[Treatment and prognosis of patients with duodenal gastrointestinal stromal tumors].

OBJECTIVE

To evaluate the clinical characteristics and survival factors of patients with duodenal gastrointestinal stromal tumors (GIST).

METHODS

The clinical data of 41 patients with duodenal GIST were analyzed retrospectively at Cancer Hospital and Institute, Chinese Academy of Medical Sciences from June 1996 to August 2011. Kaplan-Meier method was used to calculate the recurrence-free survival rate and the Cox proportional hazard regression model employed for the recurrence-free survival analysis.

RESULTS

The lesions of duodenal GIST were predominantly located in the descending (n = 26, 63.4%) and transverse portions (n = 10, 24.4%). Most duodenal GIST presented commonly with upper gastrointestinal bleeding (n = 18, 43.9%) and 12 cases (29.3%) were incidentally detected by physical examinations. Eight patients underwent pancreatoduodenectomy and 27 limited resection. The tumor size varied from 0.6 cm to 30.0 cm (mean: 8.4 cm). The recurrence-free survival rates analyzed by Kaplan-Meier method at 1, 2 and 5-year were 94.1%, 77.5% and 65.0% respectively. The results of Cox proportional hazards regression model indicated that the patients with >10/50 HP mitotic count showed a worse recurrence-free survival than those with ≤ 10/50 HP (HR = 3.7, 95%CI 1.0 - 13.7, P = 0.049). After adjusting other confounding factors, mitotic activity was one significant prognostic factor of recurrence (P = 0.024). There was no significant association between the risk of recurrence and other prognostic factors, including diagnostic age, tumor size, type of operation and the risk of aggressive behaviors (all P > 0.05).

CONCLUSIONS

Mitotic activity is one prognostic factor of duodenal GIST. And R(0) resection should be regarded as an optional treatment for duodenal GIST.