which 93.8% tumors were located in the stomach,and 86.6% tumors were removed by endoscopic surgery.The proportion of endoscopic surgery,endoscopic surgery,and local resection surgery for small GIST was higher than that for GIST with a tumor diameter greater than 2 cm(P<0.05).5.Postoperative pathology: the resection rate of R0 was 98.8%,the resection rate of R1 was 0.5%,and the resection rate of R2 was 0.7%.The spindle cell type accounted for 93.2%,the epithelial cell type accounted for 2.2%,and the mixed type accounted for 4.6%.The median value of the mitotic image is 3(0-95)/50 HPF.The positive rate of CD117 was 98.2%,the positive rate of DOG-1 was 98.4%,the positive rate of CD34 was 90.8%,the positive rate of a-SMA was 20%,the positive rate of DESMIN was 9.2%,and the positive rate of S-100 was 3.4%.The median value of the KI-67 index is 3(0-80)%.A total of 78 cases of gene testing were performed,including 44 cases of mutations in KIT 11 exon,17 cases of mutations in KIT 9 exon,2 cases of mutations in KIT 13 exon,2 cases of mutations in KIT 17 exon,1 case of mutations in both KIT 9 and 17 exons,1 case of mutations in both KIT 11 and 13 exons,3 cases of mutations in PDGFRA 18 exon,and 1 case of mutations in PDGFRA 12 exon,There were 1 case of KIT exon 11 combined with PDGFRA exon 12 mutations,and 6 cases of wild type mutations.The proportion of very low risk was 25.4%,low risk 26.8%,medium risk 14.8% and high risk 33.1%.There were 97 cases of tumor rupture,of which 59 cases had tumor rupture during surgery,18 cases had bloody ascites,4 cases had tumor site perforation,and 16 cases had tumor penetrating adjacent organs under microscope after surgery.6.Prognosis: The success rate of follow-up was 57.8%,with a median follow-up time of 43(1-191)months.The OS of patients with effective neoadjuvant IM treatment was superior to those without effective IM treatment(95% vs 50%,P<0.001),and the OS of patients with surgical treatment after neoadjuvant treatment was superior to those without surgical treatment(87.5% vs 66.7%,P=0.042).The OS and RR of extremely low risk patients were 99.7% and 0.5%,respectively.In low-risk GIST patients,there was no significant difference in OS and RR between the group receiving IM treatment for ≥ 1 year and the group receiving IM treatment for<1 year after surgery(P=0.525,P=1).In moderate risk patients,there was no significant difference in OS and RR between the group receiving IM treatment for ≥ 3 years and the group receiving IM treatment for<3 years after surgery(P=0.635,P=0.2726).In high-risk GIST patients,the OS in the group receiving IM treatment ≥ 3 years after surgery was better than that in the group receiving IM treatment<3 years(P<0.001),but there was no significant difference in RR between the two groups(P=0.1932).The OS in the group receiving IM treatment ≥ 5 years after surgery was better than that in the group receiving IM treatment ≥ 3 and<5 years(P=0.009),but there was no significant difference in RR between the two groups(P=0.3432).The results of univariate analysis suggested that the risk factors affecting OS in GIST patients were: male,open surgery,extended resection,tumor located at non gastric sites,tumor diameter ≥ 5cm,mitotic image ≥ 5/50 HPF,tumor rupture,medium to high risk,KI-67 index ≥ 5%(P<0.05).The results of multivariate analysis suggested that age ≥ 60 years and tumor rupture were independent risk factors for OS in GIST patients(P<0.05).Conclusion: 1.The incidence of GIST is mainly middle-aged and elderly people.The incidence rate of GIST is similar between men and women.The tumor is mainly located in the stomach and small intestine.The first symptoms are mainly abdominal pain,gastrointestinal bleeding,and asymptomatic physical examination.2.IM neoadjuvant therapy can not only improve the success rate of surgical resection,but also achieve long-term survival benefits.3.Surgical methods and surgical scope are selected according to tumor site and diameter.Both endoscopic surgery and laparoscopic surgery can completely remove the tumor without affecting the long-term prognosis of the patient.While ensuring complete tumor resection,extended resection should be avoided as far as possible to protect organ functions.4.It is recommended that high-risk GIST patients receive IM adjuvant treatment for at least 3 years after surgery.Extending the duration of IM adjuvant treatment(≥ 5 years)can improve the OS of high-risk GIST patients.5.Age and whether the tumor ruptures are independent factors that affect the prognosis of patients with GIST.