Clinical Characteristics， Diagnosis and Treatment of 217 Patients with Gastric Stromal Tumor_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YANG Hongxin , CHEN Xiufeng , ZHANG Bo , CHEN Haining , CHEN Zhixin , CHEN Jiaping

Center of Gastrointestinal Surgery， West China Hospital， Sichuan University， Chengdu 610041， Sichuan Province， China;

Corresponding author：

Keywords：

Gastric stromal tumor; Clinical manifestation; Treatment

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Objective 　To investigate the clinical characteristics， diagnosis， and treatment of gastric stromal tumor.
Methods 　Clinical data of 217 patients with gastric stromal tumor from October 2007 to July 2011 were analyzed.
Results 　The main clinical manifestation were abdominal pain， abdominal distension， bloody stools， abdominal mass， and so on. The tumour located at cardiac part， fundus of stomach， body of stomach， and pylorus part was 24 cases （11.0%）， 103 cases （47.5%）， 59 cases （27.2%）， and 31 cases （14.3%）， respectively. All the 217 patients underwent endoscopic or surgical resection and diagnosed by pathology and immunohistochemistry. The patients of high-low risk， low risk， intermediate risk， and high risk was 56 cases （25.8%）， 67 cases （30.9%）， 41 cases （18.9%）， and 53 cases （24.4%）， respectively. One hundred and forty patients were followed-up for 7-52 months （average 35 months）. Thirty-five patients of high risk were investigated about the drug treatment after the first operation：19 cases were treated by using imatinib （tumor progressed in 2 cases） and 16 patients were not （tumor progressed in 9 patients）. The rate of progression of patients treated by imatinib was significantly lower than another group （χ2=8.426， P=0.004）. In 11 patients with tumor progressed， tumor recurrnce in 4 cases， tumor recurrence with diffused abdominal cavity metastasis in 1 case， tumor metastasized to humerus in 1 case， metastasized to liver and abdominal cavity in 1 case， and metastasized to liver in 4 cases.
Conclusions 　Gastric stormal tumor is lack of specific clinical manifestations. Complete excision of the tumor is the main therapy method， and imatinib can improve prognosis.

Citation： YANG Hongxin,CHEN Xiufeng,ZHANG Bo,CHEN Haining,CHEN Zhixin,CHEN Jiaping,.. Clinical Characteristics， Diagnosis and Treatment of 217 Patients with Gastric Stromal Tumor. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2012, 19(9): 951-956. doi: Copy

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9.	罗小华，宋彬，庄雄杰，等. 直肠间质瘤的CT/MR表现及临床病理特征[J]. 中国普外基础与临床杂志， 2011， 18(10)：1109-1113.
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14.	Lasota J， Miettinen M. Clinical significance of oncogenic KIT and PDGFRA mutations in gastrointestinal stromal tumours[J]. Histopathology， 2008， 53(3)：245-266.
15.	陈慧娟. c-kit和PDGFRA基因对胃肠间质瘤的影响[J]. 中国生物化学与分子生物学报， 2009， 25(8)：697-701.
16.	Casali PG， Jost L， Reichardt P， et al. Gastrointestinal stromal tumours：ESMO clinical recommendations for diagnosis， treatment and follow-up[J]. Ann Oncol， 2009， 20(Suppl 4)：64-67.
17.	Gupta P， Tewari M， Shukla HS. Gastrointestinal stromaltumor[J]. Surg Oncol， 2008， 17(2)：129-138.
18.	Radenković G， Nikolić I， Todorović V. Interstitial cells of Cajal-pacemakers of the intestinal musculature[J]. Med Biol， 2005， 12(1)：1-5.
19.	Chaudhry UI， DeMatteo RP. Management of resectable gastrointestinal stromal tumor[J]. Hematol Oncol Clin North Am， 2009， 23(1)：79-96.
20.	Gervaz P， Huber O， Morel P. Surgical management of gastrointestinal stromal tumours[J]. Br J Surg， 2009， 96(6)：567-578.
21.	Lukaszczyk JJ，Preletz RJ Jr. Laparoscopic resection of benign stromal tumor of the stomach[J]. J Laparoendosc Surg， 1992， 2(6)：331-334.
22.	Matthews BD， Walsh RM， Kercher KW， et al. Laparoscopic vs. open resection of gastric stromal tumors[J]. Surg Endosc， 2002， 16(5)：803-807.
23.	秦新裕，刘凤林. 胃肠外科实验研究的进展[J]. 中国现代普通外科进展， 2007， 10(3)：188-190.
24.	Gomez D， Al-Mukthar A， Menon KV， et al. Aggressive surgical resection for the management of hepatic metastases from gastrointestinal stromal tumours：a single centre experience[J]. HPB(Oxford)， 2007， 9(1)：64-70.
25.	De Giorgi U， Pupi A， Turrisi G， et al. Critical update and emerging trends in imatinib treatment for gastrointestinal stromal tumor[J]. Rev Recent Clin Trials， 2007， 2(1)：43-48.
26.	Paz-Ares L， García del Muro X， Grande E， et al. Cost-effectiveness analysis of sunitinib in patients with metastatic and/or unresectable gastrointestinal stromal tumors (GIST) after progression or intolerance with imatinib[J]. Clin Transl Oncol， 2008， 10(12)：831-839.
27.	Demetri GD， von Mehren M， Blanke CD， et al. Efficacy and safety of imatinib mesylate in advanced gastrointestinal stromal tumors[J]. N Engl J Med， 2002， 347(7)：472-480.
28.	Demetri GD， Huang X， Garrett CR， et al. Novel statistical analysis of long-term survival to account for crossover in a phase Ⅲtrial of sunitinib (SU)vs. placebo (PL) in advanced GIST after imatinib (IM) failure[J]. J Clin Oncol， 2008， 26(Suppl 15)：10524.
29.	Blesius A， Cassier PA， Bertucci F， et al. Neoadjuvant imatinib in patients with locally advanced non metastatic GIST in the prospective BFR14 trial[J]. BMC Cancer， 2011， 11(1)：72.

1. Mazur MT，Clark HB. Gastric stromal tumors. Reappraisal of histogenesis[J]. Am J Aurg Pathol， 1983， 7(6)：507-519.
2. 伍小军，方清靖，卢震海，等. 140例胃间质瘤的外科治疗分析[J]. 中华胃肠外科杂志， 2010， 13(6)：417-420.
3. 蹇顺海，文彬，黄一凡，等. 胃肠道间质瘤新版风险分级方案的应用与评价[J]. 中国肿瘤临床， 2011， 38(14)：859-862.
4. 中国CSCO胃肠间质瘤专家委员会. 中国胃肠间质瘤诊断治疗专家共识(2011年版)[J]. 中华胃肠外科杂志， 2012， 15(3)：301-307.
5. 项阳，李青. 胃肠道间质肿瘤临床病理研究进展[J]. 中华临床医师杂志(电子版)， 2011， 5(15)：4482-4484.
6. 张剑，王昆华，龚昆梅，等. 胃肠道间质瘤35例诊治体会[J]. 中国普外基础与临床杂志， 2011， 18(11)：1220-1221.
7. Rubin BP， Heinrich MC， Corless CL. Gastrointestinal stromal tumour[J]. Lancet， 2007， 369(9574)：1731-1741.
8. Karaca C， Turner BG， Cizginer S， et al. Accuracy of EUS in the evaluation of small gastric subepithelial lesions[J]. Gastrointest Endosc， 2010， 71(4)：722-727.
9. 罗小华，宋彬，庄雄杰，等. 直肠间质瘤的CT/MR表现及临床病理特征[J]. 中国普外基础与临床杂志， 2011， 18(10)：1109-1113.
10. Corless CL， Heinrich MC. Molecular pathobiology of gastrointestinal stromal sarcomas[J]. Annu Rev Pathol， 2008， 3(2)：557-586.
11. Stamatakos M， Douzinas E， Stefanaki C， et al. Gastrointestinal stromal tumor[J]. World J Surg Oncol， 2009， 7：61.
12. 董德武，郭素芬，安锦丹. DOG1和PDGFRA在胃肠道间质瘤中的表达及意义[J]. 牡丹江医学院学报， 2010， 31(6)：36-38.
13. Espinosa I， Lee CH， Kim MK， et al. A novel monoclonal antibody against DOG1 is a sensitive and specific marker for gastrointestinal stromal tumors[J]. Am J Surg Pathol， 2008， 32(2)：210-218.
14. Lasota J， Miettinen M. Clinical significance of oncogenic KIT and PDGFRA mutations in gastrointestinal stromal tumours[J]. Histopathology， 2008， 53(3)：245-266.
15. 陈慧娟. c-kit和PDGFRA基因对胃肠间质瘤的影响[J]. 中国生物化学与分子生物学报， 2009， 25(8)：697-701.
16. Casali PG， Jost L， Reichardt P， et al. Gastrointestinal stromal tumours：ESMO clinical recommendations for diagnosis， treatment and follow-up[J]. Ann Oncol， 2009， 20(Suppl 4)：64-67.
17. Gupta P， Tewari M， Shukla HS. Gastrointestinal stromaltumor[J]. Surg Oncol， 2008， 17(2)：129-138.
18. Radenković G， Nikolić I， Todorović V. Interstitial cells of Cajal-pacemakers of the intestinal musculature[J]. Med Biol， 2005， 12(1)：1-5.
19. Chaudhry UI， DeMatteo RP. Management of resectable gastrointestinal stromal tumor[J]. Hematol Oncol Clin North Am， 2009， 23(1)：79-96.
20. Gervaz P， Huber O， Morel P. Surgical management of gastrointestinal stromal tumours[J]. Br J Surg， 2009， 96(6)：567-578.
21. Lukaszczyk JJ，Preletz RJ Jr. Laparoscopic resection of benign stromal tumor of the stomach[J]. J Laparoendosc Surg， 1992， 2(6)：331-334.
22. Matthews BD， Walsh RM， Kercher KW， et al. Laparoscopic vs. open resection of gastric stromal tumors[J]. Surg Endosc， 2002， 16(5)：803-807.
23. 秦新裕，刘凤林. 胃肠外科实验研究的进展[J]. 中国现代普通外科进展， 2007， 10(3)：188-190.
24. Gomez D， Al-Mukthar A， Menon KV， et al. Aggressive surgical resection for the management of hepatic metastases from gastrointestinal stromal tumours：a single centre experience[J]. HPB(Oxford)， 2007， 9(1)：64-70.
25. De Giorgi U， Pupi A， Turrisi G， et al. Critical update and emerging trends in imatinib treatment for gastrointestinal stromal tumor[J]. Rev Recent Clin Trials， 2007， 2(1)：43-48.
26. Paz-Ares L， García del Muro X， Grande E， et al. Cost-effectiveness analysis of sunitinib in patients with metastatic and/or unresectable gastrointestinal stromal tumors (GIST) after progression or intolerance with imatinib[J]. Clin Transl Oncol， 2008， 10(12)：831-839.
27. Demetri GD， von Mehren M， Blanke CD， et al. Efficacy and safety of imatinib mesylate in advanced gastrointestinal stromal tumors[J]. N Engl J Med， 2002， 347(7)：472-480.
28. Demetri GD， Huang X， Garrett CR， et al. Novel statistical analysis of long-term survival to account for crossover in a phase Ⅲtrial of sunitinib (SU)vs. placebo (PL) in advanced GIST after imatinib (IM) failure[J]. J Clin Oncol， 2008， 26(Suppl 15)：10524.
29. Blesius A， Cassier PA， Bertucci F， et al. Neoadjuvant imatinib in patients with locally advanced non metastatic GIST in the prospective BFR14 trial[J]. BMC Cancer， 2011， 11(1)：72.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical Characteristics， Diagnosis and Treatment of 217 Patients with Gastric Stromal Tumor

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