Department of General Surgery, Drum Tower Hospital, Medical School of Nanjing University, 321 Zhongshan RD, Nanjing, 210008, China.
Sci Rep. 2019 Jul 11;9(1):10033. doi: 10.1038/s41598-019-46520-1.
Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal tumours of the gastrointestinal tract. Recent research has shown that small intestinal GISTs exhibit more aggressive features than gastric GISTs. To compare the clinical features of gastric and small intestinal GISTs for the further prediction of different prognoses, we conducted a retrospective study. 43 patients in the small intestine group and 97 in the gastric group were collected between January 2016 and December 2017. Data on demographics, preoperative lab results, clinicopathological results and surgical management were compared between groups. Significant elements were subsequently included in logistic regression analysis for further identification. The Kaplan-Meier method and log-rank test were used to calculate the relapse-free survival (RFS) rate and cumulative survival rate. Univariable analysis demonstrated that underlying disease, gastrointestinal (GI) bleeding, lymphocyte count, haemoglobin (Hb), albumin (ALB), platelet-to-lymphocyte ratio (PLR), thrombin time (TT), National Institutes of Health (NIH) category, Dog1, surgical procedure types and postoperative hospitalization were different between the two groups. Among these factors, logistic regression analysis identified that patients in small intestinal group exhibited significantly higher GI bleeding rate (p = 0.022), NIH category (p = 0.031), longer postoperative hospitalization time (p = 0.001) with lower TT value (p = 0.030) than those in gastric group. The log-rank test indicated that the location of the GIST (p = 0.022), GIST with GI bleeding (p = 0.027) and NIH category (p = 0.031) were independent prognostic predictors for poor outcome regarding RFS. Regarding cumulative survival, only the location of the GIST (p = 0.027) was an independent prognostic predictor for poor outcome. Thus, we concluded that small intestine GISTs were associated with lower TT, recurrent GI bleeding, advanced NIH category and extended postoperative hospitalization. Nevertheless, future multicentre prospective study are expected to validate our results.
胃肠道间质瘤（GISTs）是胃肠道最常见的间叶源性肿瘤。最近的研究表明，小肠 GISTs 比胃 GISTs 具有更具侵袭性的特征。为了进一步预测不同的预后，比较胃 GISTs 和小肠 GISTs 的临床特征，我们进行了一项回顾性研究。收集了 2016 年 1 月至 2017 年 12 月期间的 43 例小肠组和 97 例胃组患者的数据。比较两组患者的人口统计学、术前实验室结果、临床病理结果和手术治疗情况。然后将显著因素纳入逻辑回归分析，以进一步确定。采用 Kaplan-Meier 法和对数秩检验计算无复发生存率（RFS）和累积生存率。单变量分析表明，两组间的基础疾病、胃肠道（GI）出血、淋巴细胞计数、血红蛋白（Hb）、白蛋白（ALB）、血小板与淋巴细胞比值（PLR）、凝血酶时间（TT）、国立卫生研究院（NIH）分级、Dog1、手术类型和术后住院时间不同。Logistic 回归分析确定，小肠组患者 GI 出血发生率（p=0.022）、NIH 分级（p=0.031）、术后住院时间（p=0.001）和 TT 值（p=0.030）均明显高于胃组。Log-rank 检验表明，GIST 的位置（p=0.022）、GIST 伴 GI 出血（p=0.027）和 NIH 分级（p=0.031）是影响 RFS 的独立预后预测因子。对于累积生存率，只有 GIST 的位置（p=0.027）是影响不良预后的独立预后预测因子。因此，我们得出结论，小肠 GISTs 与 TT 降低、复发性 GI 出血、晚期 NIH 分级和延长术后住院时间相关。然而，未来的多中心前瞻性研究有望验证我们的结果。
