Background Gastrointestinal stromal tumor （GIST）, the most common type of mesenchymal tumors of the gastrointestinal tract, is a recently recognized tumor. The biological behavior of GIST is highly variable. Surgica...Background Gastrointestinal stromal tumor （GIST）, the most common type of mesenchymal tumors of the gastrointestinal tract, is a recently recognized tumor. The biological behavior of GIST is highly variable. Surgical resection remains the major treatment for GIST. In this study we retrospectively analyzed our surgical experience with 181 GIST patients to determine the effects of the treatment and the pathological features and prognosis factors of these GIST patients. Methods The clinicopathological features and follow-up data of the 181 patients with GIST who had received surgical resection between January 1999 and December 2007 at Ren Ji Hospital were retrospectively reviewed. Immunohistochemical stains including CDl17 （KIT）, CD34, and other markers were used. Tumor size, mitotic index and other pathological parameters were recorded. According to the consensus of NIH risk-group stratification system based on maximum tumor size and mitotic index （per 50 high power field）, tumors were classified into very-low-risk group （15 tumors, 8.3%）, low-risk group （48, 26.5%）, intermediate-risk group （52, 28.7%） and high-risk group （66, 36.5%）. Prognostic factors were analyzed by Cox analysis including age, sex, tumor size, tumor site, mitotic index, NIH categories and surgical procedures. Results One hundred and seven （59.1%） of the 181 tumors were located in the stomach, 51 （28.2%） in the small intestine, 9 （5.0%） in the colon and rectum, and 14 （7.7%） in other sites including the omentum and mesentery. The median age of the patients was 58 （range, 24-84） years, and 102 patients （56.4%） were male. Tumor size ranged from 0.5 to 30 cm, while the mean size was 7.02 cm. Metastasis was found in 7 patients. One hundred and seventy-six （97.2%） of the 181 patients underwent radical resection, and among them 26 patients received extensive resection with the adjacent organ adherent to the tumors. The positive rate for the KIT protein （CDl17） in immunostaining was 94.5% （171/181）, while that for CD34 was 86.2% （156/181）. The 1-, 3-,and 5-year survival rates of the 181 patients were estimated to be 95.2%, 87.9% and 78.5%, respectively. There was a significant difference in age, tumor size, tumor site, mitotic index, NIH categories, and presence or absence of multivisceral resection （P 〈0.05）. But there was no significant difference in sex between the groups. Cox hazard proportional model revealed that advanced clinical stage and large tumor size contributed to worse prognosis. The patients who were treated with imatinib because of recurrence and metastasis or high recurrence risk showed stable disease. Conclusions Surgical resection is the gold standard of treatment for primary GIST. NIH categorization is simple and effective to evaluate GIST behavior and prognosis. Targeted therapy such as imatinib, a KIT tyrosine kinase inhibitor, may play an important rote in the treatment of GIST.展开更多
AIM:To explore the feasibility and oncologic outcomes of segmental jejunal resection on the left side of the mesenteric vessels in patients with tumors of the angle of Treitz using data from a single center.METHODS:Th...AIM:To explore the feasibility and oncologic outcomes of segmental jejunal resection on the left side of the mesenteric vessels in patients with tumors of the angle of Treitz using data from a single center.METHODS:Thirteen patients with tumors of the angle of Treitz who underwent surgery at our institution were prospectively followed.A segmental jejunal resection on the left side of the mesenteric vessels was performed in all patients.Formalin-fixed and paraffin-embedded tumor samples were examined.The primary end point of this analysis was disease-free survival.RESULTS:In this study,there were 8 males and 5females(mean age,50.1 years;range,36-74 years).The mean tumor size was 8.1 cm(range,3.2-15 cm).Histologic examination showed 11 gastrointestinal stromal tumors(GISTs)and 2 adenocarcinomas.Five of the GIST patients presented with potential low risk,and 6presented with intermediate and high risk,according to the National Institutes of Health criteria.One potentially high-risk patient showed tumor progression at 46 mo and died 52 mo after surgery.One patient with locally advanced adenocarcinoma received neoadjuvant chemotherapy and adjuvant radiotherapy,but the disease progressed,and the patient died 9 mo after surgery.One GIST patient without progression died 16 mo after surgery because of a postoperative intestinal obstruction.The median overall survival rate was 84.6 mo,and the median disease-free survival rate was 94.5 mo.CONCLUSION:The overall survival of patients with tumors of the angle of Treitz was encouraging even when the tumor size was relatively large.A segmental resection on the left side of the mesenteric vessels is considered to be a reliable and curative option for tumors of the angle of Treitz.展开更多
文摘Background Gastrointestinal stromal tumor （GIST）, the most common type of mesenchymal tumors of the gastrointestinal tract, is a recently recognized tumor. The biological behavior of GIST is highly variable. Surgical resection remains the major treatment for GIST. In this study we retrospectively analyzed our surgical experience with 181 GIST patients to determine the effects of the treatment and the pathological features and prognosis factors of these GIST patients. Methods The clinicopathological features and follow-up data of the 181 patients with GIST who had received surgical resection between January 1999 and December 2007 at Ren Ji Hospital were retrospectively reviewed. Immunohistochemical stains including CDl17 （KIT）, CD34, and other markers were used. Tumor size, mitotic index and other pathological parameters were recorded. According to the consensus of NIH risk-group stratification system based on maximum tumor size and mitotic index （per 50 high power field）, tumors were classified into very-low-risk group （15 tumors, 8.3%）, low-risk group （48, 26.5%）, intermediate-risk group （52, 28.7%） and high-risk group （66, 36.5%）. Prognostic factors were analyzed by Cox analysis including age, sex, tumor size, tumor site, mitotic index, NIH categories and surgical procedures. Results One hundred and seven （59.1%） of the 181 tumors were located in the stomach, 51 （28.2%） in the small intestine, 9 （5.0%） in the colon and rectum, and 14 （7.7%） in other sites including the omentum and mesentery. The median age of the patients was 58 （range, 24-84） years, and 102 patients （56.4%） were male. Tumor size ranged from 0.5 to 30 cm, while the mean size was 7.02 cm. Metastasis was found in 7 patients. One hundred and seventy-six （97.2%） of the 181 patients underwent radical resection, and among them 26 patients received extensive resection with the adjacent organ adherent to the tumors. The positive rate for the KIT protein （CDl17） in immunostaining was 94.5% （171/181）, while that for CD34 was 86.2% （156/181）. The 1-, 3-,and 5-year survival rates of the 181 patients were estimated to be 95.2%, 87.9% and 78.5%, respectively. There was a significant difference in age, tumor size, tumor site, mitotic index, NIH categories, and presence or absence of multivisceral resection （P 〈0.05）. But there was no significant difference in sex between the groups. Cox hazard proportional model revealed that advanced clinical stage and large tumor size contributed to worse prognosis. The patients who were treated with imatinib because of recurrence and metastasis or high recurrence risk showed stable disease. Conclusions Surgical resection is the gold standard of treatment for primary GIST. NIH categorization is simple and effective to evaluate GIST behavior and prognosis. Targeted therapy such as imatinib, a KIT tyrosine kinase inhibitor, may play an important rote in the treatment of GIST.
基金Supported by Beijing Municipal Science Technology Commis-sion Fund No.Z131107002213164the Beijing Hope Run Special Fund LC2012A09
文摘AIM:To explore the feasibility and oncologic outcomes of segmental jejunal resection on the left side of the mesenteric vessels in patients with tumors of the angle of Treitz using data from a single center.METHODS:Thirteen patients with tumors of the angle of Treitz who underwent surgery at our institution were prospectively followed.A segmental jejunal resection on the left side of the mesenteric vessels was performed in all patients.Formalin-fixed and paraffin-embedded tumor samples were examined.The primary end point of this analysis was disease-free survival.RESULTS:In this study,there were 8 males and 5females(mean age,50.1 years;range,36-74 years).The mean tumor size was 8.1 cm(range,3.2-15 cm).Histologic examination showed 11 gastrointestinal stromal tumors(GISTs)and 2 adenocarcinomas.Five of the GIST patients presented with potential low risk,and 6presented with intermediate and high risk,according to the National Institutes of Health criteria.One potentially high-risk patient showed tumor progression at 46 mo and died 52 mo after surgery.One patient with locally advanced adenocarcinoma received neoadjuvant chemotherapy and adjuvant radiotherapy,but the disease progressed,and the patient died 9 mo after surgery.One GIST patient without progression died 16 mo after surgery because of a postoperative intestinal obstruction.The median overall survival rate was 84.6 mo,and the median disease-free survival rate was 94.5 mo.CONCLUSION:The overall survival of patients with tumors of the angle of Treitz was encouraging even when the tumor size was relatively large.A segmental resection on the left side of the mesenteric vessels is considered to be a reliable and curative option for tumors of the angle of Treitz.
