Gastrointestinal Stromal Tümör Rekürrensinde Risk Faktörleri

Yıl 2021, , 3 - 10, 30.01.2021

Özgür Ekinci , Metin Leblebici , Mehmet Acar Cem Ilgın Erol , Orhan Alimoğlu

https://doi.org/10.21673/anadoluklin.755659

Öz

Amaç: Gastrointestinal stromal tümörler (GIST), gastrointestinal sistemin en yaygın mezenkimal neoplazilerindendir. Temiz sınırlı cerrahi rezeksiyon GIST tedavisinin en önemli basamaklarından birini oluşturmaktadır. Bu araştırmada primer amaç GIST tanısıyla ameliyat ettiğimiz hastalarda rekürrens için risk faktörlerini değerlendirmek, sekonder amaç ise hangi faktölerin sağkalıma etki ettiğini ortaya koymaktır.

Gereç ve Yöntem: Ocak 2013 ile Ağustos 2019 tarihleri arasında kliniğimizde cerrahi olarak tedavi edilen 28 GIST vakasının verileri retrospektif olarak incelendi. Hastalar operasyon öncesi görüntülemeler, histopatolojik ve immünohistokimyasal yönünden incelendi ve hasta bilgileri dokümante edildi.

Bulgular: Hastaların 18’i erkek, 10’u kadındı. Medyan yaş 64,5 idi. (en genç 50, en yaşlı 87). Hastaların 26’sı (%92,9) konvansiyonel, 2’si (%7,1) laparoskopik yöntemle ameliyat edildi. Hastaların 15’inde (%53,6) lezyon midede, 10’ununda (%35,7) jejenum-ileumda, 2’sinde (%7,1) duodenumda, 1’inde (%3,6) ise multifokalda yerleşimliydi. Ortalama tümör çapı 10,1cm idi (En uzun çap 21 cm, en kısa çap 0,5 cm). Hastaların 27’sinde (%96,4) DOG-1, 24’ünde (%85,7) CD117, 23’ünde (%82,1) CD-34, 9’unda (%32,1) SMA, 3’ünde (%10,7) Desmin, 2’sinde (%7,1) S-100 pozitifliği izlenildi. Toplam rekürrens görülen hasta sayısı 5 idi (%17,9). Yapılan istatistiksel analizler sonucunda tümörde nekroz olması, tümörün mide dışında bir organda yerleşmiş olması ve tümör mitoz sayısının yüksek olması rekürrens için anlamlı istatistiksel fark ortaya çıkarmıştır. Ayrıca tümör boyutunun büyük olması rekürrens için anlamlı istatistiksel farklılık ortaya çıkarmıştır. Medyan takip süresi 26 (3-60) ay idi. Yapılan analizlerde tümörde nekroz görülmesi ve tümörün iğsi hücreli tipte olması sağkalımı anlamlı ölçüte kısaltan etkenlerdi.

Sonuç: GIST rekürrensini incelediğimiz bu çalışmada tümör boyutunun büyük olması, tümör nekrozu, mitoz sayısının artmış olması ve tümörün mide dışında bir organda yerleşmiş olması rekürrens için risk faktörü olduğu gözlemlenmiştir. Çalışmanın sekonder amacı olan sağkalım sürelerini etkileyen faktörlerin ise hücre tipi ve tümör nekrozu olduğu görülmüştür.

Anahtar Kelimeler

Gastrointestinalstromal tümör, gastrointestinal sistem, mezenkimal kanser, cerrahi

Risk Factors of Gastrointestinal Stromal Tumor Recurrence

Öz

Aim: Gastrointestinal stromal tumors (GIST) are the most common mesenchymal neoplasia of gastrointestinal system. Radical surgery with negative margin is the most important step for treatment of GIST. The primary aim of this study was to evaluate the risk factors for recurrence in patients who underwent surgery with diagnosis of GIST. Secondary aim was to reveal the factors that affect survival.

Materials and Methods: The data of 28 GIST patients who underwent surgery in our clinic between January 2013 and August 2019 were analyzed retrospectively. Patients preoperative radiological images, histopathological and immunohistochemical findings were noted.

Results: Eighteen patients were male, and ten patients were female. Median age was 64.5 (range; 50-87). Twenty-six patients (92.2%) underwent open surgery and 2 patients (7.1%) underwent laparoscopic surgery. Fifteen (53.6%) of the 28 tumors were located in the stomach, 10 (35.7%) in the small intestine, 2 (7.1%) in the duodenum and 1 (3.6%) was located multifocal. Mean tumor diameter was 10.1 cm (range; 0.5-21). The number of patients with recurrence was 5 (17.9%). Tumor with necrosis, tumor located in an organ other than the stomach, and the high number of tumor mitosis revealed a significant difference for recurrence. In addition, large tumor size revealed significant statistical difference for recurrence. The median follow-up period was 26 (3-60) months. Necrosis of tumor and tumor type were the factors that significantly shortened survival.

Conclusion: In this study which we examined the GIST recurrence, it was observed that tumor size, tumor necrosis, increased number of mitosis and tumors located in an organ other than stomach are risk factors for recurrence. In this study which we examined GIST recurrence, tumor size, tumor necrosis, increased number of mitoses and tumors located in an organ other than the stomach are found to be risk factors for recurrence. It was observed that the factors affecting the survival times, which are the secondary aim of the study, were cell type and tumor necrosis.

Anahtar Kelimeler

Gastrointestinal stromal tumor, gastrointestinal system, mesenchymal cancer, surgery

Kaynakça

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