Clinical characteristics and prognostic analysis of 33 patients with rectal stromal tumor_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHOU Rui ^1,2 , GAO Shengguo ^1,2 , ZHANG Yafei ¹ , XU Teng ¹ ,  XU Wei ¹

1. Department of Gastrointestinal Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221000, P. R. China;
2. Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu 221000, P. R. China;

Corresponding author：

XU Wei, Email: eryuanxuwei@126.com

Keywords：

rectal stromal tumor; clinicopathological characteristics; treatment; prognosis

DOI：

10.7507/1007-9424.201706061

Video：

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Objective To investigate the clinical characteristics, therapeutic methods, and prognostic factors of patients with rectal stromal tumor. Methods The clinicopathological data of 33 patients with rectal stromal tumor who treated in the Affiliated Hospital of Xuzhou Medical University from January 2008 to November 2014 were retrospectively reviewed, and the therapeutic methods and prognostic factors of these patients were further analyzed. Results The major clinical manifestations of 33 patients included abdominal discomfort in 21 patients, changes of defecation habit and fecal property in 15 patients, bloody stool in 13 patients, and anal pain in 9 patients. CT and MRI examination showed a mass in the pelvic with the clear boundary, growed through the wall of rectum, with the heterogeneous density and signal, sometimes with necrosis, calcification, and haemorrhage. The results of immunohistochemical staining showed that, 31 patients were strongly positive for CD117, 28 patients were strongly positive for CD34, 15 patients were positive for smooth muscle actin (SMA), 13 patients were positive for vimentin, and 3 patients were positive for soluble acid protein (S-100). The therapeutic methods of 33 patients included local excision in 13 patients, low anterior resection in 11 patients, abdominal pelvic resection in 5 patients, and conservative treatment in 4 patients. A total of 26 patients underwent surgery combiend with imatinib therapy. The follow-up time was 10–102 months and the median time was 58 months. During follow-up period, there were 8 patients suffered from recurrence or metastasis, and 15 patients died. The results of Cox proportional hazards regression model showed that, postoperative relapse and metastasis were prognostic factors for survival〔RR=19.338, 95% CI was (2.821, 132.568), P=0.003〕. The survival situation of the patients suffered from postoperative relapse and metastasis was poor. Conclusions CD117 and CD34 could serve as valuable diagnostic indexes for rectal stromal tumor. Surgery is an effective treatment for rectal stromal tumor.

Citation： ZHOU Rui, GAO Shengguo, ZHANG Yafei, XU Teng, XU Wei. Clinical characteristics and prognostic analysis of 33 patients with rectal stromal tumor. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(12): 1496-1502. doi: 10.7507/1007-9424.201706061 Copy

1.	Fletcher CD, Berman JJ, Corless C, et al. Diagnosis of gastrointestinal stromal tumors: A consensus approach. Hum Pathol, 2002, 33(5): 459-465.
2.	Joensuu H. Risk stratification of patients diagnosed with gastrointestinal stromal tumor. Hum Pathol, 2008, 39(10): 1411-1419.
3.	Rossi CR, Mocellin S, Mencarelli R, et al. Gastrointestinal stromal tumors: from a surgical to a molecular approach. Int J Cancer, 2003, 107(2): 171-176.
4.	Yasui M, Tsujinaka T, Mori M, et al. Characteristics and prognosis of rectal gastrointestinal stromal tumors: an analysis of registry data. Surg Today, 2017, [Epub ahead of print].
5.	Jiang ZX, Zhang SJ, Peng WJ, et al. Rectal gastrointestinal stromal tumors: imaging features with clinical and pathological correlation. World J Gastroenterol, 2013, 19(20): 3108-3116.
6.	Takano M, Saito K, Kita T, et al. Preoperative needle biopsy and immunohistochemical analysis for gastrointestinal stromal tumor of the rectum mimicking vaginal leiomyoma. Int J Gynecol Cancer, 2006, 16(2): 927-930.
7.	常晓燕, 马志强, 李媛, 等. 直肠胃肠道间质瘤临床病理分析. 中华病理学杂志, 2016, 45(7):462-466.
8.	罗小华, 宋彬, 庄雄杰, 等. 直肠间质瘤的 CT/MR 表现及临床病理特征. 中国普外基础与临床杂志, 2011, 18(10): 1109-1113.
9.	王庭红. MRI 对直肠间质瘤的术前诊断价值. 中国 CT 和 MRI 杂志, 2014, 11(1): 75-78.
10.	陈义忠. CT 与 MRI 在诊断直肠间质瘤的临床价值分析. 中国 CT 和 MRI 杂志, 2017, 15(3): 112-114.
11.	张伟, 王波, 李平, 等. 胃肠道间质瘤的临床病理学分析. 中华普通外科杂志, 2007, 22(8): 571-573.
12.	Casali PG, Jost L, Reichardt P, et al. Gastrointestinal stromal tumours: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol, 2009, 20 Suppl 4: 64-67.
13.	万远廉, 汤坚强, 柳萍, 等. 直肠间质瘤 16 例临床病理分析. 中华外科杂志, 2004, 42(15): 897-900.
14.	吴斌, 肖毅, 林国乐, 等. 直肠间质瘤的临床特点及手术方式探讨. 中国普外基础与临床杂志, 2010, 17(9): 936-938.
15.	丁志, 赵平, 周祥, 等. 35 例胃肠道间质瘤临床诊治分析. 中国普外基础与临床杂志, 2012, 19(11): 1235-1237.
16.	Parfitt JR, Streutker CJ, Riddell RH, et al. Gastrointestinal stromal tumors: a contemporary review. Pathol Res Pract, 2006, 202(12): 837-847.
17.	Kyo K, Azuma M, Okamoto K, et al. Neoadjuvant imatinib treatment and laparoscopic anus-preserving surgery for a large gastrointestinal stromal tumor of the rectum. World J Surg Oncol, 2016, 14: 68.
18.	Bischof DA, Kim Y, Blazer DG 3rd, et al. Surgical management of advanced gastrointestinal stromal tumors: an international multi-institutional analysis of 158 patients. J Am Coll Surg, 2014, 219(3): 439-449.
19.	Berglund E, Ubhayasekera SJ, Karlsson F, et al. Intracellular concentration of the tyrosine kinase inhibitor imatinib in gastrointestinal stromal tumor cells. Anticancer Drugs, 2014, 25(4): 415-422.
20.	Eisenberg BL, Pipas JM. Gastrointestinal stromal tumor--background, pathology, treatment. Hematol Oncol Clin North Am, 2012, 26(6): 1239-1259.
21.	Xiao CC, Zhang S, Wang MH, et al. Clinicopathological features and prognostic factors of rectal gastrointestinal stromal tumors. J Gastrointest Surg, 2013, 17(4): 793-798.
22.	Liu Q, Zhong G, Zhou W, et al. Initial application of transanal endoscopic microsurgery for high-risk lower rectal gastrointestinal stromal tumor after imatinib mesylate neoadjuvant chemotherapy: a case report. Medicine (Baltimore), 2017, 96(29): e7538.
23.	曹志宇, 何建苗, 杨波, 等. 伊马替尼新辅助治疗联合手术对中晚期胃肠道间质瘤的疗效观察(附 92 例报告). 解放军医学杂志, 2015, 40(5): 408-410.
24.	Eisenberg BL, Smith KD. Adjuvant and neoadjuvant therapy for primary GIST. Cancer Chemother Pharmacol, 2011, 67 Suppl 1: S3-S8.
25.	Joensuu H, Vehtari A, Riihimäki J, et al. Risk of recurrence of gastrointestinal stromal tumour after surgery: an analysis of pooled population-based cohorts. Lancet Oncol, 2012, 13(3): 265-274.

1. Fletcher CD, Berman JJ, Corless C, et al. Diagnosis of gastrointestinal stromal tumors: A consensus approach. Hum Pathol, 2002, 33(5): 459-465.
2. Joensuu H. Risk stratification of patients diagnosed with gastrointestinal stromal tumor. Hum Pathol, 2008, 39(10): 1411-1419.
3. Rossi CR, Mocellin S, Mencarelli R, et al. Gastrointestinal stromal tumors: from a surgical to a molecular approach. Int J Cancer, 2003, 107(2): 171-176.
4. Yasui M, Tsujinaka T, Mori M, et al. Characteristics and prognosis of rectal gastrointestinal stromal tumors: an analysis of registry data. Surg Today, 2017, [Epub ahead of print].
5. Jiang ZX, Zhang SJ, Peng WJ, et al. Rectal gastrointestinal stromal tumors: imaging features with clinical and pathological correlation. World J Gastroenterol, 2013, 19(20): 3108-3116.
6. Takano M, Saito K, Kita T, et al. Preoperative needle biopsy and immunohistochemical analysis for gastrointestinal stromal tumor of the rectum mimicking vaginal leiomyoma. Int J Gynecol Cancer, 2006, 16(2): 927-930.
7. 常晓燕, 马志强, 李媛, 等. 直肠胃肠道间质瘤临床病理分析. 中华病理学杂志, 2016, 45(7):462-466.
8. 罗小华, 宋彬, 庄雄杰, 等. 直肠间质瘤的 CT/MR 表现及临床病理特征. 中国普外基础与临床杂志, 2011, 18(10): 1109-1113.
9. 王庭红. MRI 对直肠间质瘤的术前诊断价值. 中国 CT 和 MRI 杂志, 2014, 11(1): 75-78.
10. 陈义忠. CT 与 MRI 在诊断直肠间质瘤的临床价值分析. 中国 CT 和 MRI 杂志, 2017, 15(3): 112-114.
11. 张伟, 王波, 李平, 等. 胃肠道间质瘤的临床病理学分析. 中华普通外科杂志, 2007, 22(8): 571-573.
12. Casali PG, Jost L, Reichardt P, et al. Gastrointestinal stromal tumours: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol, 2009, 20 Suppl 4: 64-67.
13. 万远廉, 汤坚强, 柳萍, 等. 直肠间质瘤 16 例临床病理分析. 中华外科杂志, 2004, 42(15): 897-900.
14. 吴斌, 肖毅, 林国乐, 等. 直肠间质瘤的临床特点及手术方式探讨. 中国普外基础与临床杂志, 2010, 17(9): 936-938.
15. 丁志, 赵平, 周祥, 等. 35 例胃肠道间质瘤临床诊治分析. 中国普外基础与临床杂志, 2012, 19(11): 1235-1237.
16. Parfitt JR, Streutker CJ, Riddell RH, et al. Gastrointestinal stromal tumors: a contemporary review. Pathol Res Pract, 2006, 202(12): 837-847.
17. Kyo K, Azuma M, Okamoto K, et al. Neoadjuvant imatinib treatment and laparoscopic anus-preserving surgery for a large gastrointestinal stromal tumor of the rectum. World J Surg Oncol, 2016, 14: 68.
18. Bischof DA, Kim Y, Blazer DG 3rd, et al. Surgical management of advanced gastrointestinal stromal tumors: an international multi-institutional analysis of 158 patients. J Am Coll Surg, 2014, 219(3): 439-449.
19. Berglund E, Ubhayasekera SJ, Karlsson F, et al. Intracellular concentration of the tyrosine kinase inhibitor imatinib in gastrointestinal stromal tumor cells. Anticancer Drugs, 2014, 25(4): 415-422.
20. Eisenberg BL, Pipas JM. Gastrointestinal stromal tumor--background, pathology, treatment. Hematol Oncol Clin North Am, 2012, 26(6): 1239-1259.
21. Xiao CC, Zhang S, Wang MH, et al. Clinicopathological features and prognostic factors of rectal gastrointestinal stromal tumors. J Gastrointest Surg, 2013, 17(4): 793-798.
22. Liu Q, Zhong G, Zhou W, et al. Initial application of transanal endoscopic microsurgery for high-risk lower rectal gastrointestinal stromal tumor after imatinib mesylate neoadjuvant chemotherapy: a case report. Medicine (Baltimore), 2017, 96(29): e7538.
23. 曹志宇, 何建苗, 杨波, 等. 伊马替尼新辅助治疗联合手术对中晚期胃肠道间质瘤的疗效观察(附 92 例报告). 解放军医学杂志, 2015, 40(5): 408-410.
24. Eisenberg BL, Smith KD. Adjuvant and neoadjuvant therapy for primary GIST. Cancer Chemother Pharmacol, 2011, 67 Suppl 1: S3-S8.
25. Joensuu H, Vehtari A, Riihimäki J, et al. Risk of recurrence of gastrointestinal stromal tumour after surgery: an analysis of pooled population-based cohorts. Lancet Oncol, 2012, 13(3): 265-274.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical characteristics and prognostic analysis of 33 patients with rectal stromal tumor

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