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Objective:To investigate the efficacy of different laparoscopic surgeries for gastrointestinal stromal tumors (GIST) of gastric cardia and fundus.Methods:The retrospective cohort study was conducted. The clinicopathological data of 251 patients with GIST of gastric cardia and fundus who underwent laparoscopic radical resection in 14 medical centers, including Guangdong Provincial People′s Hospital et al, from December 2007 to December 2021 were collected. There were 123 males and 128 females, aged 58(24,87)years. Observation indicators: (1) treatment; (2) clinicopathological data of patients undergoing different laparoscopic surgeries; (3) subgroup analysis for special laparoscopic techniques. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test or ANOVA. Measure-ment data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the Mann-Whitney U test or Kruskal-Wallis H test. Count data were described as absolute numbers or percentages. Comparison of ordinal data was conducted using the rank sum test. Results:(1) Treatment. Of the 251 patients,202 cases underwent gastric wedge resection, 26 cases underwent special laparoscopic techniques including 10 cases with serotomy and dissection and 16 cases with transluminal gastrectomy, 23 cases underwent structural gastrectomy including 6 cases with total gastrectomy and 17 cases with proximal partial gastrectomy. There were 24 patients had postoperative complications after surgery. (2) Clinicopathological data of patients undergoing different laparoscopic surgeries. The gender (male, female), age, tumor diameter, operation time, volume of intraoperative blood loss, length of incision, time to postoperative initial whole liquid food intake, time to postoperative initial semi-liquid food intake, duration of postoperative hospital stay, cases with perioperative complications, cases with mitotic count as ≤5/50 high power field, 6?10/50 high power field, >10/50 high power field, cases be classified as very low risk, low risk, medium risk, high risk according to the National Institutes of Health risk classification, cases with tumor located at fundus and gastric cardia were 93, 109, (59±11)years, 3.50(0.40,10.00)cm, 88.00(25.00,290.00)minutes,20.00(25.00,290.00)mL, 4.00(2.00,12.00)cm, 3.00(1.00,9.00)days, 4.00(1.00,16.00)days, 5.00(1.00,18.00)days, 14, 164, 31, 7, 47, 83, 50, 22, 30, 172 in patients undergoing gastric wedge resection, respectively. The above indicators were 19, 7, (49±14)years, 2.55(0.20,5.00)cm, 101.00(59.00,330.00)minutes, 27.50(2.00,300.00)mL, 4.50(0,6.00)cm, 2.50(1.00,10.00)days, 4.00(1.00,16.00)days, 6.00(1.00,18.00)days, 3, 20, 5, 1, 15, 5, 2, 4, 24, 2 in patients undergoing special laparos-copic techniques, and 11, 12, (52±10)years, 5.00(0.80,10.00)cm, 187.00(80.00,325.00)minutes, 50.00(10.00,300.00)mL, 6.00(4.00,12.00)cm, 4.00(2.00,8.00)days, 6.00(3.00,14.00)days, 8.00(2.00,18.00)days, 7, 11, 5, 7, 2, 6, 6, 9, 13, 10 in patients undergoing structural gastrectomy. There were significant differences in the above indicators among the three groups of patients ( χ2=6.75, F=10.19, H=17.71, 37.50, 35.54, 24.68, 16.09,20.20, 13.76, χ2=13.32, Z=28.98, 32.17, χ2=82.14, P<0.05). (3) Subgroup analysis for special laparoscopic techniques. The time to postoperative initial whole liquid food intake, time to postoperative initial semi-liquid food intake, classification of tumor location (endophytic type, exophytic type, parietal type) were 4.50(1.00,10.00)days, 8.00(3.00,12.00)days, 0, 8, 2 in patients undergoing serotomy and dissection, versus 2.00(1.00,4.00)days, 3.00(1.00,6.00)days, 16, 0, 0 in patients undergoing transluminal gastrectomy. There were significant differences in time to postoperative initial whole liquid food intake, time to postoperative initial semi-liquid food intake between them ( Z=-2.65, -3.16, P<0.05); and there was a significant difference in classification of tumor location between them ( P<0.05). Conclusions:Gastric wedge resection is the most commonly used laparoscopic technique for GIST of gastric cardia and fundus. The application of special laparoscopic techniques is focused on the GIST of cardia to preserve the function of the cardia.
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Objective:To investigate the clinical efficacy and prognostic influencing factors of radical surgery for duodenal gastrointestinal stromal tumor (GIST).Methods:The retrospective cohort study was conducted. The clinicopathological data of 741 duodenal GIST patients who under-went radical surgery in 17 medical centers, including 121 cases in Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 121 cases in Chinese PLA General Hospital, 116 cases in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 77 cases in Fudan University Shanghai Cancer Center, 77 cases in West China Hospital, Sichuan University, 31 cases in Guangdong Provincial People′s Hospital, 24 cases in Fujian Cancer Hospital, 22 cases in Fujian Medical University Union Hospital, 25 cases in Shengjing Hospital of China Medical University, 19 cases in Xiangya Hospital, Central South University, 23 cases in Zhejiang Cancer Hospital, 17 cases in Liaoning Cancer Hospital＆Institute, 17 cases in the First Affiliated Hospital of Xiamen University, 15 cases in Sun Yat-sen University Cancer Center, 14 cases in the First Affiliated Hospital of Nanjing Medical University, 14 cases in Zhongshan Hospital Affiliated to Xiamen University and 8 cases in General Hospital of Chinese People′s Liberation Army Air Force, from January 2010 to April 2020 were collected. There were 346 males and 395 females, aged 55(range, 17?86)years. Observation indicators: (1) neoadjuvant treatment; (2) surgical and postoperative situations; (3) follow-up; (4) stratified analysis. Follow-up was conducted using outpatient examination or telephone interview. Patients were followed up once every 3?6 months during neoadjuvant therapy and once every 6?12 months after radical surgery to detect tumor recurrence and survival of patient up to April 2022. Measurement data with normal distribution were represented as Mean± SD. Measurement data with skewed distribution were represented as M(range), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using chi-square test or Fisher exact probability. The Kaplan-Meier method was used to draw survival curves and calculate survival rates. Log-rank test was used for survival analysis. The COX regression model was used for univariate and multivariate analyses. Propensity score matching was done by the 1∶1 nearest neighbor matching method, and the matching tolerance was 0.02. Results:(1) Neoadjuvant therapy. Of the 741 patients, 34 cases received neoadjuvant therapy for 8(range, 3?44)months. Cases assessed as partial response, stable disease and progressive disease before the radical surgery of the 34 cases were 21, 9, 4, respectively. The tumor diameter of the 34 patients before the neoadjuvant therapy and before the radical surgery were 8.0(range, 3.0?26.0)cm and 5.3(range, 3.0?18.0)cm, with the regression rate as 31.9%(range, ?166.7% to 58.3%). (2) Surgical and postoperative situations. Of the 741 patients, 34 cases underwent radical surgery after receiving neoadjuvant therapy, and 707 cases underwent radical surgery directly. All the 741 patients underwent radical surgery successfully, in which 633, 102 and 6 cases received open surgery, laparoscopic surgery and endoscopic treatment, respectively. Of the 633 cases receiving open surgery and the 102 cases receiving laparoscopic surgery, cases with surgical resection range as pancreatoduodenectomy (PD) was 238, and cases with surgical resection range as duodenal limited resection, including duodenal wedge resection, distal gastrectomy, segmental duodenal resection, local resection of duodenal tumor or segmental duodenum combined with subtotal gastrectomy, was 497, 226, 55, 204, 12. Of the 741 patients, 131 cases had post-operative complications including 113 cases with grade Ⅰ?Ⅱ complications and 18 cases with ≥ grade Ⅲ complications of the Clavien-Dindo classification. The duration of postoperative hospital stay of the 741 patients was 13(range, 4?120)days. Of the 707 patients receiving direct radical surgery, 371 cases were evaluated as extremely low risk, low risk, medium risk of the modified National Institutes of Health (NIH) risk classification after surgery, and 336 cases were evaluated as high risk in which 205 cases receive postoperative adjuvant imatinib therapy with the treatment time as 24(range, 6?110)months. (3) Follow-up. All the 741 patients were followed up for 58(range, 7?150)months. During the follow-up, 110 patients had tumor recurrence and metastasis. The 1-, 3-, 5-year overall survival rates and 1-, 3-, 5-year disease-free survival rates of the 741 patients were 100.0%, 98.6%, 94.5% and 98.4%, 90.9%, 84.9%, respectively. The 1-, 3-, 5-year overall survival rates and 1-, 3-, 5-year disease-free survival rates of the 707 patients receiving direct radical surgery were 100.0%, 98.5%, 94.3% and 98.4%, 91.1%, 85.4%, respectively. (4) Stratified analysis. ① Analysis of prognostic factors in patients undergoing radical surgery directly. Results of univariate analysis showed that primary tumor location, tumor diameter, mitotic count, modified NIH risk classification and tumor gene information were related factors affecting the overall survival of 707 patients with primary duodenal GIST who underwent direct radical surgery ( hazard ratio=0.43, 0.18, 0.22, 0.06, 0.29, 95% confidence intervals as 0.20?0.93, 0.09?0.35, 0.10?0.50, 0.03?0.12, 0.09?0.95, P<0.05). The primary tumor location, tumor diameter, mitotic count, modified NIH risk classification were related factors affecting the disease-free survival of 707 patients with primary duodenal GIST who underwent direct radical surgery ( hazard ratio=0.65, 0.25, 0.25, 0.10, 95% confidence intervals as 0.41?1.03, 0.17?0.37, 0.15?0.42, 0.07?0.15, P<0.05). Results of multivariate analysis showed that primary tumor located at the horizontal segment of duodenum, mitotic count >5/50 high power field, tumor gene KIT exon 9 mutation were independent risk factors affecting the overall survival of 365 patients with primary duodenal GIST after removing 342 patients without tumor gene information who underwent direct radical surgery ( hazard ratio=2.85, 2.73, 3.13, 95% confidence intervals as 1.12?7.20, 1.07?6.94, 1.23?7.93, P<0.05). Tumor diameter >5 cm and mitotic count >5/50 high power field were independent risk factors affecting the disease-free survival of 707 patients with primary duodenal GIST who underwent direct radical surgery ( hazard ratio=3.19, 2.98, 95% confidence intervals as 2.05?4.97, 1.99?4.45, P<0.05). ② Effect of postoperative adjuvant therapy on prognosis of high-risk patients of modified NIH risk classification. Of the 336 patients evaluated as high risk of the modified NIH risk classification, the 5-year overall survival rate and 5-year disease-free survival rate were 94.6% and 77.3% in the 205 cases with postoperative adjuvant therapy, versus 83.2% and 64.4% in the 131 cases without postoperative adjuvant therapy, showing significant differences between them ( χ2=8.39, 4.44, P<0.05). Of the 205 patients evaluated as high risk of the modified NIH risk classification who received postoperative adjuvant therapy, there were 106 cases receiving postoperative adjuvant therapy <36 months, with the 5-year overall survival rate and 5-year disease-free survival rate were 87.1% and 58.7%, and there were 99 cases receiving post-operative adjuvant therapy ≥36 months, with the 5-year overall survival rate and 5-year disease-free survival rate were 100.0% and 91.5%. There were significant differences in the 5-year overall survival rate and 5-year disease-free survival rate between the 106 patients and the 99 patients ( χ2=13.92, 29.61, P<0.05). ③ Comparison of clinical efficacy of patients with different surgical methods. Before propensity score matching, cases with primary tumor located at bulb, descending, horizontal, ascending segment of duodenum, cases with tumor diameter ≤5 cm and >5 cm were 95, 307, 147, 34, 331, 252, in the 583 patients receiving open surgery with complete clinical data, versus 15, 46, 17, 5, 67, 16 in the 83 patients receiving laparoscopic surgery with complete clinical data, showing no significant difference in the primary tumor location ( χ2=0.94, P>0.05), and a significant difference in the tumor diameter ( χ2=17.33, P<0.05) between them. After propensity score matching, the above indicator were 16, 39, 20, 8, 67, 16 in the 83 patients receiving open surgery, versus 15, 46, 17, 5, 67, 16 in the 83 patients receiving laparoscopic surgery, showing no significant difference between them ( χ2=1.54, 0.00, P>0.05). Cases with postoperative complications, cases with grade Ⅰ?Ⅱ complica-tions and ≥grade Ⅲ complications of the Clavien-Dindo classification, duration of postoperative hospital stay, the 5-year overall survival rate and 5-year disease-free survival rate were 17, 12, 5, 11(range, 5?120)days, 92.0%, 100.0% in the 83 patients receiving open surgery, versus 9, 7, 2, 11(range, 5?41)days, 91.6%, 97.3% in the 83 patients receiving laparoscopic surgery, showing no signi-ficant difference in postoperative complications, duration of postoperative hospital stay, the 5-year overall survival rate and 5-year disease-free survival rate ( χ2=2.91, Z=3 365.50, χ2=3.02, 1.49, P>0.05) between them. There was no significant difference in complications of the Clavien-Dindo classification between them ( P>0.05). ④ Comparison of clinical efficacy of patients with primary tumor located at the descending segment of duodenum who underwent surgery with different surgical resection scopes. Before propensity score matching, cases with tumor diameter ≤5 cm and >5 cm, cases with tumor located at opposite side of mesangium and mesangium were 71, 85, 28, 128 in the 156 patients with primary tumor located at the descending segment of duodenum who underwent PD with complete clinical data, versus 92, 41, 120, 13 in the 133 patients with primary tumor located at the descending segment of duodenum who underwent duodenal limited resection with complete clinical data, showing significant differences between them ( χ2=16.34, 150.10, P<0.05). After propensity score matching, the above indicator were 28, 13, 16, 25 in the 41 patients with primary tumor located at the descending segment of duodenum who underwent PD with complete clinical data, versus 28, 13, 16, 25 in the 41 patients with primary tumor located at the descending segment of duodenum who underwent duodenal limited resection with complete clinical data, showing no significant difference between them ( χ2=0.00, 0.00, P>0.05). Cases with postopera-tive complications, cases with grade Ⅰ?Ⅱ complications and ≥grade Ⅲ compli-cations of the Clavien-Dindo classification, duration of postoperative hospital stay, the 5-year overall survival rate and 5-year disease-free survival rate were 13, 11, 2, 15(range, 9?62)days, 94.2%, 64.3% in the 41 patients with primary tumor located at the descending segment of duodenum who underwent PD with complete clinical data, versus 9, 8, 0, 15(range, 7?40)days, 100.0%, 78.8% in the 41 patients with primary tumor located at the descending segment of duodenum who underwent duodenal limited resection with complete clinical data, showing no significant difference in post-operative complica-tions, the 5-year overall survival rate and 5-year disease-free survival rate ( χ2=0.99, 0.34, 1.86, P>0.05) between them. There was no significant difference in complications of the Clavien-Dindo classification ( P>0.05) and there was a significant difference in duration of postopera-tive hospital stay ( Z=614.50, P<0.05) between them. Conclusions:The clinical efficacy of radical surgery for duodenal GIST are ideal. Primary tumor located at the horizontal segment of duodenum, mitotic count >5/50 high power field, tumor gene KIT exon 9 mutation are independent risk factors affec-ting the overall survival of patients undergoing direct radical surgery and tumor diameter >5 cm and mitotic count >5/50 high power field are independent risk factors affecting the disease-free survival of patients. There is no significant difference in the short-term efficacy and long-term prognosis between patients undergoing open surgery and laparoscopic surgery. For patients with primary tumor located at the descending segment of duodenum, the duration of postoperative hospital stay is longer in patients undergoing PD compared with patients undergoing duodenal limited resection. For patients evaluated as high risk of the modified NIH risk classification, posto-perative adjuvant therapy and treatment time ≥36 months are conducive to improving the prognosis of patients.
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Objective@#To investigate the feasibility and safety of the medial approach "four-step method" in the laparoscopic mobilization of splenic flexure.@*Methods@#A retrospective cohort study was performed. Clinical data of 157 colorectal cancer patients undergoing the medial approach "four-step method" in the laparoscopic mobilization of splenic flexure at Gastrointestinal Surgical Department of Guangdong Provincial People′s Hospital from July 2015 to June 2018 were retrospectively analyzed. Of 157 cases, 17 were transverse colon cancer, 94 were descending colon cancer, 25 were sigmoid cancer and 21 were rectal cancer; 89 were male and 68 were female; mean age was (61.8±10.3) years and mean body mass index was (23.2±3.7) kg/m2. The medial approach "four-step method" in the laparoscopic mobilization of splenic flexure was performed as follows: (1) The root vessels were treated with the "provocation" technique to expand the Toldt′s gap. This expansion was extended from the lateral side to the peritoneum reflex of left colonic sulcus, from the caudal side to the posterior rectal space, and from the cephalad side to the lower edge of pancreas. (2) The left colonic sulcus was mobilized, converging with the posterior Toldt′s gap. Mobilization was carried out from cephalad side to descending colon flexure, freeing and cutting phrenicocolic ligament and splenocolic ligament, and from caudal side to peritoneal reflex. (3) Gastrocolic ligament was moblized. Whether to enter the great curvature of stomach omentum arch when the gastrocolic ligament was cut, that was, whether to clean the fourth group of lymph nodes, should be according to the tumor site and whether serosal layer was invaded. (4) Transverse mesocolon was moblized and transected at the lower edge of the pancreatic surface, merging with the posterior Toldt′s gap, and from lateral side to lower edge of the pancreatic body, merging with the lateral left paracolonic sulcus. Safety and short-term clinical efficacy of this surgical procedure was summarized.@*Results@#All the patients completed this procedure. During operation, 3 cases were complicated with organ injury, including 1 case of colon injury, 1 case of spleen injury and 1 case of pancreas injury. No operative death and conversion to open surgery was found. The average operation time was (147.5±35.1) minutes, the average intra-operative blood loss was (40.8±32.7) ml and the average number of harvested lymph node was (16.1±5.8), including (4.0±2.3) of positive lymph nodes. The first exhaust time after surgery was (41.3±20.6) hours, the fluid intake time was (1.5±1.3) days, the postoperative hospital stay was (5.2±2.3) days. Eight (5.1%) cases developed postoperative complications, and all were improved and discharged after conservative treatments. According to the TNM classification system, postoperative pathology revealed that 31 patients were stage I, 51 were stage II, 53 were stage III, 22 were stage IV.@*Conclusion@#The medial approach "four-step method" is safe and feasible, which can effectively decrease the operation difficulty of the laparoscopic mobilization of the splenic flexure.
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Objective To explore the clinical effect of enhanced recovery after surgery and pain management during the perioperative period in rectal cancer patients.Methods 100 rectal cancer patients after radical resection were divided into ERAS group (50 cases) and routine care group (50 cases).Results Compare with the routine group,the time of ERAS group was shorter in postoperative bowel function recovery [(1.8 ± 0.6) d vs.(3.4 ± 0.6) d,t =-8.1,P ＜ 0.001],oral feeding [(1.3 ± 0.6) d vs.(3.2 ± 0.6) d,t =-10.1,P ＜ 0.001],intraperitoneal catheter drain [(3.6 ± 0.7) d vs.(5.3 ±0.8) d,t=-6.7,P＜0.001] and mobilization[(1.1 ±0.3)d vs.(2.7 ±0.5) d,t=-12.7,P＜0.001].ERAS group was associated with shorter hospital stay [(4.6 ± 0.6) d vs.(6.1 ± 0.6) d,t =-7.7,P ＜ 0.001],lower costs (P =0.014),lower pain score at the time of 6 h,12 h,24 h and 48 h after surgery (P ＜0.001).There was no significant statistical difference in postoperative complication rate 8％ and 10％ (P =1.000).Conclusions ERAS management in rectal cancer patients after radical operation enhanced postoperative recovery.
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Objective To compare the effect of laparoscopy-assisted gastrectomy (LAG) and open D2 radical gastrectomy (OG) for gastric cancer.Methods The retrospective cohort study was conducted.The clinicopathological data of 117 patients who underwent D2 radical gastrectomy at the Guangdong General Hospital from January 2014 to December 2014 were collected.Of 117 patients,60 undergoing LAG and 57 undergoing OG were respectively allocated into the LAG group and OG group.Total gastrectomy,distal subtotal gastrectomy and proximal subtotal gastrectomy were performed according to the location of the tumor.The perigastric lymph nodes dissection was performed according to the Japanese " Gastric cancer treatment protocol" (the 14th edition).Eligible patients received the adjuvant chemotherapy of XELOX regimen according to the Guideline published by National Comprehensive Cancer Network (NCCN).Observation indicators:(1) comparison of intra-and postoperative recovery between groups;(2) stratified analysis of number of lymph node dissected;(3) relationship among surgical method,number of lymph node dissected and postoperative complication;(4) follow-up and survival.Follow-up using outpatient examination and telephone interview was performed to detect the postoperative adjuvant chemotherapy,tumor-free survival and tumor recurrence or metastasis up to December 2016.Measurement data with normal distribution were represented as (x)± s and comparison between groups was analyzed using the independent-sample t test.Count data were analyzed using the chi-square test or Fisher exact probability.The relationship between number of lymph node dissected and postoperative complication was done using the Logistic regression model.Results (1) Comparison of intra-and post-operative recovery between groups:all the patients completed the operation successfully.Volume of intraoperative blood loss,time to postoperative anal exsufflation and duration of postoperative hospital stay were (113±36) mL,(4.3±2.1) days,(9.7±2.9) days in the LAG group and (209 ± 77) mL,(5.3 ± 2.2) days,(11.2 ± 3.9) days in the OG group,respectively,with statistically significant differences between groups (t =6.850,-2.604,-2.405,P＜0.05).Number of lymph node dissected,numbers of patients with overall complication,incisional infection,intestinal obstruction,digestive tract fistula,intra-abdominal bleeding,cardiovascular accident,pulmonary infection,urinary tract infection and death within postoperative 30 days were respectively 31±7,6,1,0,4,0,0,1,0,0 in the LAG group and 34±6,12,0,1,2,2,1,4,1,1 in the OG group,with no statistically significant difference between groups (t=0.177,x2=2.743,0.126,0.563,0.837,P＞0.05).All the patients with complications received symptomatic treatment,1 patient with abdominal bleeding in the OG group died and other patients recovered smoothly.(2) Stratified analysis of number of lymph node dissected:number of lymph node dissected in patients with total gastrectomy,distal subtotal gastrectomy and proximal subtotal gastrectomy were 35±8,29±5,27±4 in the LAG group and 34± 5,34±6,29±6 in the OG group,respectively,with no statistically significant difference between groups (t =0.846,1.052,0.934,P＞0.05).Number of lymph node dissected in patients with stage Ⅰ,Ⅱ and Ⅲ of TNM staging were respectively 31±5,32±9,31±6 in the LAG group and 34±7,32±4,35±6 in the OG group,with no statistically significant difference between groups (t =0.494,1.657,0.136,P＞0.05).(3) Relationship among surgical method,number of lymph node dissected and postoperative complication:surgical method (LAG and OG) and number of lymph node dissected were used as the independent variable and postoperative complication between groups was used as the dependent variable,the Logistic regression model showed that surgical method and number of lymph node dissected were not related factors affecting the postoperative complication (OR =1.062,2.049,95％ confidence interval:0.998-1.140,0.695-6.042,P＞0.05).(4) Follow-up and survival:108 of 117 patients (54 in each group) were followed up for 2-35 months,with a median time of 28 months.During the follow-up,numbers of patients undergoing postoperative adjuvant chemotherapy,with tumor-free survival and with tumor recurrence were 45,43,10 in the LAG group and 42,42,10 in the OG group,respectively,with no statistically significant difference in the tumor-free survival and tumor recurrence between groups (x2 =0.055,0.002,P＞0.05).Conclusion Laparoscopy-assisted D2 radical gastrectomy is safe and feasible,which equivalent to clinical effect of open radical gastrectomy,meanwhile,it also can reduce volume of intraoperative blood loss and duration of postoperative hospital stay,and accelerate recovery of postoperative gastrointestinal function.
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Objective To analyze the clinicopathological characteristics and the related factors influencing the prognosis of rectal neuroendocrine neoplasms.Methods The clinical and follow-up data of 442 patients with rectal neuroendocrine neoplasms admitted between Sep 1993 and Dec 2015 in 5 hospitals in southern China were analyzed retrospectively.The univariate and multivariate analysis of survival prognosis were analyzed statistically.Results Of the 442 patients,the median age was 50 years and 64.7％ were males.The average tumor size was (1.4 ± 0.7) cm.NENs ＜ 1 cm accounted for 66.1％ cases,1-2 cm accounted for 17.2％ and ＞2 cm accounted for 16.7％ of the tumors.Stage Ⅰ,Ⅱ,Ⅲ and Ⅳ accounted for 73.5％,8.6％,7.2％,10.6％ of the tumors;G1,G2,G3 accounted for 76.5％,14.7％,8.8％ of the tumors;The median survival time for all 442 patients was 35 months (range,1-224 months).The overall 5-year survival rate was 85％.The 5-year survival rates for patients in stage Ⅰ-Ⅳ were 95％,94％,52％,36％ respectively.The 5-year survival rates for patients with G1-3 were 94％,80％,19％respectively.Univariate analysis showed that G grade,T stage,N stage,M stage,TNM stage,functional,gender,medication,surgical therapy,age,tumor sizes were statistically significant (all P ＜ 0.05).Multivariate analysis revealed that G grade (P =0.001),tumor sizes (P =0.012) and TNM stage (P =0.008) were the independent factors affecting the prognosis.Conclusion Patients with rectal neuroendocrine neoplasms have no specific clinical characteristics.G grade,tumor sizes and TNM stage were the independent factors affecting the prognosis.
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<p><b>OBJECTIVE</b>To evaluate and compare the value of Modified NIH criteria and AFIP criteria for the risk classification of gastrointestinal stromal tumors (GIST).</p><p><b>METHODS</b>Clinicopathological and follow-up data of 539 patients diagnosed as primary GIST with or without irregular tyrosine kinase inhibitors in the Nanfang Hospital(n=143), Sun Yat-sen University Cancer Center (n=138), Guangdong Provincial People's Hospital (n=102) and Wuhan Union Hospital (n=156) from January 2012 to December 2015 were retrospectively analyzed. Recurrence risks of these 539 patients were classified by the modified NIH criteria and AFIP criteria. Overall survival and tumor-free survival of patients with different risks were compared by Log-rank test and the accuracy of the two criteria in predicting postoperative recurrence was compared by receiver operating characteristic(ROC) curves.</p><p><b>RESULTS</b>Of 539 GIST patients, 283 were male and 256 were female; the age was (56.5±12.5) years old; tumors of 390 cases (72.4%) located in the stomach; tumor diameter of 178 cases (33.0%) was more than 5 cm; nuclear division number of 164 cases(30.4%) was more than 5/50 high magnification. The mean follow-up time was (37.5±13.6) months. According to the modified NIH criteria, the mean overall survival time of patients with very low, low, intermediate, and high risk was 52.0, 57.0, 56.9 and 53.6 months respectively (P=0.002), and the mean tumor-free survival time was 56.0, 58.1, 58.2 and 51.2 months respectively (P=0.000). According to the AFIP criteria, the mean overall survival time of patients with very low, low, intermediate, and high risk was 54.1, 57.8, 55.5 and 52.0 months respectively(P=0.015), and the mean tumor-free survival time was 57.3, 56.6, 54.9 and 50.4 months respectively(P=0.000). While predicting the risk of postoperative recurrence, the ROC curve of AFIP criteria has a larger area under the curve compared to the curve of the modified NIH criteria(0.689 vs 0.641, P<0.05).</p><p><b>CONCLUSION</b>Compared with the modified NIH criteria, AFIP criteria predicts the risk postoperative recurrence more accurately in GIST patients.</p>
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<p><b>OBJECTIVE</b>To analyze the clinicopathological features and prognostic factors of gastric neuroendocrine carcinoma(NEC) based on a multicenter database from five medical centers in Southern China.</p><p><b>METHODS</b>Clinical and pathological data of 1 183 gastroenteropancreatic neuroendocrine neoplasms patients between January 2006 and December 2015 from five centers were retrospectively analyzed. A total of 156 gastric NEC cases(13.2%) with complete follow-up information were screened and included in the study, wherein 73 cases from Sun Yat-sen University Cancer Center, 27 cases from Nanfang Hospital of Southern Medical University, 26 cases from The First Affiliated Hospital of Sun Yat-sen University, 15 cases from Guangdong General Hospital and 15 cases from Sun Yat-sen Memorial Hospital of Sun Yat-sen University. The overall survival rate was calculated by using Kaplan-Meier method. The prognostic factor was analyzed using the Cox proportional hazards model.</p><p><b>RESULTS</b>In 156 NEC patients, the ratio of male to female was 3.9 vs 1.0, the median age was 61 years old, and the maximal tumor diameter was (4.5±2.3) cm. There were 12 case(7.7%) with functional tumors. At the initial diagnosis, there were 111 patients (71.2%) with regional lymph node metastases and 58 patients (37.2%) with distant metastases. One hundred and twenty-three patients (78.8%) underwent surgical treatment and 94 patients (60.3%) received systematic treatment. There were 31 patients(19.9%) in localized disease stage, 67 patients (42.9%) in regional disease stage and 58 patients(37.2%) in distant disease stage. The 5-year overall survival rate was 44.7%. Cox regression model showed that surgical treatment (HR=0.512, 95%CI:0.287 to 0.912, P=0.023) and clinical stage(HR=1.488, 95%CI:1.067 to 2.076, P=0.019) were independent prognostic factors. The 5-year overall survival rate of patients with and without surgical treatment were 54.6% and 10.9%(P=0.000). Meanwhile, the 5-year overall survival for localized, regional and distant disease stages were 66.1%, 56.1% and 21.1% respectively(P=0.000).</p><p><b>CONCLUSIONS</b>Gastric neuroendocrine carcinoma is a group of rare tumors with strong invasiveness, high malignancy and poor prognosis. The gastric NEC patients can benefit from surgical treatment.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Carcinoma, Neuroendocrine , China , Lymphatic Metastasis , Neuroendocrine Tumors , Prognosis , Proportional Hazards Models , Retrospective Studies , Stomach Neoplasms , Survival RateABSTRACT
<p><b>OBJECTIVE</b>To investigate the clinicopathological characteristics and their relationship with prognosis of colorectal neuroendocrine neoplasms (NEN).</p><p><b>METHODS</b>Medical records of 329 patients with colorectal NEN between June 2001 and July 2016 from 6 large scale centers in China were reviewed to investigate the clinicopathological characteristics and their relationship with prognosis of colorectal NEN.</p><p><b>RESULTS</b>(1) Colonic NEN: A total of 41 patients with colonic NEN were enrolled from The First Affiliated Hospital of Sun Yat-sen University(n=11), Sun Yat-sen University Cancer Center (n=15), Guangdong General Hospital (n=10), Sun Yet-san Memorial Hospital of Sun Yat-sen University (n=3) and Fudan University Shanghai Cancer Center (n=2). 41 cases, including 20 males and 21 females with a mean age of (58.7±4.7) years. Twenty-three colonic NEN originated in hindgut (23/41, 56.1%), and 20 patients were stage IIII( (20/41, 48.8%). Nine cases (22.0%) were neuroendocrine tumor(NET), 25(61.0%) were neuroendocrine carcinoma (NEC) and 7(17.1%) were mixed adenoendocrine carcinoma (MANEC). Six cases (14.6%) were G1 grade, 3(7.3%) were G2 grade and 32(78.1%) were G3 grade. Ulcerative or cauliflower-like tumors were the most common appearance under endoscopy (both 9/41, 22.0%). Thirty-three patients (80.5%) underwent surgery. During follow-up, 19 cases died and the 3-year survival rate was 46.1%. Multivariate analysis revealed that stage IIII( was an independent risk factor of poor prognosis (HR=3.871, 95%CI:1.342 to 11.167, P=0.012) in colonic NEN patients. (2) Rectal NEN: A total of 288 patients with rectal NEN were enrolled from The First Affiliated Hospital of Sun Yat-sen University(n=130), Nanfang Hospital of Southern Medical University (n=115) and Fudan University Shanghai Cancer Center (n=43). Two hundred and eighty-eight cases, including 181 males and 107 females with a mean age of (47.7±1.5) years. One hundred and ninety-seven patients were stage I((197/288, 68.4%). Of 288 rectal NEN cases, 267(92.7%) were NET, 20(7.0%) were NEC and 1(0.3%) was MANEC; 214(74.3%) were G1 grade, 53(18.4%) were G2 grade and 21(7.3%) were G3 grade. Submucosal tumor was the most common appearance under endoscopy(164/288, 56.9%). Most of the rectal NET G1/G2 tumors were submucosal(146/214, 68.2%;18/53,34.0% respectively) while most of G3 tumors were cauliflower-like (14/21,66.7%). A total of 175 patients (60.8%) underwent endoscopic therapy, while 96 patients(33.3%) underwent surgery. During follow-up, 12 cases died and 3-year survival rate was 94.0%. Multivariate analysis revealed that poor differentiation as NEC or MANEC(HR=8.919, 95% CI:1.911 to 41.637, P=0.005) and stage III( to IIII((HR=10.304, 95%CI:1.772 to 59.916, P=0.009) were independent risk factors of poor prognosis in rectal NEN patients.</p><p><b>CONCLUSIONS</b>The clinicopathological manifestations of rectal NEN and colonic NEN are quite different. Rectal NEN are more common with better differentiation and has better prognosis than colonic NEN.</p>
Subject(s)
Female , Humans , Male , Middle Aged , Carcinoid Tumor , Carcinoma, Neuroendocrine , China , Colorectal Neoplasms , Intestinal Neoplasms , Multivariate Analysis , Neuroendocrine Tumors , Prognosis , Rectal Neoplasms , Retrospective Studies , Risk Factors , Survival RateABSTRACT
<p><b>OBJECTIVE</b>To retrospectively analyze the clinicopathology of patients with gastric gastrointestinal stromal tumor(gGIST) who underwent radical excision within 18 years in 10 domestic medical centers in order to understand the status of domestic surgical treatment of gGIST.</p><p><b>METHODS</b>Clinicopathological data of gGIST patients undergoing radical excision in 10 medical centers from January 1998 to January 2016 were collected, and their operational conditions, postoperative adjuvant therapy, gene detection and survival were analyzed retrospectively.</p><p><b>RESULTS</b>A total of 1 846 cases were recruited in this study, including 246 cases from Guangdong General Hospital, 331 cases from Sun Yat-sen University Cancer Center, 374 cases from Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, 342 cases from Nanfang Hospital of Southern Medical University, 265 cases from Fujian Medical University Union Hospital, 148 cases from Fudan University Shanghai Cancer Center, 49 cases from West China Hospital of Sichuan University, 43 cases from Peking University Cancer Hospital and Institute, 28 cases from the 81st Hospital of Pepole's Liberation Army(PLA), 20 cases from Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute. There were 918 male (49.7%) and 928 female patients (50.3%) with median onset age of 59(18 to 95) years old. Fundus(735 cases, 39.8%) and body (781 cases, 42.3%) of stomach were the common sites of lesions. The average size of tumor was (5.3±4.6) cm. There were 1 421 cases with mitotic count ≤5(77.0%). According to the operation procedure, 924 cases (50.1%) underwent laparoscopic surgery, 759 cases (41.1%) laparotomy, 120 cases (6.5%) endoscopic surgery, and 20 cases (1.1%) laparoscopic combined with endoscopic surgery, 6 cases (0.3%) laparoscopic excision surgery through gastric wall and cavity, and 17 cases (0.9%) laparoscopy and then were transferred to laparotomy. Wedge excision were performed in 1 308 cases (70.9%), proximal gastric excision in 226 cases(12.2%), distal gastric excision in 92 cases (5.0%), total gastrectomy in 94 cases (5.1%), and local gastrectomy in 126 cases(6.8%). Multi-visceral excision was performed in 138 cases, and the splenectomy was performed in 83 cases(60.1%)with the highest ratio. According to modified NIH classification, 399 cases(21.6%) were extreme low risk, 580 cases(31.4%) were low risk, 424 cases(23.0%) were moderate risk, 443 cases (24.0%) were high risk. A total of 461 cases received postoperative imatinib adjuvant therapy, accounting for 53.2%(461/867) of patients with moderate and high risk. Among 1 846 cases, 1 402 cases (75.9%) had complete follow-up data and the median follow-up time was 33.6 (0.1 to 158) months. The 5-year survival rates of extreme low risk, low risk, moderate risk and high risk were 100%, 98.5%, 92.5%, and 79.2% with significant difference(P=0.000).</p><p><b>CONCLUSIONS</b>Gastric GIST occurs mostly in fundus and body of stomach in China. Wedge excision is the main operational procedure and laparoscopic operation is over 50%. General prognosis of gastric GIST is quite good.</p>
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Antineoplastic Agents , Therapeutic Uses , China , Combined Modality Therapy , Gastrectomy , Gastrointestinal Neoplasms , Gastrointestinal Stromal Tumors , Pathology , General Surgery , Imatinib Mesylate , Therapeutic Uses , Laparoscopy , Laparotomy , Postoperative Period , Prognosis , Retrospective Studies , Splenectomy , Stomach Neoplasms , Pathology , General Surgery , Survival RateABSTRACT
<p><b>OBJECTIVE</b>To elucidate the historic and current diagnosis and treatment status of gastrointestinal stromal tumor (GIST) in the Chinese population based on four high volume databases.</p><p><b>METHODS</b>Clinicopathological data of GIST patients with follow-up information between January 1998 and December 2015 from Sun Yat-sen University Cancer Center, Union Hospital of Huazhong University of Science and Technology, Southern Medical University Nanfang Hospital and Guangdong General Hospital were retrospectively analyzed. Kaplan-Meire method was used to draw survival curve. The accumulative survival rate was calculated by life table method. Comparison of survival rate among groups was examined by Log-rank test.</p><p><b>RESULTS</b>A total of 2 610 cases were enrolled into the study, including 667(25.6%) cases from Sun Yat-sen University Cancer Center, 754(28.9%) cases from Union Hospital of Huazhong University of Science and Technology, 692(26.5%) cases from Southern Medical University Nanfang Hospital and 497 (19.0%) cases from Guangdong General Hospital. There were 1 394 male and 1 216 female cases with the ratio of 1.15 to 1.00. The age of patients was from 18 to 95 (median 58.0) years old. Three-year was used as a time stage, then 18 years were divided into 6 stages. New GIST patients increased gradually year by year. There were 13(0.5%) cases during 1998 to 2000, 68(2.6%) cases during 2001 to 2003, 256(9.8%) cases during 2004 to 2006, 517 (19.8%) cases during 2007 to 2009, 814(31.2%) cases during 2010 to 2012, and 942 (36.1%) cases during 2013 to 2015. Primary GIST sites were esophagus in 50(1.9%) cases, stomach in 1 686(64.6%) cases, duodenum in 206 (7.9%) cases, jejunum and ileum in 446 (17.1%) cases, colon and rectum in 133 (5.1%) cases, and non-gastrointestinal tract in 89 (3.4%) cases. GIST lesions of 2 404(92.1%) cases located in the primary sites and relapse/metastasis occurred in 206 cases when consulting. Among 206 relapse/metastasis cases, liver metastasis was found in 126 (61.2%) cases, abdominal cavity/pelvic cavity metastasis in 64 (31.1%) cases, liver plus abdominal cavity/pelvic cavity metastasis in 12 (5.8%) cases, and other site metastasis in 4 (1.9%) cases. Among all the patients, 352 received gene detection, including 1 (0.4%) during 2004 to 2006, 7 (1.4%) during 2007 to 2009, 150 (18.4%) during 2010 to 2012, and 194 (20.6%) during 2013 to 2015. Most of the primary oncogenic mutational site occurred in c-Kit, including 30 (8.5%) cases in exon 9, 242 (68.8%) cases in exon 11, 4 (1.1%) cases in exon 13, 2 (0.6%) cases in exon 17, while 3 (0.9%) cases in PDGFRA exon 12 and 20 (5.7%) cases in PDGFRA 18, besides, no mutations of KIT and PDGFRA were detected in 51 (14.5%) cases. A total of 2 202 cases underwent operation, including 2 038 (92.6%) of radical resection and 164 (7.4%) of palliative resection. Among 2 038 patients undergoing radical resection, 450 (22.1%) cases were very low risk, 593 (29.1%) cases were low risk, 283 (13.9%) cases were moderate risk and 712 (34.9%) cases were high risk according to NIH risk classification. Of 995 patients with moderate and high risk, 550(55.3%) cases received postoperative imatinib adjuvant therapy, whose ratio in above 6 time stages was as follows: 0, 42.8%(12/28), 19.8%(20/101), 9.8% (21/215), 65.7% (176/268) and 85.6% (321/375). Of 206 relapse/metastasis patients, 200 (97.1%) cases received imatinib as the first-line therapy, and 22 (10.7%) received sunitinib as the second-line therapy. A total of 1 743 patients had complete follow-up data and median follow-up time was 35.9 (0.1 to 173.8) months. The 5-year overall survival rates in very low, low, moderate and high risk patients were 100%, 97%, 95% and 78% respectively.</p><p><b>CONCLUSION</b>This retrospective study provides the largest data of GIST and indicates the historic changes of clinicopathological characteristics, diagnosis and treatment of GIST for further domestic GIST research.</p>