BACKGROUND Upper gastrointestinal bleeding (UGIB) is one of the major manifestations of gastrointestinal stromal tumor (GIST) of the stomach. Several studies have reported that GIST bleeding is associated with poor prognosis. However, only case reports have reported hemostasis modalities for treating hemorrhagic gastric GIST. To identify clinical outcome of gastric GIST bleeding, we analyzed risk factors and prognosis of hemorrhagic GIST evaluating hemostasis methods. METHODS Total 697 patients histopathologically diagnosed with primary gastric GIST between January 1998 and May 2015 were enrolled to the study, retrospectively. RESULTS Of 697 total patients, 46 (6.6%) patients had UGIB. Endoscopic intervention, transarterial embolization, or surgical intervention was performed for initial hemostasis in 15, 2, and 1, respectively. Over a median of 68 months of follow-up, 16 patients in bleeding group and 88 patients in non-bleeding group died; the 5-year survival rate was 79.4% in bleeding group and 91.8% in non-bleeding group (p = 0.004). Multivariate analysis showed that significant risk factors for gastric GIST bleeding included the maximal tumor diameter > 5 cm and Ki-67 positivity. Age ≥ 60 [hazard ratio (HR) = 8.124, p = 0.048], necrosis (HR = 5.093, p = 0.027), and bleeding (HR 5.743, p = 0.034) were significant factors for overall survival of gastric GIST patients. CONCLUSIONS Bleeding risk of gastric GIST was higher when tumor had diameter > 5 cm or Ki-67 positivity. In addition, tumor bleeding, necrosis, and age ≥ 60 years were associated with poor overall survival. Endoscopic intervention can be considered as an effective method for initial hemostasis of hemorrhagic gastric GIST.

中文翻译：

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胃胃肠道间质瘤患者上消化道出血的临床结局。

背景技术上消化道出血（UGIB）是胃的胃肠道间质瘤（GIST）的主要表现之一。几项研究报道GIST出血与不良预后有关。但是，只有病例报告报道了用于治疗出血性胃GIST的止血方法。为了确定胃GIST出血的临床结局，我们分析了评估止血方法的出血性GIST的危险因素和预后。方法回顾性分析了1998年1月至2015年5月期间经组织病理学诊断为原发性胃GIST的697例患者。结果在697名患者中，有46名（6.6％）患者患有UGIB。分别在15、2和1中进行了内窥镜干预，经动脉栓塞或手术干预以止血。在平均68个月的随访中，出血组16例患者，非出血组88例死亡。出血组的5年生存率是79.4％，非出血组的5年生存率是91.8％（p = 0.004）。多因素分析表明，胃GIST出血的重要危险因素包括最大肿瘤直径> 5 cm和Ki-67阳性。年龄≥60 [危险比（HR）= 8.124，p = 0.048]，坏死（HR = 5.093，p = 0.027）和出血（HR 5.743，p = 0.034）是胃GIST患者总体生存的重要因素。结论当肿瘤直径大于5 cm或Ki-67阳性时，胃GIST的出血风险较高。此外，肿瘤出血，坏死和年龄≥60岁与总体存活率低有关。