Abstract

Background

Duodenal gastrointestinal stromal tumors (GISTs) are rare, and reports on duodenal GIST bleeding are few. We analyzed the risk factors and clinical outcomes of hemorrhagic duodenal GISTs and compared them with those of gastric GISTs.

Methods

Primary duodenal GISTs surgically diagnosed between January 1998 and December 2017 were retrospectively reviewed. Furthermore, patients with duodenal GIST were compared with those with primary gastric GIST histopathologically diagnosed between January 1998 and May 2015 using previously published data.

Results

Of the 170 total patients with duodenal GISTs, 48 (28.2%) exhibited tumor bleeding. Endoscopic intervention, embolization, and non-interventional conservative treatment were performed for initial hemostasis in 17, 1, and 30 patients, respectively. The 5-year survival rate was 81.9% in the bleeding group and 89.4% in the non-bleeding group (P = 0.495). Multivariate analysis showed that p53 positivity was a significant risk factor for duodenal GIST bleeding (hazard ratio [HR] 2.781, P = 0.012), and age ≥ 60 years (HR 3.163, P = 0.027), a large maximum diameter (comparing four groups: < 2, 2–5, 5–10, and ≥ 10 cm), and mitotic count ≥ 5/high-power field (HPF) (HR 3.265, P = 0.032) were risk factors for overall survival. The incidence of bleeding was significantly higher in duodenal GISTs than in gastric GISTs (28.2% vs. 6.6%, P < 0.001), and the re-bleeding rate after endoscopic hemostasis was also higher in duodenal GISTs than in gastric GISTs (41.2% vs. 13.3%, P = 0.118).

Conclusion

In patients with duodenal GIST with old age, large tumor diameter, and mitotic count ≥ 5/HPF, a treatment plan should be established in consideration of the poor prognosis, although tumor bleeding does not adversely affect the prognosis. Duodenal GISTs have a higher incidence of tumor bleeding and re-bleeding rate after endoscopic hemostasis than gastric GISTs.

中文翻译：

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十二指肠胃肠道间质瘤肿瘤出血的临床结果：20年的单中心经验

摘要

背景

十二指肠胃肠道间质瘤（GIST）很少见，有关十二指肠GIST出血的报道也很少。我们分析了十二指肠出血性GIST的危险因素和临床结局，并将其与胃GIST进行比较。

方法

回顾性分析1998年1月至2017年12月间手术诊断的十二指肠原发性GIST。此外，使用先前发表的数据，将1998年1月至2015年5月期间经组织病理学诊断为十二指肠GIST的患者与经组织病理学诊断为原发性胃GIST的患者进行了比较。

结果

在170名十二指肠GIST患者中，有48名（28.2％）表现出肿瘤出血。内镜介入，栓塞和非介入保守治疗分别对17例，1例和30例患者进行了止血。出血组的5年生存率是81.9％，非出血组的5年生存率是89.4％（P  = 0.495）。多因素分析表明，p53阳性是十二指肠GIST出血的重要危险因素（危险比[HR] 2.781，P  = 0.012），年龄≥60岁（HR 3.163，P  = 0.027），最大直径较大（四组比较） ：<2，2–5、5–10和≥10 cm），且有丝分裂计数≥5 /高倍视野（HPF）（HR 3.265，P = 0.032）是整体生存的危险因素。十二指肠GISTs的出血发生率明显高于胃GISTs（28.2％vs. 6.6％，P  <0.001），十二指肠GISTs内镜止血后的再出血率也高于胃GISTs（41.2％vs. 13.3％，P  = 0.118）。

结论

对于年龄较大，肿瘤直径较大且有丝分裂计数≥5 / HPF的十二指肠GIST患者，应考虑不良预后制定治疗计划，尽管肿瘤出血不会对预后产生不利影响。内镜止血后十二指肠GISTs的发生率比胃GISTs高。