Preliminary understanding of gastrointestinal stromal tumor with the highest risk / 中华胃肠外科杂志

Nowadays, surgery still remains the mainstay treatment for gastrointestinal stromal tumor (GIST). Nevertheless, some GIST patients have also experienced tumor recurrence/metastasis even with R0 resection. Meanwhile, the prognosis of GIST has been dramatically improved after targeted drug imatinib used in clinical practice for GIST, but tumor recurrence/metastasis still occurred in some patients with high-risk when adjuvant treatment course ended, as such, the 2008 modified NIH criterion, which is used to guide the adjuvant treatment of GIST, still has shortcomings. This criterion can not accurately predict the postoperative recurrence probability and also fails to achieve the purpose of individualized treatment, especially for those patients with high mitotic index who may experience insufficient treatment. Therefore, some domestic and foreign scholars realize that some high-risk GIST lesions with high mitotic index exhibit higher malignant biological behavior, namely highest risk GIST, which is easier to present tumor recurrence/metastasis. The appropriate classification criteria and treatment course are still needed to further exploration.

Changes of quality of life after gastric tube reconstruction in adenocarcinoma of the esophagogastric junction

Objective: To investigate changes of quality of life [QOL] of patients with adenocarcinoma of the esophagogastric junction [AEG] after gastric tube anastomosis

Methods: From January 2009 to December 2011, eighty-seven patients with Types II and III AEG were selected for gastric tube reconstruction after proximal gastrectomy. The QOL of the patients was assessed using the Chinese versions of the EORTC QLQ-C30 and the EORTC QLQ-STO22 preoperatively, as well as one and two years postoperatively

Results: The QLQ-C30 showed that the global health of the respondents decreased at one year after the surgery [P=0.02]. The preoperative score for physical function was significantly better than the one- and two-year post-operation scores. The preoperative scores for pain, nausea and vomiting, and economic difficulties were worse than the one- and two-year post-operation scores [P < 0.05]. Diarrhea was worse at one year post-operation than during pre-operation [P = 0.00], but improved at two years after the operation. The QLQ-STO22 scales showed that the preoperative dysphagia score was better than one-year post-operation, and no significant differences were observed in terms of dysphagia between the preoperation and two-year postoperative periods. Preoperative reflux and taste scores were better than those after the operation [P < 0.05]. The hair loss score at one-year post-operation was worse than at either pre-operation or two-year post-operation

Conclusions: Most QOL scales worsened after surgery, particularly at postoperative year one. However, the scales can be gradually recovered to preoperative levels. The physical function, nausea and vomiting, reflux, taste, and financial difficulties did not fully recover two years after the operation

Expression and Clinicopathological Significance of CD9 in Gastrointestinal Stromal Tumor

This study investigated the expression and clinicopathological significance of CD9 in gastrointestinal stromal tumor (GIST). Immunohistochemistry staining for CD9 was performed on tumor tissues from 74 GIST patients. The correlation with clinicopathological features, risk classification and prognosis was analyzed. CD9-positive staining comprised 59.5% (44/74) of the GIST patients. The CD9-positive expression rate of the sample was significantly associated with diameter (P = 0.028), mitotic counts (P = 0.035), risk classification (P = 0.018) and three-year recurrence-free survival (RFS) (P < 0.001). Cox proportional hazards regression (HR = 0.352; P = 0.015) showed that CD9 is an independent factor for post-operative RFS. The subgroup analysis showed that CD9 expression in gastric stromal tumor (GST) is significantly associated with diameter (P = 0.031), risk classification (P = 0.023) and three-year RFS (P = 0.001). The Cox proportional hazards regression (HR = 0.104; P = 0.006) also showed that CD9 is an independent factor for RFS of GST. However, CD9 expression does not have a statistically significant correlation with clinicopathological features, risk classification, and prognosis in non-GST. In conclusion, CD9 expression in GIST appears to be associated with the recurrence and/or metastasis of GIST patients, especially in GST, which may indicate the important role of CD9 in the malignant biological behavior and prognosis of GST.