ObjectiveTo explore the value of ultrasonography in the diagnosis of gastrointestinal stromal tumors (GISTs). MethodWe retrospectively analyzed the clinical data of 110 patients with surgical pathology confirmed GISTs between January 2008 and December 2013. All the patients underwent routine ultrasound examination. Thirty-two patients accepted oral contrast enhanced bowel ultrasonography, and 5 patients underwent trans-rectal ultrasound (TRUS). ResultsA total of 107 cases were detected out of the 110 cases of GISTs by ultrasonography, and the other three cases were missed. Among the 107 cases, 104 were shown to be masses, and 3 had thick gastric or intestinal walls. Among the 104 masses, hypo-echoic lesions were found in 73, heterogeneous lesions were found in 25, and hyper-echoic lesions were found in 6; 30 cases of tumor were less than 5 cm in diameter, 54 were between 5 cm to 10 cm in diameter, and 20 were longer than 10 cm in diameter (including 5 were longer than 20 cm in diameter). In the 107 cases, 12 were found to have liver metastasis, 4 were detected to have abdominal lymph node enlargement, and 3 had ascites. Surgery and pathological results showed that among the 110 cases of gastrointestinal stromal tumors, 91 developed from the stomach and intestine and the other 19 were extra-gastrointestinal stromal tumors; 72 were at high risk, 21medium risk, and 17 low risk. ConclusionsThe detection rate of GISTs by ultrasonography is high, but the quantitative and qualitative diagnosis ability should be raised.
目的 探讨胃肠道间质瘤（GIST）的临床表现及诊治方法。方法 回顾性分析2003～2008年期间我院收治的35例GIST患者的临床表现和随访资料。结果 GIST发生部位：胃22例（62.8%），小肠8例（22.9%），结直肠2例（5.7%），腹膜后或肠系膜3例（8.6%）。免疫组织化学检测显示，CD117 （＋） 32例（91.4%），CD34 （＋） 18例（51.4%），SMA （＋） 4例（11.4%），S100 （＋） 2例（5.7%）。35例患者均接受了手术治疗，其中根治性手术30例，非根治性手术5例，联合脏器切除10例。随访中位时间34个月，随访率为100%（35/35）。全组患者1、3、5年累积生存率分别为95.4%、87.2%和77.9%。本组患者中有3例术后复发转移患者服用甲磺酸伊马替尼的患者至今仍带瘤生存。患者的5年累积生存率与肿瘤大小、有无肿瘤坏死、核分裂数、肿瘤细胞核异型性、肿瘤部位及手术方式有关（P＜0.05 ）。结论 GIST主要通过术后病理和免疫组织化学检测明确诊断，完整的局部手术切除是最有效的治疗手段，复发转移病例需要手术与药物治疗的结合。
Objective To analyze features of color Doppler ultrasonography in gastrointestinal stromal tumors. Method The ultrasound images of gastrointestinal stromal tumors (51 cases) and gastrointestinal cancers (59 cases) confirmed by operation and pathology were compared and analyzed. Results The gastric stromal tumor mainly occurred at the bottom of the stomach and the body of the stomach (17 cases), the intestinal stromal tumor mainly occurred at the small intestine (24 cases). The gastric cancer mainly occurred at the gastric antrum (18 cases), the intestinal cancer all occurred at the colon (20 cases) and rectum (12 cases). Compared with the gastrointestinal cancers, the gastrointestinal cavity was not surrounded by tumor, the peripheral boundary was clear, the morphology was more regular, the internal echo was uneven, and there was no peripheral lymph node metastasis in the gastrointestinal stromal tumors, the differences were statistically significant (P<0.05). There were no significant differences in the degree of blood flow and tumor diameter between the gastrointestinal stromal tumors and the gastrointestinal cancers (P>0.05), but the blood flow of the intestinal stromal tumor was significantly more abundant as compared with the intestinal cancer (P<0.05). Conclusion Color Doppler ultrasonography, as a simple and rapid method, has a certain diagnostic value for differentiation of gastrointestinal stromal tumors and gastrointestinal cancers.
ObjectiveTo analyze the relevant risk factors affecting postoperative relapse-free survival (RFS) in the primary gastrointestinal stromal tumors (GIST) and develop a Nomogram predictive model of postoperative RFS for the GIST patients. MethodsThe patients diagnosed with GIST by postoperative pathology from January 2011 to December 2020 at the First Hospital of Lanzhou University and Gansu Provincial People’s Hospital were collected, and then were randomly divided into a training set and a validation set at a ratio of 7∶3 using R software function. The univariate and multivariate Cox regression analysis were used to identify the risk factors affecting the RFS for the GIST patients after surgery, and then based on this, the Nomogram predictive model was constructed to predict the probability of RFS at 3- and 5-year after surgery for the patients with GIST. The effectiveness of the Nomogram was evaluated using the area under the receiver operating characteristic curve (AUC), consistency index (C-index), and calibration curve, and the clinical utility of the Nomogram and the modified National Institutes of Health (M-NIH) classification standard was evaluated using the decision curve analysis (DCA). ResultsA total of 454 patients were included, including 317 in the training set and 137 in the validation set. The results of multivariate Cox regression analysis showed that the tumor location, tumor size, differentiation degree, American Joint Committee onCancer TNM stage, mitotic rate, CD34 expression, treatment method, number of lymph node detection, and targeted drug treatment time were the influencing factors of postoperative RFS for the GIST patients (P<0.05). The Nomogram predictive model was constructed based on the influencing factors. The C-index of the Nomogram in the training set and validation set were 0.731 [95%CI (0.679, 0.783)] and 0.685 [95%CI (0.647, 0.722)], respectively. The AUC (95%CI) of distinguishing the RFS at 3- and 5-year after surgery were 0.764 (0.681, 0.846) and 0.724 (0.661, 0.787) in the training set and 0.749 (0.625, 0.872) and 0.739 (0.647, 0.832) in the validation set, respectively. The calibration curve results showed that a good consistency of the 3-year and 5-year recurrence free survival rates between the predicted results and the actual results in the training set, while which was slightly poor in the validation set. There was a higher net benefit for the 3-year recurrence free survival rate after GIST surgery when the threshold probability range was 0.19 to 0.57. When the threshold probability range was 0.44 to 0.83, there was a higher net benefit for the 5-year recurrence free survival rate after GIST surgery. And within the threshold probability ranges, the net benefit of the Nomogram was better than the M-NIH classification system at the corresponding threshold probability. ConclusionsThe results of this study suggest that the patients with GIST located in the other sites (mainly including the esophagus, duodenum, and retroperitoneum), with tumor size greater than 5 cm, poor or undifferentiated differentiation, mitotic rate lower than 5/50 HPF, negative CD34 expression, ablation treatment, number of lymph nodes detected more than 4, and targeted drug treatment time less than 3 months need to closely pay attentions to the postoperative recurrence. The discrimination and clinical applicability of the Nomogram predictive model are good.
ObjectiveTo investigate the current status and influencing factors of medical coping strategies in patients with gastrointestinal stromal tumors (GIST). MethodsA convenience sampling method was used to select 181 GIST patients who visited the First Affiliated Hospital of Nanjing Medical University from September 2022 to May 2024. The fear of progression questionnaire (FoP), brief illness perception questionnaire (BIPQ), social support rating scale (SSRS), and medical coping modes questionnaire (MCMQ) were administered for data collection. Multiple linear stepwise regression analysis was conducted to explore the influencing factors of the three types of medical coping strategies. ResultsMultivariate linear stepwise regression analysis showed that patients without tumor metastasis (P=0.016) and high support utilization (P=0.006) had higher score of confrontation coping. Patients with high education level (P=0.016) and subjective support (P=0.002) had higher score of avoidance coping. Patients with lower fear of physical health deterioration (P=0.003), high education level (P=0.010) and subjective support (P=0.027) had higher score of submission coping.ConclusionsThe influencing factors of medical coping strategies in GIST patients are complex, involving social support, disease-related fear, tumor metastasis, and education level. Providing comprehensive GIST-related knowledge and information to patients may help establish correct health beliefs and attitudes.
Objective To investigate preoperative blood neutrophil-to-lymphocyte ratio （NLR） in patients with gastrointestinal stromal tumor （GIST） and analyze the relationship of the NLR to prognosis. Methods The data of NLR of peripheral blood samples on 3d before surgery and the results of immunohistochemistry of 42 patients with GIST were analyzed respectively，the relation between the NLR and the prognosis of patients with GIST was understood by the survival analysis. Results The patients with high NLR （NLR≥2.5） was found in 22 cases， low NLR （NLR＜2.5） in 20 cases.The NLR was related to mitotic figures （χ2=9.45，P=0.002） and tumor size （P=0.041）. The 3-year survival rate of the patients with high NLR was shorter than that of the low NLR （χ2=5.44，P=0.022）. The 3-year survival rate was associated with NLR，mitotic figures，and tumor size （P＜0.05） in univariate analysis. The NLR and mitotic figures were independent prognostic indicators of 3-year survival （P=0.018，P=0.000） in Cox multivariate analysis. Conclusion Blood NLR and mitotic figures have some predictive value for the prognosis of patients with GIST.
Objective To detective KRAS and BRAF mutations in gastrointestinal stromal tumors (GISTs) and explore its significance in resistance of imatinib treatment. Methods Three hundred and eighty-one c-kit/PDGFRA mutation samples, 119 c-kit/PDGFRA wild type samples, and 19 pairs of samples before and after imatinib resistance from 519 patients with GIST were enrolled in this study. Polymerase chain reaction was used to detect KRAS exon 2 and BRAF exon 15 mutations. The survival data were evaluated in patients with KRAS or BRAF mutation. Results KRAS mutation was found in 2 cases (1.7%) of c-kit /PDGFRA wild type GISTs, the type of KRAS mutation was G12D and G12C, respectively. BRAFV600E mutation was found in 2 cases (1.7%) of wild type GISTs. No KRAS and BRAF mutations were found in the patients with the c-kit/PDGFRA mutation GISTs and pairs of GISTs before and after imatinib resistance. Two patients with KRAS mutation showed shorter progression free survivals for imatinib treatment. Two patients with BRAF mutation had longer recurrence free survivals. Conclusions Low frequency of KRAS or BRAF mutation only happens in wild type GISTs. KRAS mutation might be related to imatinib primary resistance, but not to secondary resistance.
ObjectiveTo summarize current treatment methods and research advances of liver metastasis in patients with gastrointestinal stromal tumor (GIST).MethodThe related literatures about treatment of liver metastasis in patients with GIST were collected and reviewed.ResultsGIST often occurred liver metastasis, which seriously affected the prognosis of patients. In the era of tyrosine kinase inhibitors (TKI) treatment, radical resection combined with TKI was the first choice. In addition, radiofrequency ablation and interventional therapy could be selected according to the patient’s condition.ConclusionsComplete resection of tumor and TKI treatment can improve the prognosis and survival rate of GIST patients with liver metastasis. GIST patients with liver metastasis need multi-disciplinary and multi-mode combined treatment.
目的 探讨甲磺酸伊马替尼治疗胃肠道间质瘤对患者细胞免疫功能的影响。方法 对病理诊断明确的16例行甲磺酸伊马替尼治疗的胃肠间质瘤患者的CD3+、CD4+、CD8+、CD4+/CD8+及NK细胞水平进行回顾性分析比较。结果 16例接受严格甲磺酸伊马替尼治疗的患者，其CD3+、CD4+、CD8+、CD4+/CD8+及NK细胞水平在甲磺酸伊马替尼治疗前、后无明显变化（Pgt;0.05）。结论 采用甲磺酸伊马替尼在对胃肠间质瘤患者进行分子靶向治疗时，对患者的细胞免疫功能无明显影响。
ObjectiveTo explore the clinical characteristics, diagnosis, and treatment norms of gastrointestinal stromal tumor, so as to deepen clinicians’ understanding of the gastrointestinal stromal tumor and avoid misdiagnosis.MethodsThe clinical data of a patient with gastrointestinal stromal tumor who treated in March 2019 in The First Hospital of Kunming was retrospectively analyzed, and determining the methods of the treatment through MDT mode.ResultsThis patient was generally in good condition. After MDT discussions among the imaging department, cardiothoracic surgery department, oncology department, and anesthesia department, it was considered that surgical treatment was the best treatment scheme. The operation time was 120 min, intraoperative bleeding was about 100 mL, and no blood transfusion was performed. No bleeding, abdominal infection, gastroesophageal reflux, and other complications occurred after the operation, and the patient was discharged successfully on the 10th day after the operation. Postoperative treatment was assisted by imatinib. Follow-up was conducted for more than 4 months, with no obvious complication occurred after discharge, so continued to follow-up.ConclusionGastrointestinal stromal tumor can be diagnosed and treated by multidisciplinary approach, and surgical resection is still the most important and effective treatment.