ABSTRACT
INTRODUCCIÓN: El tumor estromal gastrointestinal (GIST), es la designación para un tipo específico de tumor mesenquimal del tracto digestivo que proviene de las células intersticiales de Cajal (ICC) o de sus precursores multipotenciales, es de presentación infrecuente y por ello, su mejor conocimiento deberá incidir en un adecuado manejo diagnóstico y terapéutico. OBJETIVOS: Valorar las características clínicas e identificar los factores que influencian la sobrevida de los pacientes con diagnóstico de tumor estromal gastrointestinal. MATERIAL Y MÉTODOS: El presente estudio es de diseño cuantitativo, no experimental, descriptivo, retrospectivo y transversal. Ha sido realizado en 152 pacientes con diagnóstico de tumor estromal gastrointestinal que fueron atendidos en el Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima-Perú, desde Enero del año 1999 hasta Diciembre del año 2009. Para el diagnóstico definitivo se consignó el resultado de la pieza quirúrgica y la histología se complementó con test de inmuno histoquímica. Para valorar la distribución normal de la población se usaron las pruebas de Shapiro-Wolk, Anderson-Darling, Lilliefors, respecto a la estadística inferencial se usó tablas de supervivencia y para valorar la significancia en el análisis univariado (p<0.05 significativa), se usaronlas pruebas de Wilcoxon, Tarone-ware y Log-rank, además para evaluar la diferencia entre grupos en las tablas de contingencia se utilizó el chi cuadrado y el test de Fisher. El análisis multivariado se realizó utilizando el modelo de riesgo proporcional de Cox.RESULTADOS: El grupo de 152 pacientes comprendió 78 mujeres (51%) y 74 varones (49%) con rango etáreo de 16 a 92 años, con una edad promedio de 54 años. La frecuencia de presentación se incrementó a partir de la cuarta década de vida y alcanzó su mayor expresión entre los 50 y 70 años. La presentación inicial fue de enfermedad localizada para 79 pacientes (52%) y con metástasis primaria...
INTRODUCTION: The gastrointestinal stromal tumor (GIST) is the designation for a specific type of mesenchymal tumor of the digestive tract that is origin in the interstitial cells of Cajal (ICC) or its precursor multipotentials, its presentation is rare and therefore its best knowledge must affect a proper diagnosis and treatment. OBJECTIVES: To evaluate the clinical characteristics and to identify factors influencing survival of patients with gastrointestinal stromal tumor. MATERIAL AND METHODS: This study design is quantitative, non experimental, descriptive, retrospective and transversal. The study has been performed in 152 patients with gastrointestinal stromal tumor who were treated at the National Institute of Neoplastic Diseases (INEN), Lima, Peru, from January 1999 through December 2009. For the final diagnosis was registered the outcome of the surgical and histology was complemented by immunohistochemical test. To assess the normal distribution of the population was used the Shapiro-Wolk, Anderson-Darling, Lilliefors, regarding the use of inferential statistical tables for survival and to assess its significance in the univariate analysis (p<0.05 significance), was used the Wilcoxon test, Tarone-Ware Log-rank and also to evaluate the difference between groups in contingency tables used the chi square and FisherÆs test. Multivariate analysis was performed using the proportional hazards model of Cox. RESULTS: The group of 152 patients included 78 women (51%) and 74 men (49%) with age range from 16 to 92 years, with an average age of 54. The frequency presentation was increased from the fourth decade of life and reaches its highest expression between 50 and 70. The initial presentation was with localized disease to 79 patients (52%) and primary metastases in 73 patients (48%), with an average time of disease 14 months. The prevalence of GIST tumor in the differents organs was as follows: stomach with 77 patients (50.65%), jejunum with 21 patients...
Subject(s)
Humans , Male , Adolescent , Adult , Female , Middle Aged , Survival , Gastrointestinal Stromal Tumors , Evaluation Studies as Topic , Epidemiology, Descriptive , Retrospective Studies , Cross-Sectional StudiesABSTRACT
INTRODUCTION: The gastrointestinal stromal tumor (GIST) is the designation for a specific type of mesenchymal tumor of the digestive tract that is origin in the interstitial cells of Cajal (ICC) or its precursor multipotentials, its presentation is rare and therefore its best knowledge must affect a proper diagnosis and treatment. OBJECTIVES: To evaluate the clinical characteristics and to identify factors influencing survival of patients with gastrointestinal stromal tumor. MATERIAL AND METHODS: This study design is quantitative, non experimental, descriptive, retrospective and transversal. The study has been performed in 152 patients with gastrointestinal stromal tumor who were treated at the National Institute of Neoplastic Diseases (INEN), Lima, Peru, from January 1999 through December 2009. For the final diagnosis was registered the outcome of the surgical and histology was complemented by immunohistochemical test. To assess the normal distribution of the population was used the Shapiro-Wolk, Anderson-Darling, Lilliefors, regarding the use of inferential statistical tables for survival and to assess its significance in the univariate analysis (p <0.05 significance), was used the Wilcoxon test, Tarone-Ware Log-rank and also to evaluate the difference between groups in contingency tables used the chi square and Fisher's test. Multivariate analysis was performed using the proportional hazards model of Cox. RESULTS: The group of 152 patients included 78 women (51%) and 74 men (49%) with age range from 16 to 92 years, with an average age of 54. The frequency presentation was increased from the fourth decade of life and reaches its highest expression between 50 and 70. The initial presentation was with localized disease to 79 patients (52%) and primary metastases in 73 patients (48%), with an average time of disease 14 months. The prevalence of GIST tumor in the different organs was as follows: stomach with 77 patients (50.65%), jejunum with 21 patients (13.82%), retroperitoneum with 17 patients (11.18%), duodenum 11 patients (7.24%), colon 11 patients (7.24%), ileum 8 patients (5.26%),pancreas, 3 patients (1.97%), rectum, 3 patients (1.97%) and esophagus with 1 patient (0.66%). The most common symptoms of GIST tumors in general were gastrointestinal bleeding, abdominal tumor and abdominal pain. There are organ-specific symptoms such as jaundice in pancreas, dysphagia in esophagus and obstruction in the ileum. The tumor size greater than 10 centimeters was found in 92 patients (60.51%), 39 patients had size between 5 and 10 centimeters (25.65%) and 20 patients had lesions smaller than 5 centimeters (13.15%). Immunohistochemistry tests performed in 75 patients show that for all locations, the expression of KIT (CD117) is 94.8%, followed by CD34 to 70.35%; on the other hand, actin (61.68%) and S-100 (57.56%) have a smaller range of expression. Retroperitoneal GIST tumors had an expression of CD117 of 92.86% and CD34 of 60%, and GIST tumors of the pancreas had an expression of CD117 of 100% and CD34 of 100%. We evaluated 27 patients with low mitotic index, of which 10 had primary metastases (37%), in turn, of 25 patients with high mitotic index, 8 had primary metastases (32%). Of the 152 patients, 93 had complete resection of the disease, 28 had partial resection, 24 were unresectable and 07 did not undergo surgery, the more aggressive behavior was observed in ileum, 03 patients were unresectable, 02 patients had partial resection and only 02 could be completely resected, the rest of the series in general, for each location, the GIST tumors completely resected outscored the unresectable and partially resected. Of 93 patients that had completely resected, recurrence was found in 32 of these patients (34.4%), recurrence was local in 8 patients, metastases in 18 patients and local recurrence + metastases in 6 patients, with an average time of recurrence 22 months. The overall cumulative survival at 5 years was 81.35%. The survival of patients under and over 50 expressed a p = 0.08, cumulative survival rates by tumor size expressed p = 0.56, cumulative survival rates for stomach and intestinal location shows a p = 0.056. The 5-year survival of completely resected patients was 87.70%. Overall survival of patients with and without metastasis expressed p = 0.001, the cumulative survival function completely resected patients, the resected and partially resected, expresses with p <0.0001. Multivariate analysis showed that the most significant factor for disease progression was the primary metastases with p = 0.007, and that survival was directly related to complete resection of the disease which is expressed with p <0.0001. CONCLUSIONS: The most important prognostic factor of survival for gastrointestinal stromal tumors (GIST) is the complete resection of the disease. The factor that is associated with progression of the disease is the presence of metastases. In our series of 152 patients, tumor locations tend to relate better survival in gastric GIST that in intestinal GIST. Similarly, we found a tendency to express a lower survival in patients younger than 50 years. Differentiated tumor size in three size categories expressed no more related to survival. The low mitotic index associated with metastasis, not reflected a good prognosis of disease.
Subject(s)
Gastrointestinal Stromal Tumors/mortality , Adolescent , Adult , Aged , Aged, 80 and over , Cross-Sectional Studies , Female , Gastrointestinal Stromal Tumors/pathology , Gastrointestinal Stromal Tumors/therapy , Humans , Male , Middle Aged , Retrospective Studies , Survival Rate , Young AdultABSTRACT
El presente estudio pretende determinar la longitud de implantación, estudiar la forma y determinar la relación de las diferentes alteraciones del pabellón auricular con la presentación intrauterina y forma de nacimiento. Se evaluaron 363 niños recién nacidos normalmente en los que se realizó un examen físico completo y regional de los recién nacidos para su inclusión. Se realizó la auriculométria con un instrumento denominado Regla Auriculométrica que tiene como fin medir a ambas orejas simultáneamente para estudiar la longitud e implantación. Posteriormente se realiza el auriculograma con el fin de registrar la impresión de las orejas usando tampones especiales y finalmente se recolectó datos de la historia materna para relacionar las alteraciones de los pabellones con factores causales. Como resultados se encontró que la longitud de las orejas de nuestra población se encuentra dentro de parámetros normales y en su mayoría son de implantación positiva y asimismo están ubicados una más arriba y/o abajo y más adelante y/o atrás y que un cuarto del total de orejas presentan plegamiento alterando forma y longitud. Dentro de las normales menos de la mitad adoptaron formas peculiares por exceso o defecto de sus referencias anatómicas.
This research determines the implantation length and studies shape and the relations o the outer ear shape alterations with the uterine development and the ways o birth. 363 normal newborn children were evaluated with a complete physical and regional examination so that they get included in the research. An auriculometry was made with a device named Auriculometric Ruler Which has as objective to measure both ears at the same time in order to study the length and implantation. After this, the auriculogram, which has the aim of registering the ears printing using special tampons, was used. Finally data about the maternal history was collected in order to establish the outer ear alterations with causative factors.The results found were that our populations ear length is within the normal ranges. They are mostly o positive implantation, and they are placed one upper o lower than the other; and more forward o me backward. It wasfound that a quarter of the total number of ears are bent, modifying the shape and the length. Within the normal ears, less than the half adopted particular shapes due to the excess of deficiency of its anatomical references.
