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Background and Purpose: gastrointestinal stromal tumors (Gastrointestinal stromal tumor, GIST) is the most common gastrointestinal mesenchymal tumors that can occur in any part of the gastrointestinal tract, as well as omentum, retroperitoneal and mesenteric. 1983 Mazur and Clark on previous gastrointestinal mesenchymal tumors were studied retrospectively, found that non-directional differentiation of tumor stromal tumors, first named it \GIST is the cause of that proto-oncogene c-kit mutations in KIT tyrosine kinase constitutively activated, resulting in uncontrolled proliferation of mutant cells. Its clinical manifestations, preoperative diagnosis is difficult, the prognosis is related to many factors. Home and abroad in recent years, gastrointestinal stromal tumor research is relatively more, but mostly for small samples or case reports and studies on the prognosis of the disease is relatively rare. This study aims to analyze gastrointestinal stromal tumor clinical features and pathological features, explore the impact of gastrointestinal stromal tumors range of possible prognostic factors in order to provide more valuable for clinical information to guide treatment. Methods: Fourth Hospital of Hebei Medical University, July 1996 - June 2007 underwent surgery and pathologically confirmed gastrointestinal stromal tumors, 102 cases of gastrointestinal stromal tumors to establish a database. Analysis of the clinical manifestations, tumor characteristics, pathological features and other tests (such as ultrasound, CT, endoscopy, etc.) characteristics; concurrent access cases, through phone calls and letters are two ways to follow the patient's survival, in months, according to Death , survival (censored) divided into two categories, select the 20 possible pairs of gastrointestinal stromal tumor prognostic impact of clinical and biochemical parameters were analyzed for gastrointestinal stromal tumors affecting an independent prognostic factor. And cited one case of typical cases analyzed separately. Application SPSS10.0 statistical software for statistical analysis, measurement data were compared using the t test, the survival rate calculated using the Kaplan-Meier method, univariate analysis using log rank test (LRT), multivariate analysis using Cox proportional hazards model (CPHM), only statistical Univariate significant variables were entered into the final Cox model analysis of prognostic factors and prognosis using specific numerical correlation analysis (CB). p lt; 0.05 was considered statistically significant. Results: 1 General information: July 1996 to June 2007 period surgery and pathology confirmed a total of 102 cases of GIST patients. Male 52 cases (50.98%), female 50 cases (49.02%). Aged 14 to 81 years, mean (53.74 ± 12.34) years of age. Tumor longest diameter 1 ~ 30cm, average (9.59 ± 7.04) cm. Parts: 59 cases of stomach, duodenum 4 cases, 13 cases of small intestine, rectum two cases, 11 cases of retroperitoneal, mesenteric five cases, omentum eight cases. All patients no preoperative any treatment. 2 Clinical manifestations: The group of 102 patients, the most common manifestations of abdominal pain and discomfort, accounting for 49.02% (50/102); followed by gastrointestinal bleeding (such as vomiting, melena), accounting for 25.49% (26/102) . Other manifestations include weight loss, accounting for 13.73% (14/102); anorexia 6.86% (7/102); anemia in 2 cases, accounting for 1.96%. 30 cases of asymptomatic patients, accounting for 29.41%. Three auxiliary examination: 3.1 CT examination: 78 Routine abdominal CT examination, the positive rate was 93.59% (73/78). Mainly characterized by gastrointestinal or intraperitoneal round or irregular mass, the border is still clear, homogeneous or heterogeneous enhancement, close to the tube wall, luminal or expansive growth, some may have ulcers. 3.2 Abdominal ultrasound: 35 Routine ultrasound examination, which can be discovered 21 cases of tumor, the positive rate was 60%. No obvious characteristic, manifested as abdominal mass, less clear boundaries, not only the whole edge, visible flow signal interference due to intestinal gas, hollow organs show less clear. 3.3 gastroscopy: A total of 48 routine endoscopy, mainly for the gastric fundus, body submucosal tumor, hard surface mucosal owe complete lobulated or ulcers can be seen. 1 case of small omentum malignant stromal tumors, showed lesser curvature side under pressure, and mucosal integrity. 4 postoperative pathology: 4.1 naked eye: mostly gastrointestinal intramural mass, to the cavity, external or both grow. Mucosa bulge, visible ulcer formation. Showed a single tumor nodules, nodular or lobulated growth. Section gray, gray or dark red, visible hemorrhage, necrosis and cystic change. 4.2 were observed: 4.2.1 cell types: GIST tumor cells composed of two components, namely spindle cells and epithelioid cells. In accordance with the percentage of cell types (gt; 50%) classified into spindle cells and epithelioid cells predominant predominant. The former has 89 cases, accounting for 87.25%, cells were braided or fence-like arrangement, abundant cytoplasm, nucleus fusiform, ends blunt or slender; latter 13 cases, accounting for 12.75%, flaky cells or cord-like nests false rosettes like arrangement, the nuclei were round. 4.2.2 mitotic: 102 patients, mitotic lt; 5/50HPF 44 cases ,5-10 / 50HPF 30 cases, gt; 10/50HPF 28 cases. 5 Immunohistochemistry: Collection of 102 cases of GIST, 58 routine immunohistochemical examination, CD117 positive for 55 cases (94.83%); CD34-positive 50 cases (86.21%). Showed a diffuse distribution. 6 survival analysis: follow-up to the June 30, 2007, follow-up time 0.60m-131.30m (average 24.62m), a total of 19 patients were lost, lost rate of 18.63%. The overall 5-year survival rates were 91.55%, 72.63%, 60.53%. Univariate analysis showed that mitotic index, tumor size, surrounded by adhesions, transfer, ascites and other factors between the survival difference was statistically significant (p lt; 0.05). Gender, age, location, weight loss, ulcers, bleeding, serosal invasion, growth type, cell type, CD117, CD34, Gleevec application, postoperative chemotherapy, AFP, CEA between the survival difference was not statistically significant ( p gt; 0.05). Multivariate analysis showed that, mitotic, ascites is an independent prognostic factor (p lt; 0.05), relative risk (Relative risk, RR) were 3.276 and 4.266,95% confidence intervals were 1.368 ~ 7.846 and 1.316 ~ 13.828. The correlation analysis, prognosis and mitotic correlation coefficient r = 0.474, were positively correlated. Mitotic death group was significantly higher than the survival group (p lt; 0.05). Conclusion: This study found that GIST occurs in middle-aged, male and female incidence is about 1:1, the lack of specific clinical manifestations of common abdominal discomfort and gastrointestinal bleeding, some patients are asymptomatic. 2. GIST preoperative diagnosis of primary auxiliary examination of CT and ultrasound, endoscopy for the diagnosis of gastric stromal tumors helpful. CD117 and (or) CD34 for the diagnosis of GIST has a certain value. 3 In this study, univariate analysis showed that the prognosis of patients with mitotic index, tumor size, surrounded by adhesions, transfer, ascites, and other factors. Multivariate analysis showed that, mitotic ascites positive GIST with poor prognosis, is an independent prognostic factor, patients need regular follow-up.
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