Comparative study on the diagnosis and prognosis of moderate-high risk gastrointestinal stromal tumor treated by the specialized and non-specialized treatment clinics

DING Jia-ning; CHEN Zhi-liang; TIAN Hong-kun; JIANG Qi; DU Yu-qiang; ZENG Xiang-yu; LIU Wei-zhen; MA Xian-xiong; ZHANG Peng; TAO Kai-xiong

doi:10.19538/j.cjps.issn1005-2208.2025.05.18

Abstract：Objective To investigate the prognosis differences between the patients moderate-high risk gastrointestinal stromal tumors(GIST)treated by the surgeons from the specialized treatment group and the non-specialized treatment group.Methods The clinicopathological and prognostic data of 643 patients with moderate-high risk GIST diagnosed and treated at Union Hospital of Tongji Medical College of Huazhong University of Science and Technology between January 2013 and December 2023 were retrospectively collected.The attending doctors who cumulatively treated more than 100 cases of new-onset GIST were defined as the specialized treatment group,and the attending doctors who cumulatively treated less than 100 cases of new-onset GIST were defined as the non-specialized treatment group.The baseline and prognostic data between patients from the two groups was compared.Survival analysis was performed by Kaplan-Meier method(Log-rank test).Multivariate analysis was performed using the Cox regression analysis model.Results Compared with the non-specialized treatment group,the proportion of patients ≤60 years old in the specialized treatment group was higher(65.2％vs.54.7％,P=0.008),the proportion of laparoscopic surgery for GIST with tumor diameter＞5 cm in the specialized treatment group was higher(62.7％vs.46.7％,P＜0.001),the proportion of tumor mitotic figures greater than 10/50HPF in the specialized treatment group was lower(17.4％vs.26.6％,P=0.024),the incidence of postoperative complications of grade Ⅲ and above in the specialized treatment group was lower(4.4％vs.9.9％,P=0.010),the proportion of patients receiving genetic testing in the specialized treatment group was higher(88.5％vs.34.3％,P＜0.001),the proportion of patients receiving imatinib(IM)adjuvant therapy after surgery in the specialized treatment group was higher(91.9％vs.48.5％,P＜0.001),the proportion of patients receiving IM concentration monitoring in the specialized treatment group was higher(51.7％vs.29.0％,P＜0.001),the proportion of patients receiving IM dose adjustment in the specialized treatment group was higher(7.8％vs.1.3％,P＜0.001),the effective follow-up rate of patients in the specialized treatment group was higher(92.2％vs.87.1％,P=0.040),and the proportion of patients taking medication as prescribed by the doctor in the specialized treatment group was higher(63.3％vs.28.2％,P＜0.001),with statistically significant differences.Multivariate analysis showed that adjuvant treatment(HR=0.534,95％CI 0.306-0.931,P=0.027)and specialized treatment(HR=0.320,95％CI 0.161-0.638,P=0.001)were independent protective factors affecting the overall survival rate of patients.The 3-year recurrence free survival rate(94.4％vs.88.4％,P=0.010),the 3-year overall survival rate(97.8％vs.90.6％,P＜0.001),and the 5-year overall survival rate(96.7％vs.86.6％,P＜0.001)were significantly higher in the specialized treatment group,while The 5-year recurrence free survival rate showed no significant difference(89.6％vs.85.8％,P＞0.05).Conclusion The specialized treatment group is more precise and standardized in the overall management of GIST,which can further improve the prognosis of GIST patients.