101
|
Laparoscopic Versus Open Resection for Gastric Gastrointestinal Stromal Tumors (GISTs): A Size-Location-Matched Case-Control Study. World J Surg 2018; 41:2345-2352. [PMID: 28349318 DOI: 10.1007/s00268-017-4005-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Laparoscopic resection for gastric gastrointestinal stromal tumors (GISTs) is technically feasible, but the long-term effect remains uncertain. This study aims to compare the long-term oncologic outcomes of laparoscopic versus open resection of GISTs by larger cases based on tumor size-location-matched study. METHODS Between 2006 and 2015, 63 consecutive patients with a primary gastric GIST undergoing laparoscopic resection were enrolled in and matched (1:1) to patients undergoing open resection by tumor size and location. Clinical and pathologic parameters and surgical outcomes associated with each surgical type were collected and compared. RESULTS The operation time, intraoperative blood loss, return of bowel function and oral intake, nasogastric tube retention time and postoperative stay were all shorter/faster in laparoscopic group than those in open group (P < 0.001). Postoperative complications were comparable except for the higher incidence of abdominal/incision pain in open group (9.52 vs 27%, P = 0.01). There was no statistical difference in recurrence rate (9.52 vs 15.87%, P = 0.29) and long-term recurrence-free survival between the two groups (P = 0.39). CONCLUSIONS The long-term oncologic outcome of laparoscopic resection of primary gastric GISTs is comparable to that of open procedure, but laparoscopic procedure has the advantage of minimal invasion and is superior in postoperative recovery.
Collapse
|
102
|
Hong L, Zhang T, Lin Y, Fan R, Zhang M, Cheng M, Zhou X, Sun J, Sun P, Wu Q, Wang L, Wang Z, Zhong J. Prognostic Analysis of Duodenal Gastrointestinal Stromal Tumors. Gastroenterol Res Pract 2018; 2018:4812703. [PMID: 29675040 PMCID: PMC5838428 DOI: 10.1155/2018/4812703] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 09/01/2017] [Accepted: 09/10/2017] [Indexed: 01/10/2023] Open
Abstract
AIM This study aims to analyze factors possibly related to the prognosis of duodenal gastrointestinal stromal tumors (DGISTs). METHODS We collected and retrospectively analyzed clinical and pathological data of 62 patients with primary DGISTs. All the patients were hospitalized and received complete surgical resection at Shanghai Ruijin Hospital from September 2003 to April 2015. We followed up the patients to determine survival outcomes. We also analyzed the effect of clinical and pathological factors on disease-free survival (DFS) and overall survival (OS) of the patients. RESULTS Kaplan-Meier univariate survival analysis demonstrated that tumor size, mitotic index, Ki-67 index, and pathological risk were correlated with the DFS and OS of the patients (DFS P = 0.039, 0.001, <0.001, and 0.005, resp.; OS P = 0.027, 0.007, <0.001, and 0.012, resp.). Cox multivariate regression analysis revealed that Ki-67 index was an independent prognostic factor affecting DFS and OS (P = 0.007 and 0.028, resp.). Moreover, Kaplan-Meier survival analysis showed that imatinib treatment for patients with recurrence was correlated with prolonged OS (P = 0.002). CONCLUSION Prognosis for DGIST treated by R0 resection is favorable. High level of Ki-67 can be an independent risk factor of DGIST prognosis. Adjuvant imatinib therapy for patients with tumor recurrence could probably lead to prolonged survival.
Collapse
Affiliation(s)
- Liwen Hong
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Tianyu Zhang
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yun Lin
- Department of Cadre Ward, Fujian Medical Union Hospital, Fujian, China
| | - Rong Fan
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Maochen Zhang
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Mengmeng Cheng
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaolin Zhou
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Juntao Sun
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Peijun Sun
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qiangqiang Wu
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lei Wang
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhengting Wang
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jie Zhong
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| |
Collapse
|
103
|
Retrospective analysis of 85 cases of intermediate-risk gastrointestinal stromal tumor. Oncotarget 2018; 8:10136-10144. [PMID: 28052037 PMCID: PMC5354647 DOI: 10.18632/oncotarget.14359] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 12/13/2016] [Indexed: 01/24/2023] Open
Abstract
Background & Aims A significant benefit of imatinib adjuvant therapy for patients with high risk gastrointestinal stromal tumors (GIST) has been confirmed. However, the effect of imatinib adjuvant therapy for intermediate-risk GIST has not been well studied. In this article, we compare differences of recurrence-free survival (RFS) rates between patients with intermediate-risk GIST who accepted imatinib adjuvant therapy and those who did not. Method A retrospective study of intermediate-risk GIST was conducted in the First Affiliated Hospital of Zhengzhou University, China. The pathology reports of 112 patients who had been treated by surgery showed intermediate-risk GIST. The treatment and control groups were designed according to the administration of imatinib adjuvant therapy (≥1 year). Survival and recurrence data were collected and RFS of each group was calculated. Results Eighty fivepatients with intermediate-risk GIST were followed up. Thirty of them (treatment group) accepted imatinib adjuvant therapy over 1 year. Through comparing the RFS of the two groups, we established that there was no statistically significant difference in RFS rates (P=0.940). Conclusion There is no significant benefit for patients with intermediate-risk GIST to accept imatinib adjuvant treatment.
Collapse
|
104
|
Prognostic significance of neutrophil to lymphocyte ratio in patients with gastrointestinal stromal tumors: A meta-analysis. Clin Chim Acta 2018; 477:7-12. [DOI: 10.1016/j.cca.2017.11.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 11/21/2017] [Accepted: 11/23/2017] [Indexed: 12/18/2022]
|
105
|
The Effect of Marital Status on Survival of Patients with Gastrointestinal Stromal Tumors: A SEER Database Analysis. Gastroenterol Res Pract 2018; 2018:5740823. [PMID: 29483926 PMCID: PMC5816869 DOI: 10.1155/2018/5740823] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 12/10/2017] [Indexed: 02/06/2023] Open
Abstract
Background Marital status has been reported to be a prognostic factor in multiple malignancies. However, its prognostic value on gastrointestinal stromal tumors (GISTs) have not yet been determined. The objective of the present analysis was to assess the effects of marital status on survival in patients with GISTs. Methods The Surveillance, Epidemiology, and End Results (SEER) database was used to analyze 6195 patients who were diagnosed with GISTs from 2001 to 2014. We also use Kaplan-Meier analysis and Cox regression to analyze the impact of marital status on cancer-specific survival (CSS). Results Patients in the married group had more frequency in white people, more high/moderate grade tumors, and were more likely to receive surgery. Widowed patients had a higher proportion of women, a greater proportion of older patients (>60 years), and more common site of the stomach. Multivariate analysis demonstrated that marital status was an independent prognostic factor for GISTs (P < 0.001). Married patients had better CSS than unmarried patients (P < 0.001). Subgroup analysis suggested that widowed patients had the lowest CSS compared with all other patients. Conclusions Marital status is a prognostic factor for survival in patients with GISTs, and widowed patients are at greater risk of cancer-specific mortality.
Collapse
|
106
|
Aznab M, Akhmadi SM. Long-term Results of Adjuvant Imatinib Treatment for Localized Gastrointestinal Stromal Tumors after Surgery. Asian Pac J Cancer Prev 2018; 19:39-43. [PMID: 29373890 PMCID: PMC5844634 DOI: 10.22034/apjcp.2018.19.1.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Objective: Despite the development of two significant classifications for recurrence risk evaluation among patients engaged with gastrointestinal stromal tumor and corresponding treatment criteria, recurrence happens in a number of the patients who were once classified as ineligible for treatment and hence removed from treatment program. As such, the aim of the present study is to increase the number of patients recognized as eligible for treatment, so as to further reduce recurrence rate of this disease. Materials and Methods: A total of 26 patients from Ilam, Kermanshah, Lorestan, Kurdistan, and some parts of Hamedan, entered this study from 2006 until 2016. The western provinces included have similar socioeconomical conditions. Inclusion criteria were operable tumors confirmed radiologically with a gross size larger than 3 centimeters regardless of the mitosis rate in microscopic power fields, tumor location, or presence of peritoneal involvement during the surgery. Imatinib capsules were administered daily at 400 mg for 3 years. The patients were followed up every 3 months by radiology, ultrasonography, biochemical assessment, and clinical examination. Results and Conclusions: The overall survival after 10-years follow up was 100%, while 5-year survival without relapse was 95%. Mean overall survival was 106 months, and only one patient who had limited peritoneal involvement experienced relapse and he is still alive after 2 years. The drug was well tolerated and no significant side effects were observed.
Collapse
Affiliation(s)
- Mozaffar Aznab
- Medical Hematologist-Oncologist, School of Medicine, Kermanshah University of Medical Science, Kermanshah, Iran.
| | | |
Collapse
|
107
|
Systematic review of current prognostication systems for primary gastrointestinal stromal tumors. Eur J Surg Oncol 2018; 44:388-394. [PMID: 29422251 DOI: 10.1016/j.ejso.2017.12.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 12/11/2017] [Accepted: 12/20/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The advent of tyrosine kinase inhibitors as adjuvant therapy has revolutionized the management of GIST and emphasized the need for accurate prognostication systems. Numerous prognostication systems have been proposed for GIST but at present it remains unknown which system is superior. The present systematic review aims to summarize current prognostication systems for primary treatment-naive GIST. METHODS A literature review of the Pubmed and Embase databases was performed to identify all published articles in English, from the 1st January 2002 to 28th Feb 2017, reporting on clinical prognostication systems of GIST. RESULTS Twenty-three articles on GIST prognostication systems were included. These systems were classified as categorical systems, which stratify patients into risk groups, or continuous systems, which provide an individualized form of risk assessment. There were 16 categorical systems in total. There were 4 modifications of the National Institute of Health (NIH) system, 2 modifications of Armed Forces Institute of Pathology (AFIP) criteria and 3 modifications of Joensuu (modified NIH) criteria. Of the 7 continuous systems, there were 3 prognostic nomograms, 3 mathematical models and 1 prognostic heat/contour maps. Tumor size, location and mitotic count remain the main variables used in these systems. CONCLUSION Numerous prognostication systems have been proposed for the risk stratification of GISTs. The most widely used systems today are the NIH, Joensuu modified NIH, AFIP and the Memorial Sloan Kettering Cancer Center nomogram. More validation and comparison studies are required to determine the optimal prognostication system for GIST.
Collapse
|
108
|
Prognostic role of the primary tumour site in patients with operable small intestine and gastrointestinal stromal tumours: a large population-based analysis. Oncotarget 2017; 9:8147-8154. [PMID: 29487722 PMCID: PMC5814289 DOI: 10.18632/oncotarget.23692] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 11/23/2017] [Indexed: 12/12/2022] Open
Abstract
The postoperative recurrence risk of gastrointestinal stromal tumour (GIST) should be estimated when considering adjuvant systemic therapy. Previous studies in the literature have suggested that small intestinal GISTs are more aggressive than gastric GISTs. We assessed the prognostic role of the primary tumour site in patients with operable GIST to compare the outcomes of gastric and small intestinal GISTs over a decade of treatment. The Surveillance, Epidemiology, and End Results (SEER) database was queried for cases of gastric and small intestinal GISTs between 2004 and 2014 using the GIST-specific histology code (ICD-O-3 code 8936), and only patients with tissues sampled by surgical resection were selected for this study. Cancer-specific survival (CSS) and overall survival (OS) were compared between small intestinal and gastric GISTs using Cox regression analyses. GISTs were located in the stomach (n = 2594, 65%), duodenum (n = 228, 6%), and jejunum/ileum (n = 1176, 29%). The OS and CSS of patients with GISTs in the duodenum and jejunum/ileum were similar to those of patients with gastric GISTs in Cox regression analyses, except for the CSS of patients with tumour sizes 2.1-5 cm in diameter and ≤ 5 mitoses per 50 HPFs (HR 1.657; 95% CI 1.062-2.587, p = 0.026). Tumours sizes 2.1–5 cm in diameter and > 5 mitoses per 50 HPFs (HR 4.627; 95% CI 1.035-20.67, p = 0.045) in jejunal/ileal GIST locations had significantly worse CSS than did those in gastric GIST locations. In this large nationwide study, the primary tumour site was not an independent prognostic factor in patients with operable small intestinal and gastric GISTs.
Collapse
|
109
|
Park CH, Kim GH, Lee BE, Song GA, Park DY, Choi KU, Kim DH, Jeon TY. Two staging systems for gastrointestinal stromal tumors in the stomach: which is better? BMC Gastroenterol 2017; 17:141. [PMID: 29207963 PMCID: PMC5718111 DOI: 10.1186/s12876-017-0705-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 11/24/2017] [Indexed: 12/23/2022] Open
Abstract
Background The prognosis of a gastrointestinal stromal tumor (GIST) is influenced by its anatomic site; however, few studies on the prognosis of gastric GISTs have been reported. The aims of this study were to evaluate long-term prognoses of patients who underwent surgical resection for gastric GISTs and to compare the clinical efficacy of two staging systems: the National Institutes of Health (NIH) consensus criteria and the 7th Union for International Cancer Control/American Joint Committee on Cancer (UICC/AJCC) tumor-node-metastasis (TNM) staging system. Methods We conducted a retrospective observational study of 145 patients who underwent surgical resection for gastric GISTs between February 2001 and June 2012 at Pusan National University Hospital (Busan, Korea). Recurrence and 5-year recurrence-free survival (RFS) rates were analyzed. Results During a median follow-up period of 44 months (range, 6–144 months), 11 recurrent lesions were detected in 9 patients (6.4%). On multivariate analysis, tumor size (>5 cm), mitotic count (>5/50 high-power fields), and epithelioid and mixed pathological type were significantly associated with recurrence. The overall 5-year RFS rate was 93.4%. Although no statistically significant differences were detected (C-statistic difference P = 0.886), all metrics showed lower values for the UICC/AJCC TNM staging system than for the NIH consensus criteria, suggesting that the UICC/AJCC TNM staging system may be a better model. Conclusions The 5-year RFS rate in patients who underwent curative resection for gastric GISTs was excellent. The UICC/AJCC TNM staging system may be more useful than the NIH consensus criteria for risk categorization of patients with gastric GISTs.
Collapse
Affiliation(s)
- Chul Hong Park
- Department of Internal Medicine, Pusan National University School of Medicine, and Biomedical Research Institute Pusan National University Hospital, 179, Gudeok-ro, Seo-Gu, Busan, 49241, South Korea
| | - Gwang Ha Kim
- Department of Internal Medicine, Pusan National University School of Medicine, and Biomedical Research Institute Pusan National University Hospital, 179, Gudeok-ro, Seo-Gu, Busan, 49241, South Korea.
| | - Bong Eun Lee
- Department of Internal Medicine, Pusan National University School of Medicine, and Biomedical Research Institute Pusan National University Hospital, 179, Gudeok-ro, Seo-Gu, Busan, 49241, South Korea
| | - Geun Am Song
- Department of Internal Medicine, Pusan National University School of Medicine, and Biomedical Research Institute Pusan National University Hospital, 179, Gudeok-ro, Seo-Gu, Busan, 49241, South Korea
| | - Do Youn Park
- Department of Pathology, Pusan National University School of Medicine, Busan, South Korea
| | - Kyung Un Choi
- Department of Pathology, Pusan National University School of Medicine, Busan, South Korea
| | - Dae Hwan Kim
- Department of Surgery, Pusan National University School of Medicine, Busan, South Korea
| | - Tae Yong Jeon
- Department of Surgery, Pusan National University School of Medicine, Busan, South Korea
| |
Collapse
|
110
|
Adjuvant imatinib for patients with high-risk gastrointestinal stromal tumors: a retrospective cohort study. Sci Rep 2017; 7:16834. [PMID: 29203825 PMCID: PMC5715066 DOI: 10.1038/s41598-017-17266-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 11/23/2017] [Indexed: 02/07/2023] Open
Abstract
The duration of adjuvant imatinib for high-risk patients with gastrointestinal stromal tumors (GISTs) is still controversial. Therefore, we retrospectively analyzed the data of high-risk patients with GISTs to investigate the appropriate duration. All 185 patients were divided into 4 groups: <1 year (Group A), 1–2 years (Group B), 2–3 years (Group C) and >3 years (Group D). The mean recurrence-free survival (RFS) in Groups A, B, and C were 44.3, 62.1, and 86.8 months, respectively (P < 0.001); the mean overall survival (OS) in Groups A, B and C was 75.2, 88.1, and 94.7 months, respectively (P = 0.009). The 5-year RFS in Groups A, B, C, and D was 15%, 26%, 83%, and 100%, respectively (P < 0.001); and the 5-year OS was 64%, 88%, 88%, and 100%, respectively (P < 0.001). The greatest impact on unfavorable outcomes was the tumor mitotic rate (HR, 2.01, 95% CI, 1.38–2.94; P < 0.001). Duration of adjuvant imatinib was the only favorable factor (HR, −0.95, 95% CI, 0.93–0.97; P < 0.001). For high-risk patients with high tumor size or mitotic rate, or non-gastric GISTs, we recommend that more than 3 years of adjuvant imatinib is feasible.
Collapse
|
111
|
Mandrioli M, Mastrangelo L, Masetti M, Zanini N, Lega S, Nannini M, Gruppioni E, Altimari A, Dei Tos AP, Fabbri C, Jovine E. Characterization of malignant gastrointestinal stromal tumors-a single center experience. J Gastrointest Oncol 2017; 8:1037-1045. [PMID: 29299364 DOI: 10.21037/jgo.2017.10.09] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background The recurrence rate, related to the unpredictable behavior of gastrointestinal stromal tumors (GISTs), continues to be a major topic of investigation, since no actual risk evaluation scales have proven to be exceedingly effective in predicting prognosis. We therefore focus in this study on investigating the predictive variables of disease recurrence. Methods Between September 2004 and January 2011, 34 patients, 18 males and 16 females with a median age of 62 (range, 27-87) years, underwent operations for primary, localized and advanced GISTs. Immunohistochemical profile, KIT and the platelet-derived growth factor receptor-alpha (PDGFR-α) gene mutations, tumor size, tumor site, mitotic index, synchronous tumors, adjuvant therapy, symptoms and gender were considered and analyzed as predictive variables. The receiver operating characteristic (ROC) analysis was used to determine the optimal cut-off value for tumor dimension to predict recurrence. Results The median follow-up (FU) was 20 months (range, 6-86 months). A first-line adjuvant therapy was performed in nine patients. Disease relapse occurred in five cases. The tumor size and the mitotic index were the strongest predictive factors (P<0.001). The optimal maximum value for the tumor size was 7 cm [area under the curve (AUC) =0.955]. Conclusions In light of the most recent evidence, a tumor size of 7 cm should be considered the threshold value for malignancy, and smaller GISTs with low mitotic counts as tumors with a low-grade risk.
Collapse
Affiliation(s)
- Matteo Mandrioli
- Department of Surgery, C. A. Pizzardi Maggiore Hospital, Bologna, Italy
| | - Laura Mastrangelo
- Department of Surgery, C. A. Pizzardi Maggiore Hospital, Bologna, Italy
| | - Michele Masetti
- Department of Surgery, C. A. Pizzardi Maggiore Hospital, Bologna, Italy
| | - Nicola Zanini
- Department of Surgery, C. A. Pizzardi Maggiore Hospital, Bologna, Italy
| | - Stefania Lega
- Department of Pathology, C. A. Pizzardi Maggiore Hospital, Bologna, Italy
| | - Margherita Nannini
- Department of Hematology and Oncology Sciences, L. A. Seragnoli, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Elisa Gruppioni
- Molecular and Transplantation Pathology Laboratory, F. Addari Institute of Oncology, University of Bologna, Bologna, Italy
| | - Annalisa Altimari
- Molecular and Transplantation Pathology Laboratory, F. Addari Institute of Oncology, University of Bologna, Bologna, Italy
| | | | - Carlo Fabbri
- Division of Gastroenterology, C. A. Pizzardi Maggiore Hospital, Bologna, Italy
| | - Elio Jovine
- Department of Surgery, C. A. Pizzardi Maggiore Hospital, Bologna, Italy
| |
Collapse
|
112
|
Abstract
GOALS The present study aimed to investigate the clinicopathologic features and prognosis of pancreatic gastrointestinal stromal tumor (GIST). BACKGROUND Reports on clinicopathologic features and prognosis of pancreatic GIST are limited due to the extremely rare incidence. STUDY One case of pancreatic GIST from our center and 44 cases reported in MEDLINE were enrolled in this study. Clinicopathologic features and prognosis of pancreatic GISTs were analyzed and compared with 297 gastric GISTs from our center. RESULTS The most common location was head of pancreas (38.5%). The majority of pancreatic GISTs exceeded 5 cm (74.4%), displayed cystic or mixed imaging features (56.4%), and were high risk (85.7%). The 5-year disease-free survival (DFS) and disease-specific survival rates were 66.1% and 95.8%, respectively. Mitotic index was the only risk factor for DFS of pancreatic GISTs. The distribution of tumor size, histologic type and National Institutes of Health risk category were significantly different between pancreatic and gastric GISTs. The 5-year DFS rate of pancreatic GISTs was significantly lower than that of gastric GISTs. Multivariate analysis showed that location was an independent prognostic factor for DFS between pancreatic and gastric GISTs. CONCLUSIONS The most common location was head of pancreas. The majority of pancreatic GISTs were large and highly malignant. Pancreatic GISTs differed significantly from gastric GISTs in respect to clinicopathologic features. The DFS of pancreatic GISTs was worse than that of gastric GISTs.
Collapse
|
113
|
Kim JJ, Lim JY, Nguyen SQ. Laparoscopic resection of gastrointestinal stromal tumors: Does laparoscopic surgery provide an adequate oncologic resection? World J Gastrointest Endosc 2017; 9:448-455. [PMID: 28979709 PMCID: PMC5605344 DOI: 10.4253/wjge.v9.i9.448] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 06/30/2017] [Accepted: 07/24/2017] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are rare tumors of the GI tract. Surgical resection remains the mainstay of non-metastatic disease. However, the ability to provide an adequate oncologic resection using laparoscopic surgery is still an area of debate. This is a thorough review of the current literature, looking particularly at the use of laparoscopic surgery for larger GISTs and the long-term oncologic outcomes compared to the results of open surgery. Laparoscopic resections provide an adequate oncologic result for GISTs of all sizes, including those greater than 5 cm in size.
Collapse
Affiliation(s)
- Joseph J Kim
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - James Y Lim
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Scott Q Nguyen
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| |
Collapse
|
114
|
Validation of a Mitotic Index Cutoff as a Prognostic Marker in Undifferentiated Uterine Sarcomas. Am J Surg Pathol 2017. [DOI: 10.1097/pas.0000000000000894] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
|
115
|
Hedenström P, Nilsson B, Demir A, Andersson C, Enlund F, Nilsson O, Sadik R. Characterizing gastrointestinal stromal tumors and evaluating neoadjuvant imatinib by sequencing of endoscopic ultrasound-biopsies. World J Gastroenterol 2017; 23:5925-5935. [PMID: 28932084 PMCID: PMC5583577 DOI: 10.3748/wjg.v23.i32.5925] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 04/26/2017] [Accepted: 06/19/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate endoscopic ultrasound (EUS)-guided biopsies for the pretreatment characterization of gastrointestinal stromal tumors (GIST) to personalize the management of patients.
METHODS All patients with lesions suspected to be GIST who were referred for EUS-sampling at a tertiary Swedish center were eligible for inclusion 2006-2015. During the observational study phase (2006-2011), routine fine-needle-aspiration (EUS-FNA) was performed. In 2012-2015, we converted to an interventional, randomized protocol with dual sampling EUS-FNA and fine-needle-biopsy-sampling (EUS-FNB) for all lesions. c-KIT- and DOG-1-immunostaining was attempted in all samples and a manual count of the Ki-67-index was performed. FNB-sampled tissue and the resected specimens were subjected to Sanger sequencing of the KIT and platelet-derived growth factor alpha (PDGFRA) genes.
RESULTS In all, 64 unique patients with GIST were included, and of these, 38 were subjected to pretreatment dual sampling. EUS-FNB had a higher diagnostic sensitivity when compared head-to-head with EUS-FNA (98% vs 58%, P < 0.001) and was more adequate for Ki-67-indexing (Ki-67EUS) (92% vs 40%, P < 0.001). Sequencing of EUS-biopsies was successful in 43/44 (98%) patients, and the mutation profiles (KIT-mutation 73%, PDGFRA-mutation 18%, wild-type 7%) were fully congruent with those detected in the corresponding resected specimens. In imatinib-naïve patients, the Ki-67EUS was comparable with the Ki-67-index in the corresponding surgical specimens (Ki-67SURG) (2.7% vs 2.9%, P = 0.68). In patients treated with neoadjuvant imatinib who also carried mutations indicating sensitivity, the Ki-67EUS was higher than the Ki-67SURG (2.5% vs 0.2%, P = 0.005), with a significant reduction in the Ki-67-index of -91.5% (95%CI: -82.4 to -96.0, P = 0.005).
CONCLUSION EUS-guided biopsy sampling is accurate for the pretreatment diagnosis and characterization of GISTs and allows the prediction and evaluation of tumor response to neoadjuvant imatinib therapy.
Collapse
Affiliation(s)
- Per Hedenström
- Division of Medical Gastroenterology, Department of Internal Medicine, Sahlgrenska University Hospital, S-413 45 Gothenburg, Sweden
| | - Bengt Nilsson
- Department of Surgery, Sahlgrenska University Hospital, S-413 45 Gothenburg, Sweden
| | - Akif Demir
- Department of Clinical Pathology and Genetics, Sahlgrenska University Hospital, S-413 45 Gothenburg, Sweden
| | - Carola Andersson
- Department of Clinical Pathology and Genetics, Sahlgrenska University Hospital, S-413 45 Gothenburg, Sweden
| | - Fredrik Enlund
- Department of Clinical Pathology and Genetics, Sahlgrenska University Hospital, S-413 45 Gothenburg, Sweden
| | - Ola Nilsson
- Department of Clinical Pathology and Genetics, Sahlgrenska University Hospital, S-413 45 Gothenburg, Sweden
| | - Riadh Sadik
- Division of Medical Gastroenterology, Department of Internal Medicine, Sahlgrenska University Hospital, S-413 45 Gothenburg, Sweden
| |
Collapse
|
116
|
Khalikov DD, Akhmetzyanov FS, Petrov SV. [Clinical and morphological characteristics of gastrointestinal stromal tumors]. Arkh Patol 2017; 79:48-55. [PMID: 28791999 DOI: 10.17116/patol201779448-55] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. Despite this, GISTS comprise about 2% in the structure of digestive tract cancers. They are usually localized in the stomach; however, they can be found in the small intestine and more rarely in the colon and esophagus. Although approximately 70% of the GISTs consist predominantly of spindle cells; the epithelioid cell tumors represent 20% of cases; there are also mixed variants. This variability in the morphological structure of GISTs complicates their diagnosis.
Collapse
Affiliation(s)
- D D Khalikov
- Kazan State Medical University, Ministry of Health of the Russian Federation, Kazan, Russia; Republican Clinical Oncology Dispensary, Ministry of Heath of the Republic of Tatarstan, Kazan, Russia
| | - F Sh Akhmetzyanov
- Kazan State Medical University, Ministry of Health of the Russian Federation, Kazan, Russia; Republican Clinical Oncology Dispensary, Ministry of Heath of the Republic of Tatarstan, Kazan, Russia; Volga Branch, N.N. Blokhin Russian Cancer Research Center, Ministry of Health of the Russian Federation, Kazan, Russia
| | - S V Petrov
- Kazan State Medical University, Ministry of Health of the Russian Federation, Kazan, Russia; Republican Clinical Oncology Dispensary, Ministry of Heath of the Republic of Tatarstan, Kazan, Russia; Volga Branch, N.N. Blokhin Russian Cancer Research Center, Ministry of Health of the Russian Federation, Kazan, Russia
| |
Collapse
|
117
|
Contemporary Patterns and Survival Outcome of Adjuvant Systemic Therapy for Localized Gastrointestinal Stromal Tumors. Am J Clin Oncol 2017; 40:399-404. [DOI: 10.1097/coc.0000000000000175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
118
|
Joensuu H, Wardelmann E, Sihto H, Eriksson M, Sundby Hall K, Reichardt A, Hartmann JT, Pink D, Cameron S, Hohenberger P, Al-Batran SE, Schlemmer M, Bauer S, Nilsson B, Kallio R, Junnila J, Vehtari A, Reichardt P. Effect of KIT and PDGFRA Mutations on Survival in Patients With Gastrointestinal Stromal Tumors Treated With Adjuvant Imatinib: An Exploratory Analysis of a Randomized Clinical Trial. JAMA Oncol 2017; 3:602-609. [PMID: 28334365 DOI: 10.1001/jamaoncol.2016.5751] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Importance Little is known about whether the duration of adjuvant imatinib influences the prognostic significance of KIT proto-oncogene receptor tyrosine kinase (KIT) and platelet-derived growth factor receptor α (PDGFRA) mutations. Objective To investigate the effect of KIT and PDGFRA mutations on recurrence-free survival (RFS) in patients with gastrointestinal stromal tumors (GISTs) treated with surgery and adjuvant imatinib. Design, Setting, and Participants This exploratory study is based on the Scandinavian Sarcoma Group VIII/Arbeitsgemeinschaft Internistische Onkologie (SSGXVIII/AIO) multicenter clinical trial. Between February 4, 2004, and September 29, 2008, 400 patients who had undergone surgery for GISTs with a high risk of recurrence were randomized to receive adjuvant imatinib for 1 or 3 years. Of the 397 patients who provided consent, 341 (85.9%) had centrally confirmed, localized GISTs with mutation analysis for KIT and PDGFRA performed centrally using conventional sequencing. During a median follow-up of 88 months (completed December 31, 2013), 142 patients had GIST recurrence. Data of the evaluable population were analyzed February 4, 2004, through December 31, 2013. Main Outcomes and Measures The main outcome was RFS. Mutations were grouped by the gene and exon. KIT exon 11 mutations were further grouped as deletion or insertion-deletion mutations, substitution mutations, insertion or duplication mutations, and mutations that involved codons 557 and/or 558. Results Of the 341 patients (175 men and 166 women; median age at study entry, 62 years) in the 1-year group and 60 years in the 3-year group), 274 (80.4%) had GISTs with a KIT mutation, 43 (12.6%) had GISTs that harbored a PDGFRA mutation, and 24 (7.0%) had GISTs that were wild type for these genes. PDGFRA mutations and KIT exon 11 insertion or duplication mutations were associated with favorable RFS, whereas KIT exon 9 mutations were associated with unfavorable outcome. Patients with KIT exon 11 deletion or insertion-deletion mutation had better RFS when allocated to the 3-year group compared with the 1-year group (5-year RFS, 71.0% vs 41.3%; P < .001), whereas no significant benefit from the 3-year treatment was found in the other mutational subgroups examined. KIT exon 11 deletion mutations, deletions that involved codons 557 and/or 558, and deletions that led to pTrp557_Lys558del were associated with poor RFS in the 1-year group but not in the 3-year group. Similarly, in the subset with KIT exon 11 deletion mutations, higher-than-the-median mitotic counts were associated with unfavorable RFS in the 1-year group but not in the 3-year group. Conclusions and Relevance Patients with KIT exon 11 deletion mutations benefit most from the longer duration of adjuvant imatinib. The duration of adjuvant imatinib modifies the risk of GIST recurrence associated with some KIT mutations, including deletions that affect exon 11 codons 557 and/or 558. Trial Registration clinicaltrials.gov Identifier: NCT00116935.
Collapse
Affiliation(s)
- Heikki Joensuu
- Department of Oncology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Eva Wardelmann
- Gerhard Domagk Institute of Pathology, University Hospital Münster, Münster, Germany
| | - Harri Sihto
- Laboratory of Molecular Oncology and Translational Cancer Biology Program, Biomedicum, University of Helsinki, Helsinki, Finland
| | - Mikael Eriksson
- Department of Oncology, Skåne University Hospital and Lund University, Lund, Sweden
| | - Kirsten Sundby Hall
- Department of Oncology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Annette Reichardt
- Sarkomzentrum Berlin-Brandenburg, HELIOS Klinikum Berlin-Buch, Berlin, Germany
| | - Jörg T Hartmann
- Department of Hematology, Oncology, Immunology, Franziskus Hospital, Catholic Hospital Consortium Ostwestfalen, Bielefeld, Germany
| | - Daniel Pink
- Department of Hematology, Oncology and Palliative Care, HELIOS Klinikum Bad Saarow, Germany
| | - Silke Cameron
- Department of Gastroenterology/Endocrinology, University of Göttingen, Göttingen, Germany
| | - Peter Hohenberger
- Division of Surgical Oncology & Thoracic Surgery, Mannheim University Medical Center, Mannheim, Germany
| | - Salah-Eddin Al-Batran
- Clinical Cancer Research, Krankenhaus Nordwest, Universitäres Centrum für Tumorerkrankungen University Cancer Center Frankfurt, Frankfurt, Germany
| | - Marcus Schlemmer
- Department of Internal Medicine III, University Hospital-Großhadern, Ludwig Maximilians University, Munich, Germany
| | - Sebastian Bauer
- Sarcoma Center, West German Cancer Center, University of Duisburg-Essen, Essen, Germany
| | - Bengt Nilsson
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Raija Kallio
- Department of Oncology and Radiotherapy, Oulu University Hospital, Oulu, Finland
| | | | - Aki Vehtari
- Helsinki Institute for Information Technology, Department of Computer Science, Aalto University, Espoo, Finland
| | - Peter Reichardt
- Sarkomzentrum Berlin-Brandenburg, HELIOS Klinikum Berlin-Buch, Berlin, Germany
| |
Collapse
|
119
|
Robotic Versus Laparoscopic Gastric Resection for Primary Gastrointestinal Stromal Tumors >5 cm: A Size-Matched and Location-Matched Comparison. Surg Laparosc Endosc Percutan Tech 2017; 27:65-71. [PMID: 28079762 DOI: 10.1097/sle.0000000000000371] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This study compared robotic (RR) and laparoscopic resection (LR) for primary gastrointestinal stromal tumors (GISTs) of the stomach >5 cm. Twelve consecutive patients who underwent RR from 2012 to 2015 were matched for tumor size and location with 24 patients who underwent LR from 2000 to 2012. The median tumor size was 7.1 cm (range, 5.5 to 11.5). GISTs were resected by wedge resection (91.7%) or distal gastrectomy. The median RR operative time was longer than that of LR (162.5 vs. 130 min, respectively; P=0.004). Only 1 LR patient required conversion. The time to flatus and hospital stay were similar between groups. Overall, 3 patients developed minor postoperative complications that were medically treated. Mortality was nil. All resections were R0. No difference was observed in the incidence of recurrence. RR was significantly more expensive (+21.6%) than LR. RR appears to be safe and feasible for GISTs>5 cm, but is associated with longer operative times and greater costs.
Collapse
|
120
|
Case report of diffusely metastatic rectal GIST. Int J Surg Case Rep 2017; 37:4-9. [PMID: 28605620 PMCID: PMC5470555 DOI: 10.1016/j.ijscr.2017.05.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 05/25/2017] [Accepted: 05/27/2017] [Indexed: 02/02/2023] Open
Abstract
Rectal gastrointestinal tumors (GISTs) are rare mesenchymal tumors. Rectal GISTs are extremely rare and account for approximately 2% of all GIST tumors. Majority of GISTs have a benign course. Treatment with imatinib mesylate should be arranged as soon as possible. The most common cause of death after resection of a rectal GIST is distant metastasis.
This is a case report of an aggressive, diffusely disseminated Stage IV rectal gastrointestinal stromal tumor (GIST) in a 57-year-old male that presented for symptoms of malaise, constipation, and twenty pound weight loss in 2 months. Upon rectal examination, a hard 4 centimeter submucosal mass was found at the 9–12 o’clock position. Liver and lung metastases were visualized on computerized tomography (CT) of the chest, abdomen, and pelvis on metastatic work-up. He was deemed a poor surgical candidate due to diffuse metastatic disease and referred for palliative chemotherapy. The patient had suffered a perforation of his rectal wall two weeks after his initial presentation and passed away shortly thereafter. He never received palliative chemotherapy. We present a case report as a unique case of an extremely aggressive and quickly fatal GIST tumor.
Collapse
|
121
|
Phase II study of neoadjuvant imatinib in large gastrointestinal stromal tumours of the stomach. Br J Cancer 2017; 117:25-32. [PMID: 28535156 PMCID: PMC5520207 DOI: 10.1038/bjc.2017.144] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 04/15/2017] [Accepted: 04/26/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Gastrointestinal stromal tumours (GISTs) with high-risk features have poor prognosis even if adjuvant treatment is given. Neoadjuvant imatinib may increase the cure rate by shrinking large GISTs and preserve organ function. METHODS We conducted an Asian multinational phase II study for patients with gastric GISTs ≥10 cm. Patients received neoadjuvant imatinib (400 mg/day) for 6-9 months. The primary end point was R0 resection rate. RESULTS A total of 56 patients were enroled in this study. In the full analysis set of 53 patients, neoadjuvant imatinib for ≥6 months was completed in 46 patients. Grade 3-4 neutropenia and rash occurred in 8% and 9%, respectively, but there were no treatment-related deaths. The response rate by RECIST was 62% (95% CI, 48-75%). The R0 resection rate was 91% (48/53) (95% CI, 79-97%). Preservation of at least half of the stomach was achieved in 42 of 48 patients with R0 resection. At the median follow-up time of 32 months, 2-year overall and progression-free survival rates were 98% and 89%, respectively. CONCLUSIONS Neoadjuvant imatinib treatment for 6-9 months is a promising treatment for large gastric GISTs, allowing a high R0 resection rate with acceptable toxicity.
Collapse
|
122
|
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasm of the gastrointestinal tract. The stomach is the most common site of origin. Management of GISTs changed after the introduction of molecularly targeted therapies. Although the only potentially curative treatment of resectable primary GISTs is surgery, recurrence is common. Patients with primary GISTs at intermediate or high risk of recurrence should receive imatinib postoperatively. Imatinib is also first-line therapy for advanced disease. Cytoreductive surgery might be considered in advanced GIST for patients with stable/responding disease or limited focal progression on tyrosine kinase inhibitor therapy. GIST requires multidisciplinary management.
Collapse
Affiliation(s)
- Emily Z Keung
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1484, Houston, TX 77030, USA
| | - Chandrajit P Raut
- Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02115, USA.
| |
Collapse
|
123
|
Yu C, Liao G, Fan C, Yu J, Nie X, Yang S, Bai J. Long-term outcomes of endoscopic resection of gastric GISTs. Surg Endosc 2017; 31:4799-4804. [PMID: 28424911 DOI: 10.1007/s00464-017-5557-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 04/01/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Although the endoscopic treatment of gastric stromal tumors is a recently accepted therapy, the long-term outcomes of this approach remain unknown. The aims of this study were to assess the long-term effectiveness and safety of endoscopic resection for gastric GISTs. METHODS A total of 60 consecutive patients undergoing endoscopic resection of gastric GISTs were enrolled in a retrospective single-center study. Clinical data, perioperative complications, histopathologic characteristics of the tumors, and long-term outcomes were recorded. RESULTS Sixty patients successfully underwent complete resection of lesions, including 25 cases of endoscopic submucosal dissection (ESD) and 35 cases of endoscopic full-thickness resection (EFTR), with an average tumor size of 1.76 ± 1.55 cm (range 0.5-7.6 cm). The average operation time was 43.97 ± 26.95 min (range 11.7-138.9 min). Two cases were observed with an intraoperative hemorrhage of 200 mL, which were successfully managed by hemostatic forceps. Perforations of 2-11 mm of ESD occurred in four cases (4/25) and were well closed with endoclips, with no conversions to surgical operation. Mucosal laceration of esophagus occurred in 1 case, when a large tumor was removed. The average length of hospitalization was 6.50 ± 3.06 days (range 3-21 days). Out of a total of 60 patients, 44 (73.3%) were at very low risk, 10 (16.7%) were at low risk, 5 (8.3%) were at intermediate risk, and 1 (1.7%) was at high risk. All patients were followed-up for 36.15 ± 12.92 months (range 14-73 months). Primary tumor recurrence occurred in 1 patient who underwent a second operation after 32 months, and no other cases were observed to have either tumor recurrence or metastasis. CONCLUSIONS For long-term outcomes, endoscopic resection of ESD or EFTR is a safe and effective approach for removing gastric stromal tumors (<5 cm), and it can be a resection technique for them with no metastasis.
Collapse
Affiliation(s)
- Changji Yu
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Guobin Liao
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Chaoqiang Fan
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Jing Yu
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Xubiao Nie
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Shiming Yang
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Chongqing, China.
| | - Jianying Bai
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Chongqing, China.
| |
Collapse
|
124
|
Loureiro MDP, Almeida RAAD, Claus CMP, Bonin EA, Cury-Filho AM, Dimbarre D, Costa MARD, Vital ML. LAPAROSCOPIC RESECTION OF GASTROINTESTINAL STROMAL TUMORS (GIST). ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2017; 29:1-4. [PMID: 27120729 PMCID: PMC4851140 DOI: 10.1590/0102-6720201600010001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 11/19/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Gastrointestinal mesenchymal or stromal tumors (GIST) are lesions originated on digestive tract walls, which are treated by surgical resection. Several laparoscopic techniques, from gastrectomies to segmental resections, have been used successfully. AIM Describe a single center experience on laparoscopic GIST resection. METHOD Charts of 15 operated patients were retrospectively reviewed. Thirteen had gastric lesions, of which ten were sub epithelial, ranging from 2-8 cm; and three were pure exofitic growing lesions. The remaining two patients had small bowel lesions. Surgical laparoscopic treatment consisted of two distal gastrectomies, 11 wedge gastric resections and two segmental enterectomies. Mechanical suture was used in the majority of patients except on six, which underwent resection and closure using manual absorbable sutures. There were no conversions to open technique. RESULTS Mean operative time was 1h 29 min±92 (40-420 min). Average lenght of hospital stay was three days (2-6 days). There were no leaks, postoperative bleeding or need for reintervention. Mean postoperative follow-up was 38±17 months (6-60 months). Three patients underwent adjuvant Imatinib treatment, one for recurrence five months postoperatively and two for tumors with moderate risk for recurrence . CONCLUSION Laparoscopic GIST resection, not only for small lesions but also for tumors above 5 cm, is safe and acceptable technique.
Collapse
|
125
|
Skeletal Muscle Metastasis of a GIST: A Case Report and Review of the Literature. Case Rep Surg 2017; 2016:7867545. [PMID: 28116208 PMCID: PMC5220413 DOI: 10.1155/2016/7867545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 11/29/2016] [Indexed: 12/17/2022] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common malignant mesenchymal tumors of the gastrointestinal tract. The most common sites of metastasis are the liver and the peritoneum, whereas metastasis to soft tissue is rare. The authors present the case of a 78-year-old male with a soft tissue metastasis of a GIST and the current literature is reviewed.
Collapse
|
126
|
Ignee A, Jenssen C, Hocke M, Dong Y, Wang WP, Cui XW, Woenckhaus M, Iordache S, Saftoiu A, Schuessler G, Dietrich CF. Contrast-enhanced (endoscopic) ultrasound and endoscopic ultrasound elastography in gastrointestinal stromal tumors. Endosc Ultrasound 2017; 6:55-60. [PMID: 28218202 PMCID: PMC5331845 DOI: 10.4103/2303-9027.200216] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background and Objectives: Gastrointestinal stromal tumors (GISTs) represent the largest group of subepithelial tumors (SET) of the upper gastrointestinal (GI) tract. They may show malignant behavior, in contrast to other SET. Endoscopic ultrasound (EUS) is frequently used to characterize SET. With the introduction of contrast-enhanced ultrasound (CEUS) into EUS (CE-EUS), distinct enhancement patterns can be detected. In the presented study, the characteristic features of CE-EUS in GIST are analyzed and compared with those of other SET. Materials and Methods: Consecutive patients from four centers with SET of the upper and middle GI tract were included and received endoscopic or transcutaneous CEUS. The results were compared with EUS-guided tissue acquisition, forceps biopsy, or surgical resection. Results: Forty-two out of 62 (68%) patients had SET of the stomach, 17/62 (27%) of the small intestine, 2/62 (3%) of the esophagus, and 1/62 (2%) extraintestinal. Eighty-one percent underwent surgery. Leiomyoma was found in 5/62 (8%) and GIST in 57/62 patients (92%). Thirty-nine out of 57 (68%) patients had GIST lesions in the stomach, 17/57 (30%) had GIST of the small intestine, and 1/57 (2%) patients had extraintestinal GISTs. GIST size was 62.6 ± 42.1 (16–200) mm. Hyperenhancement had a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 98%, 100%, 100%, 93%, and 98% for the diagnosis of GIST. Fifty out of 57 patients with GIST (88%) showed avascular areas in the center of the lesions. Conclusion: CE-EUS and CEUS show hyperenhancement and avascular areas in a high percentage of GIST but not in leiomyoma. Thus, GIST and leiomyoma can be discriminated accurately.
Collapse
Affiliation(s)
- Andre Ignee
- Caritas-Krankenhaus, Bad Mergentheim, Germany
| | - Christian Jenssen
- Krankenhaus Märkisch Oderland, Wriezen, Akademisches Lehrkrankenhaus Medizinische Hochschule Brandenburg, Germany
| | | | - Yi Dong
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wen-Ping Wang
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xin-Wu Cui
- The Department of Medical Ultrasound, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | | | | | - Adrian Saftoiu
- Research Center in Gastroenterology and Hepatology, Craiova, Romania
| | | | | |
Collapse
|
127
|
Weldon CB, Madenci AL, Boikos SA, Janeway KA, George S, von Mehren M, Pappo AS, Schiffman JD, Wright J, Trent JC, Pacak K, Stratakis CA, Helman LJ, La Quaglia MP. Surgical Management of Wild-Type Gastrointestinal Stromal Tumors: A Report From the National Institutes of Health Pediatric and Wildtype GIST Clinic. J Clin Oncol 2016; 35:523-528. [PMID: 28029307 DOI: 10.1200/jco.2016.68.6733] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Purpose Wild-type gastrointestinal stromal tumors (WT-GISTs) that lack KIT or PDGFRA mutations represent a unique subtype of GIST that predominantly affects children. We sought to determine the effect on event-free survival (EFS) of staging variables, extent of resection, and repeat resection of tumors. Methods In 2008, a WT-GIST clinic was established at the National Cancer Institute, allowing the development of a large clinical database. We included participants who underwent resection of WT-GIST. Associations with EFS (ie, freedom from disease progression or recurrence) were evaluated using the Kaplan-Meier method and Cox proportional hazards modeling. Results Among 76 participants with WT-GISTs, the median follow-up was 4.1 years. Overall EFS (± SE) was 72.6 ± 5.4% at 1 year, 57.6 ± 6.2% at 2 years, 23.7 ± 6.0% at 5 years, and 16.3 ± 5.5% at 10 years postoperatively. Hazard of disease progression or recurrence was significantly increased for patients with metastatic disease (adjusted hazard ratio [AHR], 2.3; 95% CI, 1.0 to 5.1; P = .04) and > 5 mitoses per 50 high-power fields (AHR, 2.5; 95% CI, 1.1 to 6.0; P = .03), whereas there was no significant effect of negative microscopic resection margins (AHR, 0.9; 95% CI, 0.4 to 2.2; P = 0.86). There was no association between type of gastric resection (ie, anatomic v partial/wedge) and EFS ( P = .67). Repeated resection after the initial resection was significantly associated with decreasing postoperative EFS ( P < .01). Five patients (6%) died after initial enrollment in 2008. Conclusion WT-GIST is an indolent disease, and most patients survive with disease progression. We found no improvement in EFS with more extensive or serial resections. Disease progression or recurrence may be more closely related to tumor biology than surgical management. These data suggest that resections for WT-GISTs be restricted to the initial procedure and that subsequent resections be performed only to address symptoms such as obstruction or bleeding.
Collapse
Affiliation(s)
- Christopher B Weldon
- Christopher B. Weldon and Arin L. Madenci, Boston Children's Hospital; Christopher B. Weldon, Arin L. Madenci, Katherine A. Janeway, and Suzanne George, Harvard Medical School; Christopher B. Weldon, Katherine A. Janeway, and Suzanne George, Dana-Farber/Boston Children's Cancer and Blood Disorders Center; Arin L. Madenci, Brigham and Women's Hospital, Boston, MA; Sosipatros A. Boikos, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA; Margaret von Mehren, Fox Chase Cancer Center, Philadelphia, PA; Alberto S. Pappo, St Jude Children's Research Hospital, Memphis, TN; Joshua D. Schiffman and Jennifer Wright, Huntsman Cancer Institute, Salt Lake City, UT; Jonathan C. Trent, Sylvester Comprehensive Cancer Center, Miami, FL; Karel Pacak and Constantine A. Stratakis, Eunice Kennedy Shriver National Institute of Child Health and Human Development; Lee J. Helman, National Cancer Institute, Bethesda, MD; and Michael P. La Quaglia, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Arin L Madenci
- Christopher B. Weldon and Arin L. Madenci, Boston Children's Hospital; Christopher B. Weldon, Arin L. Madenci, Katherine A. Janeway, and Suzanne George, Harvard Medical School; Christopher B. Weldon, Katherine A. Janeway, and Suzanne George, Dana-Farber/Boston Children's Cancer and Blood Disorders Center; Arin L. Madenci, Brigham and Women's Hospital, Boston, MA; Sosipatros A. Boikos, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA; Margaret von Mehren, Fox Chase Cancer Center, Philadelphia, PA; Alberto S. Pappo, St Jude Children's Research Hospital, Memphis, TN; Joshua D. Schiffman and Jennifer Wright, Huntsman Cancer Institute, Salt Lake City, UT; Jonathan C. Trent, Sylvester Comprehensive Cancer Center, Miami, FL; Karel Pacak and Constantine A. Stratakis, Eunice Kennedy Shriver National Institute of Child Health and Human Development; Lee J. Helman, National Cancer Institute, Bethesda, MD; and Michael P. La Quaglia, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Sosipatros A Boikos
- Christopher B. Weldon and Arin L. Madenci, Boston Children's Hospital; Christopher B. Weldon, Arin L. Madenci, Katherine A. Janeway, and Suzanne George, Harvard Medical School; Christopher B. Weldon, Katherine A. Janeway, and Suzanne George, Dana-Farber/Boston Children's Cancer and Blood Disorders Center; Arin L. Madenci, Brigham and Women's Hospital, Boston, MA; Sosipatros A. Boikos, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA; Margaret von Mehren, Fox Chase Cancer Center, Philadelphia, PA; Alberto S. Pappo, St Jude Children's Research Hospital, Memphis, TN; Joshua D. Schiffman and Jennifer Wright, Huntsman Cancer Institute, Salt Lake City, UT; Jonathan C. Trent, Sylvester Comprehensive Cancer Center, Miami, FL; Karel Pacak and Constantine A. Stratakis, Eunice Kennedy Shriver National Institute of Child Health and Human Development; Lee J. Helman, National Cancer Institute, Bethesda, MD; and Michael P. La Quaglia, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Katherine A Janeway
- Christopher B. Weldon and Arin L. Madenci, Boston Children's Hospital; Christopher B. Weldon, Arin L. Madenci, Katherine A. Janeway, and Suzanne George, Harvard Medical School; Christopher B. Weldon, Katherine A. Janeway, and Suzanne George, Dana-Farber/Boston Children's Cancer and Blood Disorders Center; Arin L. Madenci, Brigham and Women's Hospital, Boston, MA; Sosipatros A. Boikos, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA; Margaret von Mehren, Fox Chase Cancer Center, Philadelphia, PA; Alberto S. Pappo, St Jude Children's Research Hospital, Memphis, TN; Joshua D. Schiffman and Jennifer Wright, Huntsman Cancer Institute, Salt Lake City, UT; Jonathan C. Trent, Sylvester Comprehensive Cancer Center, Miami, FL; Karel Pacak and Constantine A. Stratakis, Eunice Kennedy Shriver National Institute of Child Health and Human Development; Lee J. Helman, National Cancer Institute, Bethesda, MD; and Michael P. La Quaglia, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Suzanne George
- Christopher B. Weldon and Arin L. Madenci, Boston Children's Hospital; Christopher B. Weldon, Arin L. Madenci, Katherine A. Janeway, and Suzanne George, Harvard Medical School; Christopher B. Weldon, Katherine A. Janeway, and Suzanne George, Dana-Farber/Boston Children's Cancer and Blood Disorders Center; Arin L. Madenci, Brigham and Women's Hospital, Boston, MA; Sosipatros A. Boikos, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA; Margaret von Mehren, Fox Chase Cancer Center, Philadelphia, PA; Alberto S. Pappo, St Jude Children's Research Hospital, Memphis, TN; Joshua D. Schiffman and Jennifer Wright, Huntsman Cancer Institute, Salt Lake City, UT; Jonathan C. Trent, Sylvester Comprehensive Cancer Center, Miami, FL; Karel Pacak and Constantine A. Stratakis, Eunice Kennedy Shriver National Institute of Child Health and Human Development; Lee J. Helman, National Cancer Institute, Bethesda, MD; and Michael P. La Quaglia, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Margaret von Mehren
- Christopher B. Weldon and Arin L. Madenci, Boston Children's Hospital; Christopher B. Weldon, Arin L. Madenci, Katherine A. Janeway, and Suzanne George, Harvard Medical School; Christopher B. Weldon, Katherine A. Janeway, and Suzanne George, Dana-Farber/Boston Children's Cancer and Blood Disorders Center; Arin L. Madenci, Brigham and Women's Hospital, Boston, MA; Sosipatros A. Boikos, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA; Margaret von Mehren, Fox Chase Cancer Center, Philadelphia, PA; Alberto S. Pappo, St Jude Children's Research Hospital, Memphis, TN; Joshua D. Schiffman and Jennifer Wright, Huntsman Cancer Institute, Salt Lake City, UT; Jonathan C. Trent, Sylvester Comprehensive Cancer Center, Miami, FL; Karel Pacak and Constantine A. Stratakis, Eunice Kennedy Shriver National Institute of Child Health and Human Development; Lee J. Helman, National Cancer Institute, Bethesda, MD; and Michael P. La Quaglia, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Alberto S Pappo
- Christopher B. Weldon and Arin L. Madenci, Boston Children's Hospital; Christopher B. Weldon, Arin L. Madenci, Katherine A. Janeway, and Suzanne George, Harvard Medical School; Christopher B. Weldon, Katherine A. Janeway, and Suzanne George, Dana-Farber/Boston Children's Cancer and Blood Disorders Center; Arin L. Madenci, Brigham and Women's Hospital, Boston, MA; Sosipatros A. Boikos, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA; Margaret von Mehren, Fox Chase Cancer Center, Philadelphia, PA; Alberto S. Pappo, St Jude Children's Research Hospital, Memphis, TN; Joshua D. Schiffman and Jennifer Wright, Huntsman Cancer Institute, Salt Lake City, UT; Jonathan C. Trent, Sylvester Comprehensive Cancer Center, Miami, FL; Karel Pacak and Constantine A. Stratakis, Eunice Kennedy Shriver National Institute of Child Health and Human Development; Lee J. Helman, National Cancer Institute, Bethesda, MD; and Michael P. La Quaglia, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Joshua D Schiffman
- Christopher B. Weldon and Arin L. Madenci, Boston Children's Hospital; Christopher B. Weldon, Arin L. Madenci, Katherine A. Janeway, and Suzanne George, Harvard Medical School; Christopher B. Weldon, Katherine A. Janeway, and Suzanne George, Dana-Farber/Boston Children's Cancer and Blood Disorders Center; Arin L. Madenci, Brigham and Women's Hospital, Boston, MA; Sosipatros A. Boikos, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA; Margaret von Mehren, Fox Chase Cancer Center, Philadelphia, PA; Alberto S. Pappo, St Jude Children's Research Hospital, Memphis, TN; Joshua D. Schiffman and Jennifer Wright, Huntsman Cancer Institute, Salt Lake City, UT; Jonathan C. Trent, Sylvester Comprehensive Cancer Center, Miami, FL; Karel Pacak and Constantine A. Stratakis, Eunice Kennedy Shriver National Institute of Child Health and Human Development; Lee J. Helman, National Cancer Institute, Bethesda, MD; and Michael P. La Quaglia, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Jennifer Wright
- Christopher B. Weldon and Arin L. Madenci, Boston Children's Hospital; Christopher B. Weldon, Arin L. Madenci, Katherine A. Janeway, and Suzanne George, Harvard Medical School; Christopher B. Weldon, Katherine A. Janeway, and Suzanne George, Dana-Farber/Boston Children's Cancer and Blood Disorders Center; Arin L. Madenci, Brigham and Women's Hospital, Boston, MA; Sosipatros A. Boikos, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA; Margaret von Mehren, Fox Chase Cancer Center, Philadelphia, PA; Alberto S. Pappo, St Jude Children's Research Hospital, Memphis, TN; Joshua D. Schiffman and Jennifer Wright, Huntsman Cancer Institute, Salt Lake City, UT; Jonathan C. Trent, Sylvester Comprehensive Cancer Center, Miami, FL; Karel Pacak and Constantine A. Stratakis, Eunice Kennedy Shriver National Institute of Child Health and Human Development; Lee J. Helman, National Cancer Institute, Bethesda, MD; and Michael P. La Quaglia, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Jonathan C Trent
- Christopher B. Weldon and Arin L. Madenci, Boston Children's Hospital; Christopher B. Weldon, Arin L. Madenci, Katherine A. Janeway, and Suzanne George, Harvard Medical School; Christopher B. Weldon, Katherine A. Janeway, and Suzanne George, Dana-Farber/Boston Children's Cancer and Blood Disorders Center; Arin L. Madenci, Brigham and Women's Hospital, Boston, MA; Sosipatros A. Boikos, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA; Margaret von Mehren, Fox Chase Cancer Center, Philadelphia, PA; Alberto S. Pappo, St Jude Children's Research Hospital, Memphis, TN; Joshua D. Schiffman and Jennifer Wright, Huntsman Cancer Institute, Salt Lake City, UT; Jonathan C. Trent, Sylvester Comprehensive Cancer Center, Miami, FL; Karel Pacak and Constantine A. Stratakis, Eunice Kennedy Shriver National Institute of Child Health and Human Development; Lee J. Helman, National Cancer Institute, Bethesda, MD; and Michael P. La Quaglia, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Karel Pacak
- Christopher B. Weldon and Arin L. Madenci, Boston Children's Hospital; Christopher B. Weldon, Arin L. Madenci, Katherine A. Janeway, and Suzanne George, Harvard Medical School; Christopher B. Weldon, Katherine A. Janeway, and Suzanne George, Dana-Farber/Boston Children's Cancer and Blood Disorders Center; Arin L. Madenci, Brigham and Women's Hospital, Boston, MA; Sosipatros A. Boikos, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA; Margaret von Mehren, Fox Chase Cancer Center, Philadelphia, PA; Alberto S. Pappo, St Jude Children's Research Hospital, Memphis, TN; Joshua D. Schiffman and Jennifer Wright, Huntsman Cancer Institute, Salt Lake City, UT; Jonathan C. Trent, Sylvester Comprehensive Cancer Center, Miami, FL; Karel Pacak and Constantine A. Stratakis, Eunice Kennedy Shriver National Institute of Child Health and Human Development; Lee J. Helman, National Cancer Institute, Bethesda, MD; and Michael P. La Quaglia, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Constantine A Stratakis
- Christopher B. Weldon and Arin L. Madenci, Boston Children's Hospital; Christopher B. Weldon, Arin L. Madenci, Katherine A. Janeway, and Suzanne George, Harvard Medical School; Christopher B. Weldon, Katherine A. Janeway, and Suzanne George, Dana-Farber/Boston Children's Cancer and Blood Disorders Center; Arin L. Madenci, Brigham and Women's Hospital, Boston, MA; Sosipatros A. Boikos, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA; Margaret von Mehren, Fox Chase Cancer Center, Philadelphia, PA; Alberto S. Pappo, St Jude Children's Research Hospital, Memphis, TN; Joshua D. Schiffman and Jennifer Wright, Huntsman Cancer Institute, Salt Lake City, UT; Jonathan C. Trent, Sylvester Comprehensive Cancer Center, Miami, FL; Karel Pacak and Constantine A. Stratakis, Eunice Kennedy Shriver National Institute of Child Health and Human Development; Lee J. Helman, National Cancer Institute, Bethesda, MD; and Michael P. La Quaglia, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Lee J Helman
- Christopher B. Weldon and Arin L. Madenci, Boston Children's Hospital; Christopher B. Weldon, Arin L. Madenci, Katherine A. Janeway, and Suzanne George, Harvard Medical School; Christopher B. Weldon, Katherine A. Janeway, and Suzanne George, Dana-Farber/Boston Children's Cancer and Blood Disorders Center; Arin L. Madenci, Brigham and Women's Hospital, Boston, MA; Sosipatros A. Boikos, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA; Margaret von Mehren, Fox Chase Cancer Center, Philadelphia, PA; Alberto S. Pappo, St Jude Children's Research Hospital, Memphis, TN; Joshua D. Schiffman and Jennifer Wright, Huntsman Cancer Institute, Salt Lake City, UT; Jonathan C. Trent, Sylvester Comprehensive Cancer Center, Miami, FL; Karel Pacak and Constantine A. Stratakis, Eunice Kennedy Shriver National Institute of Child Health and Human Development; Lee J. Helman, National Cancer Institute, Bethesda, MD; and Michael P. La Quaglia, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Michael P La Quaglia
- Christopher B. Weldon and Arin L. Madenci, Boston Children's Hospital; Christopher B. Weldon, Arin L. Madenci, Katherine A. Janeway, and Suzanne George, Harvard Medical School; Christopher B. Weldon, Katherine A. Janeway, and Suzanne George, Dana-Farber/Boston Children's Cancer and Blood Disorders Center; Arin L. Madenci, Brigham and Women's Hospital, Boston, MA; Sosipatros A. Boikos, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA; Margaret von Mehren, Fox Chase Cancer Center, Philadelphia, PA; Alberto S. Pappo, St Jude Children's Research Hospital, Memphis, TN; Joshua D. Schiffman and Jennifer Wright, Huntsman Cancer Institute, Salt Lake City, UT; Jonathan C. Trent, Sylvester Comprehensive Cancer Center, Miami, FL; Karel Pacak and Constantine A. Stratakis, Eunice Kennedy Shriver National Institute of Child Health and Human Development; Lee J. Helman, National Cancer Institute, Bethesda, MD; and Michael P. La Quaglia, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| |
Collapse
|
128
|
Giuliano K, Nagarajan N, Canner J, Najafian A, Wolfgang C, Schneider E, Meyer C, Lennon AM, Johnston FM, Ahuja N. Gastric and small intestine gastrointestinal stromal tumors: Do outcomes differ? J Surg Oncol 2016; 115:351-357. [PMID: 27885685 DOI: 10.1002/jso.24514] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 11/09/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVES Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. Previous literature has suggested that small intestine GISTs are more aggressive than gastric GISTs. Our primary objective was to compare the outcomes of gastric and small intestine GISTs in the decade after approval of imatinib for treatment. METHODS The SEER database was queried for cases of gastric and small intestine GIST between the years 2002 and 2012, using the ICD-O-3 histology code 8936. Survival analysis was performed using generalized gamma models for time to cause-specific mortality (CSM). RESULTS CSM was 14.0% for the 3,759 gastric GIST patients and 14.3% for the 1,848 small intestine GIST patients. Five-year survival was 82.2% and 83.3% for gastric and small intestine patients, respectively. The number of diagnosed cases of GIST increased over the course of this study, especially for tumors <5 cm in size and in patients over age 50 years. CONCLUSIONS In this large nation-wide study, we found that patients with gastric and small intestine GISTs had similar outcomes, in contrast to previous reports. The diagnosis of GIST has significantly increased in the last decade, which may reflect the increased recognition of this entity and frequent use of imaging. J. Surg. Oncol. 2017;115:351-357. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Katherine Giuliano
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Neeraja Nagarajan
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Joseph Canner
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alireza Najafian
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christopher Wolfgang
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eric Schneider
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Christian Meyer
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Anne Marie Lennon
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Fabian M Johnston
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nita Ahuja
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
129
|
Rectal GIST-Outcomes and viewpoint from a tertiary cancer center. Indian J Gastroenterol 2016; 35:445-449. [PMID: 27783353 DOI: 10.1007/s12664-016-0710-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 10/12/2016] [Indexed: 02/04/2023]
Abstract
INTRODUCTION There is scarce data relating to methods to improve sphincter preservation in rectal gastrointestinal stromal tumor (GIST). Increasing the duration of neoadjuvant (NA) imatinib resulting in improved sphincter preservation rate has not been established. This retrospective analysis looks at the rates of sphincter preservation in rectal GIST with NA imatinib and effect of duration of NA imatinib on the same to find out optimum duration of NA with respect to sphincter preservation in rectal GIST patients. METHODS Twenty-three cases of GIST of lower third of rectum were treated at our centre from 2005 till 2015. NA imatinib was used in a dose of 400 mg. Response evaluation was done every 3 months with a pelvic magnetic resonance imaging. Surgical management was determined by a team of experienced gastrointestinal oncosurgeons. RESULTS Five patients underwent upfront surgery which included local resection in four patients and abdominoperineal resection in one patient. NA imatinib was used in 69.5 % (16/23) patients. Median duration of NA imatinib was 15 months (3-84 months). Amongst who underwent a sphincter-salvage surgery median duration of NA imatinib was 13 months whereas 18 months in patients who required a sphincter-sacrificing surgery (p = 0.683). The radiologic response included partial response in 75 % (12/16) patients, stable disease in 18.7 % (3/16) and one with progressive disease. Definitive surgical resection was possible in 13 patients (81.3 %) after NA imatinib. Median progression-free survival (PFS) was 120 months in the whole cohort whereas median overall survival (OS) was not reached. Four-year estimated PFS and OS was 81 % and 100 %, respectively. Median disease-free survival in upfront surgery group vs. neoadjuvant imatinib group was 70 vs. 120 months, respectively (p = 0.039). CONCLUSION Neoadjuvant imatinib appears to be a useful option in improving chances of sphincter preservation without adversely affecting the outcome. Use of neoadjuvant imatinib leads to improvement in progression-free survival in patients with GIST of lower third of the rectum.
Collapse
|
130
|
Abstract
OPINION STATEMENT Gastrointestinal stromal tumors (GISTs) are the most common sarcomas and mesenchymal neoplasms of the gastrointestinal tract. Macroscopically complete (R0/R1) resection is the standard treatment for localized resectable GIST with adjuvant imatinib therapy recommended for patients with intermediate or high-risk disease. In patients with advanced unresectable or metastatic GIST, imatinib has significantly improved outcomes. However, while most patients achieve partial response (PR) or stable disease (SD) on imatinib (with maximal response typically seen by 6 months on treatment), approximately half will develop secondary resistance by 2 years. Available data suggest that cytoreductive surgery may be considered in patients with metastatic GIST who respond to imatinib, particularly if a R0/R1 resection is achieved. The benefit of surgery in patients with focal tumor progression on imatinib is unclear, but may be considered. Patients with multifocal progression undergoing surgery generally have poor outcomes. Thus, surgery should be considered in patients with metastatic GIST whose disease responds to imatinib with a goal of performing R0/R1 resection. Optimal timing of surgery is unclear but should be considered between 6 months and 2 years after starting imatinib. Although surgery in patients with metastatic GIST treated with sunitinib is feasible, incomplete resections are common, complication rates are high, and survival benefit is unclear. Therefore, a careful multidisciplinary consultation is required to determine optimal treatment options on a case-by-case basis. Finally, patients with metastatic GIST should resume tyrosine kinase inhibitor treatment postoperatively.
Collapse
|
131
|
Liu Z, Tian Y, Liu S, Xu G, Guo M, Lian X, Fan D, Zhang H, Feng F. Clinicopathological feature and prognosis of primary hepatic gastrointestinal stromal tumor. Cancer Med 2016; 5:2268-75. [PMID: 27484851 PMCID: PMC5055144 DOI: 10.1002/cam4.808] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 05/25/2016] [Accepted: 06/01/2016] [Indexed: 12/27/2022] Open
Abstract
Compared to gastric gastrointestinal stromal tumor (GIST), hepatic GIST is very rare in clinic. Reports on clinicopathological feature and prognosis of this rare disease are limited in literature. The purpose of this study was, therefore, to summarize clinical and pathological features as well as prognosis of the primary hepatic GIST. One case of primary hepatic GIST from our center and 22 cases reported in MEDLINE or China National Knowledge Infrastructure (CNKI) were enrolled into this study. Clinicopathological features as well as survival data of hepatic GIST were analyzed and compared with 297 gastric GISTs and 59 small intestinal GISTs from our center. Majority of the 22 cases (95.7%) of hepatic GIST was larger than 5 cm in size, and 75.0% of the tumors were over 5/50 HPF in mitotic index. Most of the hepatic GISTs (85.7%) displayed spindle cell shape in morphology. All of the hepatic GIST (100%) enrolled in this study were classified as high-risk category by the National Institute of Health (NIH) risk classification. The 5-year median disease-free survival (DFS) time was 24.0 months and 5-year disease-specific survival (DSS) rate was 33.3%, respectively. Distribution of clinicopathological features was significantly different among hepatic, gastric, and small intestinal GIST. The DFS and DSS of hepatic GIST were significantly lower than those of the other two groups. Majority of the hepatic GIST is large in size and highly malignant. Prognosis of the primary hepatic GIST is worse than that of gastric GIST and small intestinal GIST.
Collapse
Affiliation(s)
- Zhen Liu
- Department of Digestive Surgery, Xijing Hospital, The Fourth Military Medical University, 127 West Changle Road, Xi'an, Shaanxi, 710032, China
| | - Yangzi Tian
- Department of Dermatology, Xijing Hospital, The Fourth Military Medical University, 127 West Changle Road, Xi'an, Shaanxi, 710032, China
| | - Shushang Liu
- Department of Digestive Surgery, Xijing Hospital, The Fourth Military Medical University, 127 West Changle Road, Xi'an, Shaanxi, 710032, China
| | - Guanghui Xu
- Department of Digestive Surgery, Xijing Hospital, The Fourth Military Medical University, 127 West Changle Road, Xi'an, Shaanxi, 710032, China
| | - Man Guo
- Department of Digestive Surgery, Xijing Hospital, The Fourth Military Medical University, 127 West Changle Road, Xi'an, Shaanxi, 710032, China
| | - Xiao Lian
- Department of Digestive Surgery, Xijing Hospital, The Fourth Military Medical University, 127 West Changle Road, Xi'an, Shaanxi, 710032, China
| | - Daiming Fan
- Department of Digestive Surgery, Xijing Hospital, The Fourth Military Medical University, 127 West Changle Road, Xi'an, Shaanxi, 710032, China
| | - Hongwei Zhang
- Department of Digestive Surgery, Xijing Hospital, The Fourth Military Medical University, 127 West Changle Road, Xi'an, Shaanxi, 710032, China.
| | - Fan Feng
- Department of Digestive Surgery, Xijing Hospital, The Fourth Military Medical University, 127 West Changle Road, Xi'an, Shaanxi, 710032, China.
| |
Collapse
|
132
|
Capelli L, Petracci E, Quagliuolo V, Saragoni L, Colombo P, Morgagni P, Calistri D, Tomezzoli A, Di Cosmo M, Roviello F, Vindigni C, Coniglio A, Villanacci V, Catarci M, Coppola L, Alfieri S, Ricci R, Capella C, Rausei S, Gulino D, Amadori D, Ulivi P. Gastric GISTs: Analysis of c-Kit, PDGFRA and BRAF mutations in relation to prognosis and clinical pathological characteristics of patients – A GIRCG study. Eur J Surg Oncol 2016; 42:1206-14. [DOI: 10.1016/j.ejso.2016.05.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 04/28/2016] [Accepted: 05/20/2016] [Indexed: 12/14/2022] Open
|
133
|
Stotz M, Liegl-Atzwanger B, Posch F, Mrsic E, Thalhammer M, Stojakovic T, Bezan A, Pichler M, Gerger A, Szkandera J. Blood-Based Biomarkers Are Associated with Disease Recurrence and Survival in Gastrointestinal Stroma Tumor Patients after Surgical Resection. PLoS One 2016; 11:e0159448. [PMID: 27454486 PMCID: PMC4959723 DOI: 10.1371/journal.pone.0159448] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 07/01/2016] [Indexed: 12/18/2022] Open
Abstract
Background Inflammatory blood count biomarkers may improve recurrence risk stratification and inform long-term prognosis of cancer patients. Here, we quantify the prognostic impact of blood-based biomarkers on recurrence risk and long-term survival in a large cohort of gastrointestinal stroma tumor (GIST) patients after curative surgery. Methods One-hundred-forty-nine consecutive GIST patients were followed-up for a median period of 4.8 years. Local recurrence, distant metastasis, and death occurred in 9, 21, and 31 patients, respectively. Time-to-event and competing risk analysis were applied to study the association between haemoglobin (Hb) level, white blood cell count (WBC), neutrophil/lymphocyte ratio (NLR), derived NLR (dNLR), lymphocyte/monocyte ratio (LMR), and platelet/lymphocyte ratio (PLR) with risk of local or distant recurrence (RR), recurrence free survival (RFS), and overall survival (OS). Results A low Hb (p = 0.029), and elevations in the parameters WBC (p = 0.004), NLR (p = 0.015) and dNLR (p = 0.037) were associated with a poor OS in GIST patients in multivariate analysis. Moreover, a low Hb (p = 0.049) and an elevated WBC (p = 0.001), NLR (p = 0.007), dNLR (p = 0.043) and PLR (p = 0.024) were independently associated with decreased RFS after adjusting for Miettinen score. However, only an increase of dNLR/NLR showed a significant association to higher RR (p = 0.048). Inclusion of NLR or PLR to Miettinen risk score did not reasonably improve the clinical risk prediction of 2-year RFS. Conclusion Low Hb, elevated WBC, elevated dNLR, and elevated PLR are independent prognostic factors for a worse clinical outcome in GIST patients after curative resection.
Collapse
Affiliation(s)
- Michael Stotz
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Graz, Austria
- Research Unit Genetic Epidemiology and Pharmacogenetics, Division of Clinical Oncology, Medical University of Graz, Graz, Austria
| | | | - Florian Posch
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Graz, Austria
| | - Edvin Mrsic
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Graz, Austria
| | - Michael Thalhammer
- Division of General Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Tatjana Stojakovic
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Angelika Bezan
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Graz, Austria
- Research Unit Genetic Epidemiology and Pharmacogenetics, Division of Clinical Oncology, Medical University of Graz, Graz, Austria
| | - Martin Pichler
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Graz, Austria
- Research Unit for non-coding RNAs and genome editing in cancer, Division of Clinical Oncology, Medical University of Graz, Graz, Austria
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, United States of America
| | - Armin Gerger
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Graz, Austria
- Research Unit Genetic Epidemiology and Pharmacogenetics, Division of Clinical Oncology, Medical University of Graz, Graz, Austria
- Center for Biomarker Research in Medicine (CBmed), Medical University of Graz, Graz, Austria
| | - Joanna Szkandera
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Graz, Austria
- Research Unit Genetic Epidemiology and Pharmacogenetics, Division of Clinical Oncology, Medical University of Graz, Graz, Austria
| |
Collapse
|
134
|
Feng F, Tian Y, Liu Z, Xu G, Liu S, Guo M, Lian X, Fan D, Zhang H. Clinicopathological features and prognosis of colonic gastrointestinal stromal tumors: evaluation of a pooled case series. Oncotarget 2016; 7:40735-40745. [PMID: 27166191 PMCID: PMC5130040 DOI: 10.18632/oncotarget.9196] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 04/16/2016] [Indexed: 01/03/2023] Open
Abstract
Background Due to the extremely rare incidence, data about colonic GISTs are limited. Therefore, aim of the present study was to explore clinicopathological characteristics and prognosis of colonic GISTs. Patients and Methods Colonic GISTs cases were obtained from our center and from case report and clinical studies extracted from MEDLINE. Clinicopathological features and survivals were analyzed. Results There were 79 colonic GISTs patients with a female predominance. The median age was 66 years (range 0.17-84). The median tumor size was 5.8 cm (range 0.5-29). The most common location was sigmoid colon (45.8%), followed by transverse colon (19.5%). The majority of colonic GISTs were high risk (70.8%). Mitotic index was correlated with gender (P = 0.002) and tumor size (P = 0.005), and tumor location was correlated with age (P = 0.017). The five year DFS and DSS were 57.4% and 61.6%, respectively. Mitotic index and NIH risk classification were associated with prognosis of colonic GISTs. However, mitotic index was the only independent risk factor. The distribution of tumor size and NIH risk classification were significantly different between colonic and gastric GISTs (both P = 0.000). The DFS and DSS of colonic GISTs were significantly lower than that of gastric GISTs (P = 0.012 and P = 0.002, respectively). Conclusions The most common location for colonic GISTs was sigmoid colon. Most tumors were high risk. Mitotic index was the only independent risk factor for prognosis of colonic GISTs. Colonic GISTs differ significantly from gastric GISTs in respect to clinicopathological features. The prognosis of colonic GISTs was worse than that of gastric GISTs.
Collapse
Affiliation(s)
- Fan Feng
- Department of Digestive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yangzi Tian
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Zhen Liu
- Department of Digestive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Guanghui Xu
- Department of Digestive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Shushang Liu
- Department of Digestive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Man Guo
- Department of Digestive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Xiao Lian
- Department of Digestive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Daiming Fan
- Department of Digestive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Hongwei Zhang
- Department of Digestive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| |
Collapse
|
135
|
Jiang Z, Zhang J, Li Z, Liu Y, Wang D, Han G. A meta-analysis of prognostic value of KIT mutation status in gastrointestinal stromal tumors. Onco Targets Ther 2016; 9:3387-98. [PMID: 27350754 PMCID: PMC4902249 DOI: 10.2147/ott.s101858] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Numerous types of KIT mutations have been reported in gastrointestinal stromal tumors (GISTs); however, controversy still exists regarding their clinicopathological significance. In this study, we reviewed the publicly available literature to assess the data by a meta-analysis to characterize KIT mutations and different types of KIT mutations in prognostic prediction in patients with GISTs. Twenty-eight studies that included 4,449 patients were identified and analyzed. We found that KIT mutation status was closely correlated with size of tumors and different mitosis indexes, but not with tumor location. KIT mutation was also observed to be significantly correlated with tumor recurrence, metastasis, as well as the overall survival of patients. Interestingly, there was higher risk of progression in KIT exon 9-mutated patients than in exon 11-mutated patients. Five-year relapse-free survival (RFS) rate was significantly higher in KIT exon 11-deleted patients than in those with other types of KIT exon 11 mutations. In addition, RFS for 5 years was significantly worse in patients bearing KIT codon 557–558 deletions than in those bearing other KIT exon 11 deletions. Our results strongly support the hypothesis that KIT mutation status is another evaluable factor for prognosis prediction in GISTs.
Collapse
Affiliation(s)
- Zhiqiang Jiang
- Department of General Surgery, Affiliated Tumor Hospital, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Jian Zhang
- Department of General Surgery, Affiliated Tumor Hospital, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Zhi Li
- Department of General Surgery, Affiliated Tumor Hospital, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Yingjun Liu
- Department of General Surgery, Affiliated Tumor Hospital, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Daohai Wang
- Department of General Surgery, Affiliated Tumor Hospital, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Guangsen Han
- Department of General Surgery, Affiliated Tumor Hospital, Zhengzhou University, Zhengzhou, People's Republic of China
| |
Collapse
|
136
|
Mastoraki A, Toliaki E, Chrisovergi E, Mastoraki S, Papanikolaou IS, Danias N, Smyrniotis V, Arkadopoulos N. Metastatic Liver Disease Associated with Gastrointestinal Stromal Tumors: Controversies in Diagnostic and Therapeutic Approach. J Gastrointest Cancer 2016; 46:237-42. [PMID: 26163021 DOI: 10.1007/s12029-015-9748-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Gastrointestinal stromal tumors (GISTs) are the most frequent mesenchymal lesions of the GI tract. They are considered to originate from neoplastic transformation of either the intestinal pacemaker cells of Cajal or the precursor pluripotential stem cells. The genetic basis of GIST growth is an activating mutation of two receptor tyrosine kinases. Recent epidemiologic studies demonstrate that the GIST prevalence is approximately 20/1000000/year. Although GISTs develop in every part of the GI tract, stomach remains the most common localization. About 80 % of the patients experience tumor recurrence or hepatic metastasis after radical resection. GIST liver metastases are usually multiple, large in diameter, and localized in both lobes. In addition, GISTs are usually completely asymptomatic, discovered incidentally. Symptoms are not typical and depend on the location, size, and aggressiveness of the tumor. DISCUSSION Diagnostic evaluation is based on imaging techniques, such as computed tomography, magnetic resonance imaging, positron emission tomography, and endoscopic ultrasound. Despite recent research on the therapeutic strategies against GISTs, surgical resection appears the only potentially curative approach. For the advanced metastatic disease, imatinib, a tyrosine kinase inhibitor, has been proposed neoadjuvantly with the surgery performed after the adequate reduction of tumor burden. The aim of this review was to evaluate the results of surgical treatment for metastatic GIST with special reference to the extent of its histological spread and to present the recent literature in order to provide an update on the current concepts of advanced surgical management of this entity.
Collapse
Affiliation(s)
- Aikaterini Mastoraki
- 4th Department of Surgery, Medical School, ATTIKON University Hospital, Athens University, 1 Rimini str, 12462, Chaidari, Athens, Greece,
| | | | | | | | | | | | | | | |
Collapse
|
137
|
Valappil FK, Rajan R, Natesh B, Sindhu RS, Raviram S, Mathew J. Evaluation of Gold's nomogram for predicting recurrence-free survival in gastrointestinal stromal tumors in Indian patients. Indian J Gastroenterol 2016; 35:225-8. [PMID: 27256432 DOI: 10.1007/s12664-016-0667-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 05/01/2016] [Indexed: 02/04/2023]
Abstract
Gold described a nomogram for prediction of recurrence-free survival (RFS) after surgery for gastrointestinal stromal tumors (GIST). This retrospective study was intended to evaluate the utility of this nomogram for predicting a 2-year RFS in our patients. Twenty-eight consecutive eligible patients from January 2009 to January 2013 who underwent R0 resection and had histopathologically proven GIST were included in the study. Nomogram predicted RFS was compared with observed RFS in four groups as in the National Institutes of Health (NIH)-Fletcher classification. Calibration was assessed by plotting the predicted probabilities of RFS against the actual outcome. For validation of the nomogram, the graph obtained should be closer to the 45-degree line. The observed overall 2-year RFS was 85.7 % (24 patients). Four patients had recurrence within 2 years. The observed RFS was 87.5 %, 77.8 %, 90 %, and 100 % in the high, intermediate, low, and very low risk groups, respectively. The nomogram predicted the 2-year RFS was 40 %, 84.8 %, 88.6 %, and 90 % for high, intermediate, low, and very low risk groups, respectively. Thus, the predicted probabilities of the 2-year RFS in intermediate, low, and very low risk groups were similar to the observed outcomes. However, for the high risk group, the observed RFS was better than predicted RFS. This variation in the high risk group may be due to the use of adjuvant imatinib in our study.
Collapse
Affiliation(s)
- Fysal Kollanta Valappil
- Department of Surgical Gastroenterology, Government Medical College, Thiruvananthapuram, 695 011, India.
| | - Ramesh Rajan
- Department of Surgical Gastroenterology, Government Medical College, Thiruvananthapuram, 695 011, India
| | - Bonny Natesh
- Department of Surgical Gastroenterology, Government Medical College, Thiruvananthapuram, 695 011, India
| | - R S Sindhu
- Department of Surgical Gastroenterology, Government Medical College, Thiruvananthapuram, 695 011, India
| | - S Raviram
- Department of Surgical Gastroenterology, Government Medical College, Thiruvananthapuram, 695 011, India
| | - Jacob Mathew
- Department of Surgical Gastroenterology, Government Medical College, Thiruvananthapuram, 695 011, India
| |
Collapse
|
138
|
Yegin EG, Duman DG. Small EUS-suspected gastrointestinal stromal tumors of the stomach: An overview for the current state of management. Endosc Ultrasound 2016; 5:69-77. [PMID: 27080604 PMCID: PMC4850798 DOI: 10.4103/2303-9027.180469] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors found in the gastrointestinal (GI) tract, with the stomach being the most common site. They represent a distinct group of GI tumors originating from the interstitial cells of Cajal and are characterized by gain-of-function mutations of KIT. KIT oncoprotein serves as both diagnostic and therapeutic targets. Prognosis is related to size, mitotic activity, and site of the tumor. Asymptomatic, small endoscopic ultrasonography (EUS)-suspected GISTs are increasingly encountered with the wide availability of endoscopic/endosonographic examination. The majority of small GISTs are biologically indolent, albeit possibly harboring c-KIT gene mutations. An ongoing controversy exists regarding the management and surveillance policy for small gastric GISTs. A number of reports on the management of GISTs have been published, not confidently addressing the issue of gastric GISTs of small size. This work provides an overview on the current state of management considerations, specifically focusing on small EUS-suspected gastric GISTs, which are increasingly encountered by clinicians.
Collapse
Affiliation(s)
- Ender Gunes Yegin
- Department of Gastroenterology, Bozyaka State Hospital, Izmir, Turkey
| | | |
Collapse
|
139
|
Feng F, Tian Y, Liu S, Zheng G, Liu Z, Xu G, Guo M, Lian X, Fan D, Zhang H. Combination of PLR, MLR, MWR, and Tumor Size Could Significantly Increase the Prognostic Value for Gastrointestinal Stromal Tumors. Medicine (Baltimore) 2016; 95:e3248. [PMID: 27057867 PMCID: PMC4998783 DOI: 10.1097/md.0000000000003248] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Systemic inflammation and immune response were associated with prognosis of tumors. However, data was limited due to the relatively low incidence of gastrointestinal stromal tumors (GISTs). The aim of the present study was to investigate the predictive value of preoperative peripheral blood cells in prognosis of GISTs.From September 2008 to July 2015, a total of 274 GIST patients in our department were enrolled in the present study. Clinicopathological features of GISTs were recorded. The association between preoperative peripheral blood cells and prognosis of GISTs were analyzed.Tumor location, tumor size, mitotic index, intratumoral necrosis, and National Institutes of Health (NIH) risk category were associated with prognosis of GISTs. High neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), neutrophil-to-white blood cell ratio (NWR), monocyte-to-white blood cell ratio (MWR) and low lymphocyte-to-white blood cell ratio (LWR) was associated with poor prognosis of GISTs (76.2% vs 83.7%, P = 0.010. 70.5% vs 98.7%, P = 0.000. 65.7% vs 96.4%, P = 0.004. 78.5% vs 82.5%, P = 0.044. 73.5% vs 97.8%, P = 0.004. 76.6% vs 83.6%, P = 0.012, respectively). However, tumor size was the only independent risk factor for prognosis according to multivariate analysis (P = 0.006). Tumor location, tumor size, mitotic index, and NIH risk category were significantly correlated with the above-mentioned parameters (all P < 0.05). The prognosis of GISTs with tumor size >5 cm, high MLR, high PLR, and high MWR was significantly lower than the remnant patients (P = 0.010).The peripheral blood routine test is convenient, reproducible, and inexpensive. High NLR, MLR, PLR, NWR, MWR, and low LWR were associated with poor prognosis of GISTs. The association between the above parameters and prognosis of GISTs may be attributed to their correlation with tumor size, mitotic index, and NIH risk category. The combination of tumor size, MLR, PLR, and MWR could further increase the predictive value of prognosis of GISTs.
Collapse
Affiliation(s)
- Fan Feng
- From the Department of Digestive Surgery (FF, SL, GZ, ZL, GX, MG, XL, DF, HZ), Xijing Hospital, Fourth Military Medical University; and Department of Dermatology (YT), Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | | | | | | | | | | | | | | | | | | |
Collapse
|
140
|
Hølmebakk T, Bjerkehagen B, Boye K, Bruland Ø, Stoldt S, Sundby Hall K. Definition and clinical significance of tumour rupture in gastrointestinal stromal tumours of the small intestine. Br J Surg 2016; 103:684-691. [PMID: 26988241 DOI: 10.1002/bjs.10104] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 11/26/2015] [Accepted: 12/11/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Tumour rupture is a risk factor for recurrence of gastrointestinal stromal tumour (GIST). In this study, patterns of recurrence after potential tumour seeding were investigated, and a new definition of tumour rupture, based on major and minor defects of tumour integrity, is proposed. METHODS Patients undergoing surgery for non-metastatic small intestinal GIST from 2000 to 2012 were included in the study. Tumour spillage, tumour fracture or piecemeal resection, bowel perforation at the tumour site, blood-tinged ascites, microscopic tumour infiltration into an adjacent organ, and surgical biopsy were defined as major defects of tumour integrity. Peritoneal tumour penetration, iatrogenic peritoneal laceration and microscopically involved margins were defined as minor defects. RESULTS Seventy-two patients were identified. Median follow-up was 58 (range 7-122) months. Radical surgery was performed in 71 patients. A major defect was recorded in 20 patients, and a minor defect in 21. The 5-year recurrence rate was 64, 29 and 31 per cent in patients with major, minor and no defect respectively (P = 0·001). The hazard ratio (HR) for major defect versus no defect was 3·55 (95 per cent c.i. 1·51 to 8·35). Peritoneal recurrence rates for major, minor and no defect were 52, 25 and 19 per cent respectively (P = 0·002), and the HR for major defect versus no defect was 4·98 (1·69 to 14·68). On multivariable analysis, mitotic index, major defect of tumour integrity, tumour size and age were independently associated with risk of recurrence. CONCLUSION Recurrence rates were increased after major, but not minor tumour ruptures.
Collapse
Affiliation(s)
- T Hølmebakk
- Departments of Abdominal and Paediatric Surgery, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - B Bjerkehagen
- Departments of Pathology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - K Boye
- Departments of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - Ø Bruland
- Departments of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - S Stoldt
- Departments of Abdominal and Paediatric Surgery, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - K Sundby Hall
- Departments of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| |
Collapse
|
141
|
Shiroshita H, Shiraishi N, Shitomi Y, Etoh T, Kitano S, Inomata M. A gastrointestinal stromal tumor at the esophagogastric junction successfully treated by laparoscopic wedge resection with seromuscular layer dissection: a case report. Surg Case Rep 2016; 1:89. [PMID: 26943414 PMCID: PMC4883463 DOI: 10.1186/s40792-015-0090-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 09/16/2015] [Indexed: 11/10/2022] Open
Abstract
Herein, we report a case of a gastrointestinal stromal tumor (GIST) at the esophagogastric junction (EGJ) that was successfully treated by a laparoscopic wedge resection (LWR) after dissection of the seromuscular layer around the tumor to prevent postoperative deformities and stenosis of the EGJ. Subsequently, the abdominal esophagus was wrapped by the gastric fornix according to Dor's method in order to prevent reflux esophagitis after surgery.A 71-year-old female patient was admitted with a diagnosis of a GIST (23 × 20 × 20 mm) at the EGJ. We performed the abovementioned operation.Gastroduodenal endoscopic examination revealed no deformity or stenosis of the EGJ at 6 months after the operation. The patient has not experienced any reflux symptoms. Tumor recurrence was not noted 26 months after the operation.This procedure is useful in preventing the deformity and stenosis of the EGJ as well as postoperative reflux esophagitis.
Collapse
Affiliation(s)
- Hidefumi Shiroshita
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama Machi, Yufu, Oita, 879-5593, Japan.
| | - Norio Shiraishi
- Center for Community Medicine, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama Machi, Yufu, Oita, 879-5593, Japan.
| | - Yuki Shitomi
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama Machi, Yufu, Oita, 879-5593, Japan.
| | - Tsuyoshi Etoh
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama Machi, Yufu, Oita, 879-5593, Japan.
| | - Seigo Kitano
- Oita University, 1-1 Idaigaoka, Hasama Machi, Yufu, Oita, 879-5593, Japan.
| | - Masafumi Inomata
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama Machi, Yufu, Oita, 879-5593, Japan.
| |
Collapse
|
142
|
Schöffel N, Groneberg DA, Kaul T, Laatsch D, Thielemann H. [Gastrointestinal stromal tumors (GIST)--literature review]. MMW Fortschr Med 2016; 158:60-62. [PMID: 27119704 DOI: 10.1007/s15006-016-7824-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Norman Schöffel
- Klinik für Allgemein- und Viszeralchirurgie Unfallkrankenhaus Berlin, Warener Str. 7, D-12683, Berlin, Deutschland.
| | | | | | | | | |
Collapse
|
143
|
Miyake KK, Nakamoto Y, Mikami Y, Tanaka S, Higashi T, Tadamura E, Saga T, Minami S, Togashi K. The predictive value of preoperative 18F-fluorodeoxyglucose PET for postoperative recurrence in patients with localized primary gastrointestinal stromal tumour. Eur Radiol 2016; 26:4664-4674. [PMID: 26852217 DOI: 10.1007/s00330-016-4242-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Revised: 01/14/2016] [Accepted: 01/22/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To assess the potential value of preoperative 18F-FDG PET to predict postoperative recurrence of solitary localized primary gastrointestinal stromal tumour (GIST) after radical resection. METHODS A total of 46 patients with primary GIST who received preoperative 18F-FDG PET and underwent complete resection without neoadjuvant therapy were retrospectively studied. PET findings, including ring-shaped uptake and intense uptake, were compared with Joensuu risk grades using Fisher's exact test. The prognostic value of the preoperative clinico-imaging variables-age ≥60 years, male, ring-shaped uptake, intense uptake, tumour size >5 cm, heterogeneous CT attenuation and lower gastrointestinal origin-and Joensuu high risk for recurrence-free survival was evaluated using log-rank test and multivariate Cox regression analysis. RESULTS Ring-shaped uptake and intense uptake were significantly associated with Joensuu high risk. Univariate analysis showed that ring-shaped uptake, intense uptake, size >5 cm and Joensuu high risk were significantly associated with inferior recurrence-free survival. Multivariate analysis showed that ring-shaped uptake (P = 0.004) and Joensuu high risk (P = 0.021) were independent adverse prognostic factors of postoperative recurrence. CONCLUSIONS Ring-shaped uptake on preoperative 18F-FDG PET may be a potential predictor of postoperative tumour recurrence of localized primary GISTs. KEY POINTS • Clinical course of resectable solitary localized primary GISTs varies widely. • Ring-shaped uptake is an independent adverse prognostic factor of postoperative recurrence. • Preoperative 18 F-FDG PET may help predict postoperative recurrence of GISTs.
Collapse
Affiliation(s)
- Kanae Kawai Miyake
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Hospital, Kyoto, Japan.
| | - Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Hospital, Kyoto, Japan
| | - Yoshiki Mikami
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan.,Department of Diagnostic Pathology, Kumamoto University Hospital, Kumamoto, Japan
| | - Shiro Tanaka
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | | | - Eiji Tadamura
- Department of Radiology, Sakazaki Clinic, Kyoto, Japan
| | - Tsuneo Saga
- Dianostic Imaging Group, Molecular Imaging Center, National Institute of Radiological Sciences, Chiba, Japan
| | - Shunsuke Minami
- Department of Radiology, Shiga Medical Center for Adults, Shiga, Japan
| | - Kaori Togashi
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Hospital, Kyoto, Japan
| |
Collapse
|
144
|
Bouchet S, Poulette S, Titier K, Moore N, Lassalle R, Abouelfath A, Italiano A, Chevreau C, Bompas E, Collard O, Duffaud F, Rios M, Cupissol D, Adenis A, Ray-Coquard I, Bouché O, Le Cesne A, Bui B, Blay JY, Molimard M. Relationship between imatinib trough concentration and outcomes in the treatment of advanced gastrointestinal stromal tumours in a real-life setting. Eur J Cancer 2016; 57:31-8. [PMID: 26851399 DOI: 10.1016/j.ejca.2015.12.029] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 12/30/2015] [Indexed: 01/27/2023]
Abstract
BACKGROUND Imatinib has dramatically improved the prognosis of advanced gastrointestinal stromal tumours (GISTs). Clinical trial data showed that patients with trough imatinib plasma concentrations (Cmin) below 1100 ng/ml (quartile 1) had shorter time to progression, but no threshold has been defined. The main objective of this study was to investigate in advanced GIST whether a Cmin threshold value associated with a longer progression-free survival (PFS) could be specified. This would be the first step leading to therapeutic drug monitoring of imatinib in GIST. PATIENTS AND METHODS Advanced GIST patients (n=96) treated with imatinib 400 mg/d (41 stomach, 34 small bowel, and 21 other primary site localisations) were prospectively included in this real-life setting study. Routine plasma level testing imatinib (Cmin) and clinical data of were recorded prospectively. RESULTS Small bowel localisation was associated with an increased relative risk of progression of 3.09 versus stomach localisation (p=0.0255). Mean Cmin (±standard deviation) was 868 (±536) ng/ml with 75% inter-individual and 26% intra-patient variability. A Cmin threshold of 760 ng/ml defined by log-rank test was associated with longer PFS for the whole population (p=0.0256) and for both stomach (p=0.043) and small bowel (p=0.049) localisations when analysed separately. Multivariate Cox regression analysis found that Cmin above 760 ng/ml was associated with 65% reduction risk of progression (p=0.0271) in the whole population independently of the anatomical localisation. CONCLUSION Concentration of imatinib significantly influences duration of tumour control treatment in GIST patients with a Cmin threshold of 760 ng/ml associated with prolonged PFS in real-life setting.
Collapse
Affiliation(s)
- Stéphane Bouchet
- Univ. de Bordeaux, Bordeaux, F-33000, France; INSERM, U1219, Bordeaux, F-33000, France; CHU de Bordeaux, Bordeaux, F-33000, France
| | | | - Karine Titier
- Univ. de Bordeaux, Bordeaux, F-33000, France; INSERM, U1219, Bordeaux, F-33000, France; CHU de Bordeaux, Bordeaux, F-33000, France
| | - Nicholas Moore
- Univ. de Bordeaux, Bordeaux, F-33000, France; INSERM, U1219, Bordeaux, F-33000, France; CHU de Bordeaux, Bordeaux, F-33000, France
| | - Régis Lassalle
- Univ. de Bordeaux, Bordeaux, F-33000, France; INSERM CIC Bordeaux CIC1401 Pharmaco-épidemiologie, Bordeaux, F-33000, France
| | - Abdelilah Abouelfath
- Univ. de Bordeaux, Bordeaux, F-33000, France; INSERM CIC Bordeaux CIC1401 Pharmaco-épidemiologie, Bordeaux, F-33000, France
| | | | - Christine Chevreau
- Institut Universitaire du Cancer Toulouse - Oncopole, Toulouse, F-31300, France
| | | | - Olivier Collard
- Institut de Cancérologie Lucien Neuwirth, Saint Priest-en-Jarez, F-42270, France
| | - Florence Duffaud
- CHU La Timone, Marseille, F-13385, France; Aix Marseille Université (AMU), France
| | - Maria Rios
- Institut de Cancérologie de Lorraine - Alexis Vautrin, Nancy, F-54500, France
| | | | | | - Isabelle Ray-Coquard
- Centre Léon Bérard, Lyon, F-69008, France; Université Claude Bernard Lyon 1, France
| | | | | | - Binh Bui
- Institut Bergonié, Bordeaux, F-33000, France
| | - Jean-Yves Blay
- Centre Léon Bérard, Lyon, F-69008, France; Université Claude Bernard Lyon 1, France
| | - Mathieu Molimard
- Univ. de Bordeaux, Bordeaux, F-33000, France; INSERM, U1219, Bordeaux, F-33000, France; CHU de Bordeaux, Bordeaux, F-33000, France.
| |
Collapse
|
145
|
Feng F, Tian Y, Liu Z, Xu G, Liu S, Guo M, Lian X, Fan D, Zhang H. Clinicopathologic Features and Clinical Outcomes of Esophageal Gastrointestinal Stromal Tumor: Evaluation of a Pooled Case Series. Medicine (Baltimore) 2016; 95:e2446. [PMID: 26765432 PMCID: PMC4718258 DOI: 10.1097/md.0000000000002446] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Clinicopathologic features and clinical outcomes of gastrointestinal stromal tumors (GISTs) in esophagus are limited, because of the relatively rare incidence of esophageal GISTs. Therefore, the aim of the current study was to investigate the clinicopathologic features and clinical outcomes of esophageal GISTs, and to investigate the potential factors that may predict prognosis.Esophageal GIST cases were obtained from our center and from case reports and clinical studies extracted from MEDLINE. Clinicopathologic features and survivals were analyzed and compared with gastric GISTs from our center.The most common location was lower esophagus (86.84%), followed by middle and upper esophagus (11.40% and 1.76%). The majority of esophageal GISTs were classified as high-risk category (70.83%). Mitotic index was correlated with histologic type, mutational status, and tumor size. The 5-year disease-free survival and disease-specific survival were 65.1% and 65.9%, respectively. Tumor size, mitotic index, and National Institutes of Health risk classification were associated with prognosis of esophageal GISTs. Only tumor size, however, was the independent risk factor for the prognosis of esophageal GISTs. In comparison to gastric GISTs, the distribution of tumor size, histologic type, and National Institutes of Health risk classification were significantly different between esophageal GISTs and gastric GISTs. The disease-free survival and disease-specific survival of esophageal GISTs were significantly lower than that of gastric GISTs.The most common location for esophageal GISTs was lower esophagus, and most of the esophageal GISTs are high-risk category. Tumor size was the independent risk factor for the prognosis of esophageal GISTs. Esophageal GISTs differ significantly from gastric GISTs in respect to clinicopathologic features. The prognosis of esophageal GISTs was worse than that of gastric GISTs.
Collapse
Affiliation(s)
- Fan Feng
- From the Department of Digestive Surgery, Xijing Hospital, Fourth Military Medical University (FF, ZL, GX, SL, MG, XL, DF, HZ) and Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, China (YT)
| | | | | | | | | | | | | | | | | |
Collapse
|
146
|
Patrikidou A, Domont J, Chabaud S, Ray-Coquard I, Coindre JM, Bui-Nguyen B, Adenis A, Rios M, Bertucci F, Duffaud F, Chevreau C, Cupissol D, Pérol D, Emile JF, Blay JY, Le Cesne A. Long-term outcome of molecular subgroups of GIST patients treated with standard-dose imatinib in the BFR14 trial of the French Sarcoma Group. Eur J Cancer 2015; 52:173-80. [PMID: 26687836 DOI: 10.1016/j.ejca.2015.10.069] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 10/28/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND The added value of tumoural genomic profiles to conventional clinico-biological factors to predict progression-free survival (PFS) and overall survival (OS) was prospectively investigated in patients with advanced gastrointestinal stromal tumours (GIST) treated in the BFR14 study. METHODS Of the 434 included patients, mutational analysis was performed in 322 patients. Survival analysis was performed in patients with validated mutational status. RESULTS Mutational status was validated in 228 patients. We identified 196 patients with tumours harbouring 200 KIT alterations (exon 11: 173 patients, exon 9: 22 patients, exon 17: 3 patients, exon 13: 2 patients; 4 patients had double KIT mutations), 6 patients with PDGFRA mutations and 26 patients with wild-type (WT) GIST genotype. On a median follow-up of 73 months, median PFS/OS were 12.3/54.9 months for WT GIST, 12.6/55 months for KIT exon 9, and 39.4 months/not reached (69.1% at 5 years) for KIT exon 11. Tumour size, female gender, KIT exon 11 mutations and CD34 positivity were independent prognostic factors for a higher PFS. A higher OS was predicted by performance status (PS) <2, low neutrophil and normal lymphocyte counts, KIT exon 11 mutations, non-advanced tumour and female gender. KIT exon 11 mutations at codons 557-558 showed better tumour response (p=0.028) but shorter PFS (p=0.0176). CONCLUSIONS In GIST patients, presence of a KIT exon 11 mutation is an independent prognostic factor for PFS and OS, along with gender, PS, tumour size, lymphocyte and neutrophil counts. Subsets of exon 11 mutations are associated with significantly different response patterns and PFS.
Collapse
Affiliation(s)
- Anna Patrikidou
- Department of Cancer Medicine, Gustave Roussy, Villejuif, France
| | - Julien Domont
- Department of Cancer Medicine, Gustave Roussy, Villejuif, France
| | - Sylvie Chabaud
- Biostatistics Department, Centre Léon Bérard, Lyon, France
| | | | | | - Binh Bui-Nguyen
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - Antoine Adenis
- Department of Medical Oncology, Centre Oscar Lambret, Lille, France
| | - Maria Rios
- Department of Medical Oncology, Centre Alexis Vautrin, Nancy, France
| | - François Bertucci
- Department of Medical Oncology, Institut Paoli Calmettes, Marseille, France
| | | | | | - Didier Cupissol
- Department of Medical Oncology, Institut du Cancer du Montpellier, Montpellier, France
| | - David Pérol
- Biostatistics Department, Centre Léon Bérard, Lyon, France
| | | | - Jean-Yves Blay
- CRCL INSERM U1052 & Université Claude Bernard Lyon 1 & Centre Léon Bérard, Lyon, France
| | - Axel Le Cesne
- Department of Cancer Medicine, Gustave Roussy, Villejuif, France.
| |
Collapse
|
147
|
Xing GS, Wang S, Sun YM, Yuan Z, Zhao XM, Zhou CW. Small Bowel Stromal Tumors: Different Clinicopathologic and Computed Tomography Features in Various Anatomic Sites. PLoS One 2015; 10:e0144277. [PMID: 26646242 PMCID: PMC4672882 DOI: 10.1371/journal.pone.0144277] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 11/16/2015] [Indexed: 12/18/2022] Open
Abstract
Gastrointestinal stromal tumors (GISTs) can present with different clinical and immunohistochemical characteristics according to different anatomic sites. The aim of this study was to compare clinicopathologic and computed tomography (CT) features of small bowel stromal tumors located in the duodenum, jejunum, and ileum. In total, 197 patients (109 male, 88 female) with small bowel GISTs were retrospectively reviewed. All tumors had definite anatomic sites in the small bowel tract with surgical confirmation. The clinicopathologic variables included age, sex, onset of symptoms, and tumor risk category. CT variables included tumor size, degree enhancement, enhancement pattern (region of necrosis), adjacent tissue involvement, lymphadenopathy, and distant metastasis. We assessed any possible differences according to different GIST site of origin. Based on tumor size and mitotic count, the risk categories in different anatomic sites did not differ significantly between duodenal and jejunal GISTs. However, high risk ileum GISTs accounted for 66.0% of ileal cases, which was higher than duodenum cases (36.8%, P = 0.002) and jejunum cases (43.9%, P = 0.004). The mean size of GISTs in the ileum was 9.77 cm, which was significantly larger than in the duodenum (7.41 cm, P = 0.043), and in the jejunum (8.14 cm, P = 0.027). On CT images, enhancement degree appeared to gradually increase from the duodenum to the ileum in the portal phase, and the enhancement pattern presented a tendency for heterogeneity. In Conclusions, the clinicopathologic and CT features of small bowel GISTs can differ according to different primary anatomic sites.
Collapse
Affiliation(s)
- Gu-sheng Xing
- Department of Diagnostic Imaging, Cancer Hospital & Institute, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Shuang Wang
- Department of Diagnostic Imaging, Cancer Hospital & Institute, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yue-Min Sun
- Department of Abdominal Surgical Oncology, Cancer Hospital & Institute, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Zheng Yuan
- Department of Pathology, Cancer Hospital & Institute, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xin-Ming Zhao
- Department of Diagnostic Imaging, Cancer Hospital & Institute, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Chun-wu Zhou
- Department of Diagnostic Imaging, Cancer Hospital & Institute, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- * E-mail:
| |
Collapse
|
148
|
Li J, Zhang H, Chen Z, Su K. Clinico-pathological characteristics and prognostic factors of gastrointestinal stromal tumors among a Chinese population. Oncol Lett 2015; 16:4905-4914. [PMID: 30250556 PMCID: PMC6144732 DOI: 10.3892/ol.2018.9320] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 07/11/2018] [Indexed: 12/13/2022] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms in the gastrointestinal tract, exhibiting wide variability in their biological behavior. The aim of the present study was to investigate the clinicopathological characteristics and prognostic factors of GISTs in Chinese patients. All GIST cases (n=182) retrieved from the pathology database and the archived files in Shanghai Changzheng Hospital between January 2011 and December 2014 were reviewed. The clinical symptoms, preoperative investigations, treatments, pathological characteristics and follow-up data of these patients were reviewed, and univariate and multivariate survival analyses were performed. A total of 73.1% of the GISTs were located in the stomach, and the most common three symptoms included abdominal pain (30.2%), dyspepsia (23.1%) and gastrointestinal bleeding (21.4%). Univariate analysis revealed that larger tumor size (P<0.001), higher mitotic rate (P<0.001), aggressive behavior (P<0.001), negative smooth muscle actin expression (P=0.009) and palliative resection (P<0.001) contributed toward poor overall survival (OS). In addition, non-gastric disease location (P<0.001), larger tumor size (P<0.001), higher mitotic rate (P=0.004), aggressive behavior (P<0.001) and palliative resection (P<0.001) were associated with poor relapse-free survival (RFS). Multivariate analysis indicated that mitotic rate [hazard ratio (HR=3.761, P=0.015)] and aggressive behavior (HR=3.916, P=0.010) were independent risk factors for OS, while non-gastric location (HR=4.740, P=0.002) and aggressive behavior (HR=4.009, P=0.004) were independent risk factors for RFS. The present study provided information on the clinicopathological characteristics and epidemiology of GISTs in the Chinese population. Non-gastric disease location, higher mitotic rate and tumor metastasis or local invasion prior to treatment were identified as predictors of a poor prognosis.
Collapse
Affiliation(s)
- Jiehua Li
- Department of Gastrointestinal and Gland Surgery, The First Affiliated Hospital of Guangxi Medical University Nanning, Guangxi Province, China
| | - Haitian Zhang
- Department of Gastrointestinal and Gland Surgery, The First Affiliated Hospital of Guangxi Medical University Nanning, Guangxi Province, China
| | - Zhibai Chen
- Department of Gastrointestinal and Gland Surgery, The First Affiliated Hospital of Guangxi Medical University Nanning, Guangxi Province, China
| | - Ka Su
- Department of Gastrointestinal and Gland Surgery, The First Affiliated Hospital of Guangxi Medical University Nanning, Guangxi Province, China
| |
Collapse
|
149
|
Ahmad A, Libbey NP, Somasundar P, Katz SC. Gastrointestinal stromal tumour metastatic to the epididymis. BMJ Case Rep 2015; 2015:bcr-2015-211555. [PMID: 26400593 DOI: 10.1136/bcr-2015-211555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Gastrointestinal stromal tumours (GIST) are mesenchymal neoplasms with a propensity to metastasise to the liver and peritoneal cavity. Since the advent of tyrosine kinase inhibitors, outcomes for patients with metastatic GIST have improved dramatically. Secondary to the longevity in survival, patients may develop metastatic disease in very unusual locations, which poses significant diagnostic dilemmas and management challenges. We report a case of a patient with GIST who presented with an epididymal metastasis manifesting as a scrotal mass. Resistance to targeted medical therapies continues to pose a challenge, and our case highlights the importance of a multidisciplinary approach in such patients, including long-term follow-up.
Collapse
Affiliation(s)
- Ali Ahmad
- Department of Surgery, Roger Williams Medical Center, Providence, Rhode Island, USA
| | - Norman Peter Libbey
- Department of Pathology, Roger Williams Medical Center, Providence, Rhode Island, USA
| | - Ponnandai Somasundar
- Department of Surgery, Roger Williams Medical Center, Providence, Rhode Island, USA
| | - Steven C Katz
- Department of Surgery, Roger Williams Medical Center, Providence, Rhode Island, USA
| |
Collapse
|
150
|
Sandvik OM, Søreide K, Gudlaugsson E, Søreide JA. Surgery for gastrointestinal stromal tumors (GISTs) of the stomach and small bowel: short- and long-term outcomes over three decades. World J Surg 2015; 39:446-52. [PMID: 25315092 DOI: 10.1007/s00268-014-2824-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Many studies on gastrointestinal stromal tumors (GISTs) derive from tertiary referral centers, but few examine strictly population-based cohorts. Thus, we evaluated the clinical features, surgical treatments, clinical outcomes, and factors predicting the survival of patients with GISTs in a population-based series. METHODS Patients with GISTs diagnosed at Stavanger University Hospital over three decades (1980-2012) were analyzed. Data were retrieved from hospital records. Descriptive statistics and survival analyses (Kaplan-Meier) are presented. A limited number of colorectal GISTs (n = 6) restricted most analyses to those with a gastric or small bowel location. RESULTS Among 66 patients surgically treated for GISTs, 60 patients (91 %) had either a gastric or a small bowel localization. Females comprised 61 %. The median age at diagnosis was 63 (range, 15-88) years. Clinical symptoms were recorded in 43 patients (65 %). Complete tumor resection was achieved in 85 % of the patients. During follow-up, 6 patients were surgically treated for local recurrence or metastatic disease. The median follow-up time was 6.1 years. At last follow-up, 30 patients (46 %) were deceased, 10 of whom died from GISTs. The median overall survival was 10.4 years. For GISTs with a gastric or small bowel location, a 1- and 5-year disease-specific survival of 100 and 96 %, and a relapse-free survival of 96 and 78 % were observed. Male gender, incidental diagnosis, smaller tumor size, a low mitotic rate, an intact pseudocapsule, low-risk categorization, and an early stage were significantly associated with improved outcomes. CONCLUSION Surgery in a low-volume, population-based setting yields enhanced long-term disease and recurrence-free survival for patients with GISTs of the stomach or small bowel. Incidental diagnosis, complete tumor resection, and low-risk categorization are good predictors of long-term prognosis.
Collapse
Affiliation(s)
- Oddvar M Sandvik
- Department of Gastrointestinal Surgery, Stavanger University Hospital, 4068, Stavanger, Norway
| | | | | | | |
Collapse
|