Xingyu Feng1, Renjie Li1, Peng Zhang2, Tao Chen3, Haibo Qiu4, Yongjian Zhou5, Chunyan Du6, Xiaonan Yin7, Fang Pan8, Guoliang Zheng9, Xiaowei Sun4, Jiang Yu3, Zhijing Chen1, Yan Zhao10, Xiufeng Liu11, Jian Li12, Bo Zhang13, Ye Zhou14, Changming Huang15, Zhiwei Zhou16, Guoxin Li17, Kaixiong Tao18, Yong Li19. 1. Department of General Surgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China. 2. Department of General Surgery, Union Hospital Tongji Medical College Huazhong University of Science and Techinology, Wuhan 430022, China. 3. Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China. 4. Department of Gastric and Pancreatic Surgery, Sun Yat-sen University Cancer Center University, Guangzhou 510060, China. 5. Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China. 6. Department of Gastric and Soft Tissue Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China. 7. Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China. 8. Department of Gastrointestinal Oncology, Peking University Cancer Hospital and Institute, Beijing 100142, China. 9. Department of Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang 110042, China. 10. Department of Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang 110042, China. zhaoyan@cancerhosp-In-cmu.com. 11. Department of Oncology, People's Liberation Army (PLA) Cancer Center, 81st Hospital of PLA, Nanjing 210002, China. liuxiufeng@csco.org.cn. 12. Department of Gastrointestinal Oncology, Peking University Cancer Hospital and Institute, Beijing 100142, China. oncogene@163.com. 13. Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China. zhangbo7310@126.com. 14. Department of Gastric and Soft Tissue Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China. zhouye79@yahoo.com. 15. Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China. hcmlr2002@163.com. 16. Department of Gastric and Pancreatic Surgery, Sun Yat-sen University Cancer Center University, Guangzhou 510060, China. zhouzhw@sysucc.org.cn. 17. Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China. gzliguoxin@163.com. 18. Department of General Surgery, Union Hospital Tongji Medical College Huazhong University of Science and Techinology, Wuhan 430022, China. tao_kaixiong@163.com. 19. Department of General Surgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China. yuan821007@126.com.
Abstract
OBJECTIVE: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.
OBJECTIVE: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.