Clinicopathological analysis of gastric stromal tumor with primary gastrointestinal carcinoma / 肿瘤研究与临床

Objective To analyze the clinicopathological features of gastric stromal tumor with primary gastrointestinal carcinoma.Methods 469 cases of gastrointestinal stromal tumor (GIST) from January 2011 to December 2014 admitted to PLA General Hospital were retrospectively analyzed.Gastric stromal tumor patients with primary gastrointestinal carcinoma were screened.The concomitant gastrointestinal cancer site,stromal tumor size,mitotic activity,immunohistochemistry were also detected.Results The gastric stromal tumor with primary gastrointestinal carcinoma accounted for 14.7 ％ (69/469) of all the GIST,in which the small gastric stromal tumor accounted for 65.2 ％ (45/69) of the total and 9.59 ％ (45/469) of all the GIST.The diameter of all tumors was ＜ 5 cm,and the mitotic was ＜ 5/50 HPF.The positive rates of CD117,CD34,DOG-1 were 92.8 ％ (64/69),92.8 ％ (64/69),94.1％ (65/69).The Fletcher was classified as low-risk and extreme low-risk.Conclusions Gastric stromal tumor with primary gastrointestinal carcinoma has no specific clinical features and pathological immunohistochemical markers.Its malgnant degree is lower than GIST.Its prognosis is associated with primary gastrointestinal cancer staging.

Clinical analysis on gastrointestinal stromal tumor patients with hepatic metastases: 24 cases report / 肿瘤研究与临床

Objective To analyze the clinical characters,treatment effects and influential factors of gastrointestinal stromal tumor patients with hepatic metastases,and to explore the reasonable clinical treatment protocols.Methods The clinical data of 24 gastrointestinal stromal tumor patients with hepatic metastases who were admitted to Peoples Liberation Army Hospital from April 2007 to April 2010 were retrospectively analyzed.Results The 1-,2-,3-and 4-year cumulative survival rates of hepatic metastases patients with gastrointestinal stromal tumors were 91％,72 ％,22 ％ and 6 ％,respectively.The 1-,2-and 3-year survival rates of the patients treated with imatinib after operation were 91％,70 ％,28 ％,respectively,the median survival time was 26 months,the mortality rate was 27.3 ％ (3/11),and 9 cases got the tumor complete elimination.The 1-,2-and 3-year survival rates of the patients treated without imatinib after operation were 90 ％,68 ％,18 ％,respectively,the median survival time was 24 months,the mortality rate was 14.3 ％ (2/13),and 12 cases got the tumor complete elimination.The recurrence rate after complete resection was 28.6 ％(4/14),and the mortality rate was 7.1％ (1/14).The mortality rate after incomplete resection was 40 ％ (4/10).Conclusion Surgical treatment of eliminating the primary and metastatic lesion,and adjuvant therapy of imtinib could prolong the survival time,reduce postoperative recurrence rate and improve the quality of life,which are the effective methods for the treatment of the gastrointestinal stromal tumor patients with hepatic metastases.

Analysis of gene and targeted therapy for 340 patients with gastrointestinal stromal tumor / 肿瘤研究与临床

Objective To investigate clinical and pathological features of gastrointestinal stromal tumors,the frequency and type of mutation of c-kit and platelet-derived growth factor receptor α (PDGFRA)genes.Methods 340 patients underwent surgical resection and diagnosed as gastrointestinal stromal tumors by postoperative pathology from Junuary 2012 to December 2014 were enrolled,and their tumor tissues were collected.The direct sequencing method was applied to detect the mutation status of c-kit gene (exon 9,11,13 and 17) and PDGFRA gene (exon12 and 18).Results There were 138 males and 192 females,and their median age was 58 years old (37-81 years old).There were 178 patients (52.4 ％) with gastric stromal tumors,21 cases (6.2 ％) with duodenal stromal tumors,82 cases (24.1％) with small intestinal stromal tumor,10 cases (2.9 ％) with colon stromal tumor,15 cases (4.4 ％) with rectal stromal tumors,30 cases (8.8 ％) with parenteral stromal tumor (from the peritoneum,mesentery,retroperitoneum or attachment),4 cases (1.2 ％) of liver tissues (gene detection tissues from the liver biopsy or surgical resection specimens).In the mutation analysis of all 340 patients with gastrointestinal stromal tumor,the total mutation rate was 89.4 ％ (304/340),including 81.2 ％ (276 cases) of c-kit,8.2 ％ (28 cases) of PDGFR and 10.6 ％ (36 cases) of wild type.Among 125 cases underwent the detection of the gene mutation sequences,there were 49 cases of exon11 deletion mutation,4 cases of exon11 insertion mutation,12 cases of exon 11 missense mutation,8 cases of exon9 insertion mutation,1 case of 3xon13 missense mutation,1 case of exon17 missense mutation,24 cases of exon12 synonymous mutation and 20 cases of exon18 synonymous mutation.Conclusions Gene detection is becoming more and more obvious in predicting the therapeutic effect of molecular targeted therapy,the mechanism of drag resistance and the clinical treatment,c-kit exon11 mutation is one of the most common gene mutation types related to the choice of targeted medicine.

Diagnosis and treatment for complicated gastrointestinal stromal tumors / 中华胃肠外科杂志

Tyrosine kinase inhibitor(TKI) combined with surgical treatment is the optimal strategy for gastrointestinal stromal tumors(GIST). However, there is no systemic report about the complicated GIST(recurrence or metastasis, peritoneal dissemination, combined resection of multiple organs), except the cases review and experimental studies. Tyrosine kinase inhibitor combined with surgery may increase the overall survival of complicated GIST. This article will describe the definition, clinical features, surgical and drug therapy, and prognosis, in order to provide reliable theoretical basis and experience for clinical doctors, prolong patient survival and improve the quality of survival.

Screening for the hemostatic active extracts of Callicarpa nudi f lora,in mice in vivo / 药学实践杂志

Objective To screen the hemostatic active extracts from Callicarpa nudif lora .Methods The powdered Callicarpanudiflora was extracted with 70% EtOH and concentrated to give EtOH-extract .The EtOH-extract was further chromatographed over HP-20 macroporous resin column ,eluting with aqua and 95% EtOH to get HP-H2 O-elution and HP-EtOH-elution ,respectively .The obtained three extracts of EtOH-extrract ,HP-EtOH-elution and HP-H2 O-elution were set as large ,middle and small dosage groups for drug preparation ,respectively .Yunnan Baiyao was used as a positive control group . The weight increment ,bleeding time and clotting time of fed mice were detected by cutting tail and grass slide methods after in-tragastric administration for 7 days .Results As compared with blank model and positive control ,each dosage groups of HP-EtOH-elution could significantly shortened the bleeding time ,of which the small dosage group and middle dosage group even ex-hibited better results than the positive control group .Whereas the EtOH-extract ,HP-EtOH-elution and HP-H2 O-elution didn′t demonstrated significant effect on clotting time as well as the weight increment .Conclusion The HP-EtOH-elution was suggested to be the major active extract possessing hemostatic activity to mice under tested dosages .The hemostatic mechanism may through in-trinsic coagulation pathway .This study would be helpful for further phytochemical investigation of C .nudi f lora .

Efficacy and prognosis of different treatments on 63 patients with small intestinal gastrointestinal stromal tumors / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To analyze the efficacy and prognosis of different treatments on small intestinal gastrointestinal stromal tumors(SIGIST).</p><p><b>METHODS</b>Clinical data of 63 patients with SIGIST who were admitted to the Chinese PLA General Hospital from January 2004 to December 2013 were analyzed retrospectively. According to resection procedure and postoperative use of imatinib, patients were divided into R0 resection plus imatinib group (13 cases), R0 resection without imatinib group (42 cases), non-R0 resection plus imatinib group (7 cases), non-R0 resection without imatinib group (1 case). Survival was compared among groups. Result All the patients were followed up with a median length of 24 months(3 to 120 months), and the over survival (OS) rates at 1-year, 3-year, 5-year were 97%, 94% and 80%. In R0 resection plus imatinib group, R0 resection without imatinib group, and non-R0 resection plus imatinib group, the progression free survival(PFS) time was 24, 24 and 23 months; the 1-year PFS were 100%, 97% and 83%; the 3-year PFS were 100%, 45% and 83%; the 5-year PFS were 100%, 28% and 42%. R0 resection plus imatinib group had significantly higher PFS(all P<0.05). The case of non-R0 resection without imatinib died 6 months after operation. Among 55 patients undergoing R0 resection, recurrence was found in 16 patients, whose recurrence rates of 1-year, 3-yeart and 5-year were 2%,43% and 58%. Local recurrence was found in 8 cases, hepatic recurrence in 3 cases and widespread recurrence in 5 cases, who received simple imatinib, operation plus imatinib and imatinib intervention, with median survival time of 66.5 months, 92.5 months and 48 months respectively. One patient initiatively abandoned treatment and died 17 months later.</p><p><b>CONCLUSION</b>The total resection and postoperative imatinib administration can improve the prognosis and raise the progression free survival of patients with small intestinal stromal tumors.</p>

Prognotic analysis of 132 cases with gastrointestinal stromal tumors / 肿瘤研究与临床

Objective To analyze the survival rates of gastrointestinal stromal tumors (GISTs),and the influence of surgical treatment and imatinib to the survival times.Methods The clinical data of 132 patients with GIST who were admitted to Peoples Liberation Army Hospital from January 2003 to December 2013 were retrospectively analyzed.Results All the patients were followed up with a median time of 22 months (1-83 months).The survival rates of 1-year,3-year,5-year were 99 ％,96 ％,92 ％ in this study.The tumor located at cardiac part,fundus of stomach,greater curvature,lesser curvature and pylorus part was 19 cases (14.4 ％),34 cases (25.8 ％),38 cases (28.8 ％),38 cases (28.8 ％) and 3 cases (2.3 ％),respectively.The positive rates of CD117,CD34 and Ki-67 was 116 cases (87.9 ％),119 cases (90.2 ％),51 cases (38.6 ％).According to Fletcher risk classification,the patients of high-low risk,low risk,intermediate risk,and high risk were 10 cases (7.6 ％),34 cases (25.8 ％),14 cases (10.6 ％),and 74 cases (56.1％),respectively.The differences of survive rates in the different excision method and imatinib treatment had statistics significance (P =0.000).The differences of survive rates in Fletcher risk classification had statistics significance (P =0.028).However,the differences of survive rates in location of gastric GIST showed no significant difference (P ＞ 0.05).Conclusions GIST in different parts of gastric have not obviously different survival rates,respectively.The total resection and imatinib treatment could raise the survival rates of patients with GIST.

Expression of CD117, CD34 and Ki-67 in gastric stromal tumors and their significances / 肿瘤研究与临床

Objective To investigate the clinicopathologic and immunohistochemical features of gastric stromal tumors.Methods A total of 105 cases with gastric stromal tumors were included in the study.The expression of cluster of differentiation 117 (CD117),cluster of differ entiation 34 (CD34),smooth muscle actin (SMA),S-100 protein and Ki-67 in gastric stromal tumors specimens was detected by immunohistochemistry.The clinico-pathologic features of gastric stromal tumors were also analyzed.Results Of 105 gastric stromal tumors specimens,90 were positive for CD117 [85.7 ％ (90/105)],98 positive for CD34 [93.3 ％ (98/105)],21 positive for SMA [20.4 ％ (21/105)],60 positive for Ki-67 [56.1％ (60/105)],13 positive for S-100 [12.4 ％ (13/105)].Conclusion Combined detection of CD117 and CD34 can improve the diagnostic accuracy of gastric stromal tumors.The expression of Ki-67 can be used as a prognostic parameter for gastric stromal tumors as it is correlated with tumor size,risk and mitotic.

Clinical cases and prognosis analysis of primary gastrointestinal stromal tumors / 中华消化杂志

Objective To analyze the clinical characters,therapeutic effect of gastrointestinal stromal tumors (GIST),the effects of surgical approach and imatinib adjuvant therapy on it.Methods From January 2004 to April 2010,the clinical data of 214 patients with primary GIST were retrospectively analyzed.The effects of surgical approach and imatinib on the survival of the GIST patients were compared.Count data were analyzed by chi-square test,and the survival rates were analyzed with the life table method and Kaplan-Meier curve.Results A total of 214 GIST patients'survival rates of 1-year,3-year,5-year were 93.0％,87.0％ and 80.0％.According to the risk classification of National Institutes of Health,the differences of overall survival rates after surgery were statistically significant (x2 =22.058,P＜0.05).The differences of survival rate among different nuclear division number were statistically significant (x2=26.599,P＜0.05).The survival rate of pathological nuclear division number over 10/50 high power field (HPF) was the lowest.The overall survival rate of patients with gastrointestinal GIST was higher than patients with extragastrointestinal GIST,and the difference was statistically significant (x2 =68.139,P ＜ 0.05).After complete resection of the tumor,the survival rate of patients with local recurrence was higher than those with widely recurrence,and the difference was statistically significant (x2 =4.409,P＜ 0.05).After complete resection of the tumor,the survival rate of patients taking imatinib was higher than that of patients not taking imatinib.Conclusions The surgical treatment was the main therapy for GIST.Complete resection of the tumor and taking imatinib after surgery could improve the prognosis and the survival rate of the GIST patients.

Cox model analysis for multiple factors in prognosis of patients with the primary gastrointestinal stromal tumors / 肿瘤研究与临床

ObjectiveTo analyze the clinical characteristics,effects of adjuvant therapy and influential factors of gastrointestinal stromal tumors (GIST).MethodsA retrospective and multiple factor Cox model analysis on 216 cases of primary GIST diagnosed by surgery and pathology was conducted.Results The total survival rates of patients at one to five years were 94.4 ％ (204/216),90.2 ％ (129/143),88.3 ％(68/77),87.5 ％ (35/40) and 85.0 ％ (17/20),respectively.The statistically significant prognostic factors for survival rates of patients with GIST included age,location of tumor,local or total tumor resection,rupture of tumor,adjuvant treatment,recurrence,mitotic rate,and tumor size (P ＜ 0.05).Due to those influence factors,the greater of the values,the higher of the risk of death.Among those factors,whether having grass total resection played a decisive role in the prognosis of patients with GIST.Other factors,such as sex,CD117,biopsies,endoscopic mucosal erosion,and operation cutting margin had no significant relevance with the survival rate of patients (P ＞0.05).Postoperative adjuvant therapy could significantly improve the survival rate of patients with GIST,especially for patients with high risk.ConclusionSurgical treatment should be given priority to treatment of GIST,and the choice of the surgery strategies depends mainly on the location and size of tumors.The complete resection or extensive resection could improve survival rates.Age,location,total tumor resection,rupture of tumor,adjuvant treatment,recurrence,mitotic rate,and tumor size are important factors affecting prognosis and survival rate of patients with GIST,which could guide standardized clinical treatment.

Clinical study of combined treatment following breast-conserving surgery for early breast cancer / 解放军医学杂志

Objective To explore the surgical indication, the operative procedure and effect of breast-conserving surgery plus combined treatment for the patients with early breast cancer. Methods 51 patients with early breast cancer were treated with breast-conserving surgery (BCS) plus radiotherapy, chemotherapy and hormonotherapy postoperatively. The result of breast-conserving group was compared with 56 patients treated by modified radical mastectomy (control group). Results 25 patients underwent quadrant resection plus axillary lymph node dissection (ALND), 15 patients were subjected to local resection plus ALND, and 11 patients received quadrant resection only. All patients were followed-up for an average of 16.9 months. In BCS group, one patient was found to have local recurrence, and the distant metastasis rate was 0%. In the control group, no patient had local recurrence and the distant metastasis rate was 3.6%. The operative complication rate in BCS group and control group was 13.7% and 33.9% respectively (p﹤0.05). Conclusion Breast-conserving surgery plus combined treatment is safe and satisfactory for early breast cancer. It can be considered as the first choice for the treatment of patients with breast cancer in early stage.

Clinical study on the micrometastasis of sentinel lymph nodes in oral squamous cell carcinoma / 解放军医学杂志

Objective To evaluate the feasibility and predictive ability of the sentinel node localization technique for patients with oral squamous cell carcinoma and determine whether the pathology of the SLN reflected the status of all the neck lymph nudes. Methods Perioperative use of a gamma probe identified radioactive SLNs. The pathology of the SLN was compared with that of the remaining neck dissection. Results Sentinel lymph node biopsy was performed on 20 cases. SLNs were found in 16 necks, among them 6 were found to be subclinical metastases. The SLN was the only lymph node containing tumor in 5 of 6. Conclusions Our preliminary investigation shows that sentinel node localization is technically feasible and predictive of cervical metastasis. SLN biopsy may aid in identifying the clinically N0 patient with occult lymph node metastasis and has the potential to decrease the number of neck dissections performed in clinically negative necks.