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Liu P, Tan F, Liu H, Li B, Lei T, Zhao X. The Use of Molecular Subtypes for Precision Therapy of Recurrent and Metastatic Gastrointestinal Stromal Tumor. Onco Targets Ther 2020; 13:2433-2447. [PMID: 32273716 PMCID: PMC7102917 DOI: 10.2147/ott.s241331] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 03/10/2020] [Indexed: 12/19/2022] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumor in the digestive tract. Tyrosine kinase inhibitors (TKIs), represented by imatinib, sunitinib, and regorafenib, have become the main treatment for recurrent and metastatic GISTs. With the wide application of mutation analysis and the precision medicine, molecular characteristics have been determined that not only predict the prognosis of patients with recurrent and metastatic GISTs, but also are closely related to the efficacy of first-, second- and third-line TKIs for GISTs, as well as other TKIs. Despite the significant effects of TKIs, the emergence of primary and secondary resistance ultimately leads to treatment failure and tumor progression. Currently, due to the signal transmission of KIT/PDGFRA during onset and tumor progression, strategies to counteract drug resistance include the replacement of TKIs and the development of new drugs that are directed towards carcinogenic mutations. In addition, it is also the embodiment of precision medicine for GISTs to explore new carcinogenic mechanisms and develop new drugs relying on new biotechnology. Surgery can benefit specific patients but its major purpose is to diminish the resistant clones. However, the prognosis of recurrent and metastatic patients is still unsatisfactory. Therefore, it is worth paying attention to how to maximize the benefits for patients.
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Affiliation(s)
- Peng Liu
- Department of Gastrointestinal Surgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, People's Republic of China
| | - Fengbo Tan
- Department of Gastrointestinal Surgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, People's Republic of China
| | - Heli Liu
- Department of Gastrointestinal Surgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, People's Republic of China
| | - Bin Li
- Department of Oncology, Xiangya Hospital, Central South University, Changsha 410008, Hunan, People's Republic of China
| | - Tianxiang Lei
- Department of Gastrointestinal Surgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, People's Republic of China
| | - Xianhui Zhao
- Department of Gastrointestinal Surgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, People's Republic of China
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202
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Decoding the Genomic Report for Radiologists. AJR Am J Roentgenol 2020; 214:949-961. [PMID: 32182095 DOI: 10.2214/ajr.19.21677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The purpose of this review is to provide a guide for radiologists that explains the language and format of modern genomic reports and summarizes the relevance of this information for modern oncologic imaging. CONCLUSION. Genomic testing plays a critical role in guiding oncologic therapies in the age of targeted treatments. Understanding and interpreting genomic reports is a valuable skill for radiologists involved with oncologic imaging interpretation.
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203
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Marcella C, Sarwar S, Ye H, Shi RH. Efficacy and Safety of Endoscopic Treatment for Gastrointestinal Stromal Tumors in the Upper Gastrointestinal Tract. Clin Endosc 2020; 53:458-465. [PMID: 32178486 PMCID: PMC7403013 DOI: 10.5946/ce.2019.121] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 12/23/2019] [Indexed: 12/11/2022] Open
Abstract
Background/Aims: Endoscopic treatment (ET) has been applied for decades to treat subepithelial tumors, including gastrointestinal stromal tumors (GISTs). However, the efficacy of ET remains debatable. In this study, we evaluated the efficacy and safety of ET for GISTs in the upper gastrointestinal tract.
Methods: This retrospective single-center study included 97 patients who underwent ET. All patients were enrolled from July 2014 to July 2018. Parameters such as demographics, size, resection margin, complications, pathological features, procedure time, total cost, and follow-up were investigated and analyzed.
Results: Our study achieved 100% en bloc resection and 77.4% (72/93) R0 resection. The most common location was the fundus with a mean tumor size of 2.1±1.4 cm. The mean age, procedure time, hospital stay, and cost were 59.7±11.3 years, 64.7±35.2 minutes, 6.8 days, and 5,337 dollars, respectively. According to National Institutes of Health classification, 63 (64.9%), 26 (26.8%), 5 (5.2%), and 3 (3.1%) patients belonged to the very low, low, intermediate, and high risk classification, respectively. Immunohistochemistry results showed a 100% positive rate of CD34, DOG-1, CD117, and Ki67. A mean follow-up of 21.3±13.0 months showed no recurrence or metastasis.
Conclusions: ET is effective and safe for curative removal of GISTs in the upper gastrointestinal tract, and it can be a treatment of choice for patients with no metastasis.
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Affiliation(s)
- Cicilia Marcella
- Department of Gastroenterology, Southeast University Affiliated Zhongda Hospital, Nanjing, China
| | - Shakeel Sarwar
- Department of Orthopedics, Southeast University Affiliated Zhongda Hospital, Nanjing, China
| | - Hui Ye
- Department of Gastroenterology, Southeast University Affiliated Zhongda Hospital, Nanjing, China
| | - Rui Hua Shi
- Department of Gastroenterology, Southeast University Affiliated Zhongda Hospital, Nanjing, China
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204
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Koo YJ, Lee SY, Jang MH, Lee DH. Extragastrointestinal stromal tumour arising in the vulva: a case report and literature review. J OBSTET GYNAECOL 2020; 41:492-494. [PMID: 32172668 DOI: 10.1080/01443615.2020.1726303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Yu-Jin Koo
- Department of Obstetrics and Gynecology, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Soo-Young Lee
- Department of Obstetrics and Gynecology, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Min Hye Jang
- Department of Pathology, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Dae-Hyung Lee
- Department of Obstetrics and Gynecology, Yeungnam University Medical Center, Daegu, Republic of Korea
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205
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Saito Y, Takahashi T, Obata Y, Nishida T, Ohkubo S, Nakagawa F, Serada S, Fujimoto M, Ohkawara T, Nishigaki T, Sugase T, Koh M, Ishida T, Tanaka K, Miyazaki Y, Makino T, Kurokawa Y, Nakajima K, Yamasaki M, Hirota S, Naka T, Mori M, Doki Y. TAS-116 inhibits oncogenic KIT signalling on the Golgi in both imatinib-naïve and imatinib-resistant gastrointestinal stromal tumours. Br J Cancer 2020; 122:658-667. [PMID: 31857719 PMCID: PMC7054534 DOI: 10.1038/s41416-019-0688-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 10/16/2019] [Accepted: 11/28/2019] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Despite the effectiveness of imatinib mesylate (IM), most gastrointestinal stromal tumours (GISTs) develop IM resistance, mainly due to the additional kinase-domain mutations accompanied by concomitant reactivation of KIT tyrosine kinase. Heat-shock protein 90 (HSP90) is one of the chaperone molecules required for appropriate folding of proteins such as KIT. METHODS We used a novel HSP90 inhibitor, TAS-116, which showed specific binding to HSP90α/β with low toxicity in animal models. The efficacy and mechanism of TAS-116 against IM-resistant GIST were evaluated by using IM-naïve and IM-resistant GIST cell lines. We also evaluated the effects of TAS-116 on the other HSP90 client protein, EGFR, by using lung cell lines. RESULTS TAS-116 inhibited growth and induced apoptosis in both IM-naïve and IM-resistant GIST cell lines with KIT activation. We found KIT was activated mainly in intracellular compartments, such as trans-Golgi cisternae, and TAS-116 reduced autophosphorylated KIT in the Golgi apparatus. In IM-resistant GISTs in xenograft mouse models, TAS-116 caused tumour growth inhibition. We found that TAS-116 decreased phosphorylated EGFR levels and inhibited the growth of EGFR-mutated lung cancer cell lines. CONCLUSION TAS-116 may be a novel promising drug to overcome tyrosine kinase inhibitor-resistance in both GIST and EGFR-mutated lung cancer.
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Affiliation(s)
- Yurina Saito
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tsuyoshi Takahashi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan.
| | - Yuuki Obata
- National Cancer Center Hospital, Tsukiji, Japan
| | | | | | | | | | | | | | - Takahiko Nishigaki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takahito Sugase
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masahiro Koh
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tomo Ishida
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Koji Tanaka
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yasuhiro Miyazaki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tomoki Makino
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kiyokazu Nakajima
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Makoto Yamasaki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Seiichi Hirota
- Department of Surgical Pathology, Hyogo College of Medicine, Nishinomiya, Japan
| | | | - Masaki Mori
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
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206
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Albano D, Mattia B, Giubbini R, Bertagna F. Role of 18F-FDG PET/CT in restaging and follow-up of patients with GIST. Abdom Radiol (NY) 2020; 45:644-651. [PMID: 31646354 DOI: 10.1007/s00261-019-02274-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE Gastrointestinal stromal tumor (GIST) is a rare tumor with high risk of recurrence and poor prognosis in case of advanced GIST. The aim of this study was to evaluate the possible role of 18F-FDG PET/CT in restaging GIST. METHODS Fifty-four patients (30 male) with histological proven GIST underwent 100 18F-FDG PET/CT for restaging in suspected recurrence or during follow-up. Histopathology results and/or clinical/imaging follow-up for at least 12 months were considered as reference standard. Moreover, the diagnostic accuracy and clinical impact of 18F-FDG PET/CT were calculated. RESULTS Twenty-seven (27%) 18F-FDG PET/CT were positive, while the remaining 73 (73%) were negative. Sensitivity, specificity, PPV, NPV, and accuracy of PET/CT were 89% (95% CI 72-98%), 97% (95% CI 90-100%), 93% (95% CI 76-98%), 96% (95% CI 89-98%), and 95% (95% CI 89-98%). 18F-FDG PET/CT had a positive clinical impact in 18/100 studies changing the management, in 8 cases switching from local therapy to systemic therapy due to the detection of disseminate disease at PET/CT, in three cases recognizing relapse not detected by conventional imaging, and in 7 cases demonstrating to be true negative and avoiding unnecessary therapies. CONCLUSIONS 18F-FDG PET/CT seems to be an accurate method for detection and localization of local and distant recurrence in GIST with good sensitivity and specificity and significant impact on clinical decision-making.
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Affiliation(s)
- Domenico Albano
- Nuclear Medicine, Spedali Civili Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy.
| | - Bonacina Mattia
- Nuclear Medicine, Spedali Civili Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy
| | - Raffaele Giubbini
- Nuclear Medicine, University of Brescia and Spedali Civili Brescia, Brescia, Italy
| | - Francesco Bertagna
- Nuclear Medicine, University of Brescia and Spedali Civili Brescia, Brescia, Italy
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207
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Li H, Zhang R, Wang S, Fang M, Zhu Y, Hu Z, Dong D, Shi J, Tian J. CT-Based Radiomic Signature as a Prognostic Factor in Stage IV ALK-Positive Non-small-cell Lung Cancer Treated With TKI Crizotinib: A Proof-of-Concept Study. Front Oncol 2020; 10:57. [PMID: 32133282 PMCID: PMC7040202 DOI: 10.3389/fonc.2020.00057] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 01/13/2020] [Indexed: 12/24/2022] Open
Abstract
Objectives: To identify a computed tomography (CT)-based radiomic signature for predicting progression-free survival (PFS) in stage IV anaplastic lymphoma kinase (ALK)-positive non-small-cell lung cancer (NSCLC) patients treated with tyrosine kinase inhibitor (TKI) crizotinib. Materials and Methods: This retrospective proof-of-concept study included a cohort of 63 stage IV ALK-positive NSCLC patients who had received TKI crizotinib therapy for model construction and validation. Another independent cohort including 105 stage IV EGFR-positive NSCLC patients was also used for external validation in EGFR-TKI treatment. We initially extracted 481 quantitative three-dimensional features derived from manually segmented tumor volumes of interest. Pearson's correlation analysis along with the least absolute shrinkage and selection operator (LASSO) penalized Cox proportional hazards regression was successively performed to select critical radiomic features. A CT-based radiomic signature for PFS prediction was obtained using multivariate Cox regression. The performance evaluation of the radiomic signature was conducted using the concordance index (C-index), time-dependent receiver operating characteristic (ROC) analysis, and Kaplan-Meier survival analysis. Results: A radiomic signature containing three features showed significant prognostic performance for ALK-positive NSCLC patients in both the training cohort (C-index, 0.744; time-dependent AUC, 0.895) and the validation cohort (C-index, 0.717; time-dependent AUC, 0.824). The radiomic signature could significantly risk-stratify ALK-positive NSCLC patients (hazard ratio, 2.181; P < 0.001) and outperformed other prognostic factors. However, no significant association with PFS was captured for the radiomic signature in the EGFR-positive NSCLC cohort (log-rank tests, P = 0.41). Conclusions: The CT-based radiomic features can capture valuable information regarding the tumor phenotype. The proposed radiomic signature was found to be an effective prognostic factor in stage IV ALK mutated nonsynchronous nodules in NSCLC patients treated with a TKI.
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Affiliation(s)
- Hailin Li
- School of Automation, Harbin University of Science and Technology, Harbin, China
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Rui Zhang
- School of Automation, Harbin University of Science and Technology, Harbin, China
| | - Siwen Wang
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China
- School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China
| | - Mengjie Fang
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China
- School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China
| | - Yongbei Zhu
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine, Beihang University, Beijing, China
| | - Zhenhua Hu
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China
- School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China
| | - Di Dong
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China
- School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China
| | - Jingyun Shi
- Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jie Tian
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine, Beihang University, Beijing, China
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208
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Gastric Gastrointestinal Stromal Tumors (GIST): a Case Series and Current State of the Art in the Workup and Treatment of This Rare Disease. J Gastrointest Cancer 2020; 50:548-555. [PMID: 29192406 DOI: 10.1007/s12029-017-0034-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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209
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Computed tomography-based radiomics model for discriminating the risk stratification of gastrointestinal stromal tumors. Radiol Med 2020; 125:465-473. [PMID: 32048155 DOI: 10.1007/s11547-020-01138-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 01/16/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE The pathological risk degree of gastrointestinal stromal tumors (GISTs) has become an issue of great concern. Computed tomography (CT) is beneficial for showing adjacent tissues in detail and determining metastasis or recurrence of GISTs, but its function is still limited. Radiomics has recently shown a great potential in aiding clinical decision-making. The purpose of our study is to develop and validate CT-based radiomics models for GIST risk stratification. METHODS Three hundred and sixty-six patients clinically suspected of primary GISTs from January 2013 to February 2018 were retrospectively enrolled, among which data from 140 patients were eventually analyzed after exclusion. Data from patient CT images were partitioned based on the National Institutes of Health Consensus Classification, including tumor segmentation, radiomics feature extraction and selection. A radiomics model was then proposed and validated. RESULTS The radiomics signature demonstrated discriminative performance for advanced and nonadvanced GISTs with an area under the curve (AUC) of 0.935 [95% confidence interval (CI) 0.870-1.000] and an accuracy of 90.2% for validation cohort. The radiomics signature demonstrated favorable performance for the risk stratification of GISTs with an AUC of 0.809 (95% CI 0.777-0.841) and an accuracy of 67.5% for the validation cohort. Radiomics analysis could capture features of the four risk categories of GISTs. Meanwhile, this CT-based radiomics signature showed good diagnostic accuracy to distinguish between nonadvanced and advanced GISTs, as well as the four risk stratifications of GISTs. CONCLUSION Our findings highlight the potential of a quantitative radiomics analysis as a complementary tool to achieve an accurate diagnosis for GISTs.
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210
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Serrano C, Vivancos A, López-Pousa A, Matito J, Mancuso FM, Valverde C, Quiroga S, Landolfi S, Castro S, Dopazo C, Sebio A, Virgili AC, Menso MM, Martín-Broto J, Sansó M, García-Valverde A, Rosell J, Fletcher JA, George S, Carles J, Arribas J. Clinical value of next generation sequencing of plasma cell-free DNA in gastrointestinal stromal tumors. BMC Cancer 2020; 20:99. [PMID: 32024476 PMCID: PMC7003348 DOI: 10.1186/s12885-020-6597-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 01/31/2020] [Indexed: 02/08/2023] Open
Abstract
Background Gastrointestinal stromal tumor (GIST) initiation and evolution is commonly framed by KIT/PDGFRA oncogenic activation, and in later stages by the polyclonal expansion of resistant subpopulations harboring KIT secondary mutations after the onset of imatinib resistance. Thus, circulating tumor (ct)DNA determination is expected to be an informative non-invasive dynamic biomarker in GIST patients. Methods We performed amplicon-based next-generation sequencing (NGS) across 60 clinically relevant genes in 37 plasma samples from 18 GIST patients collected prospectively. ctDNA alterations were compared with NGS of matched tumor tissue samples (obtained either simultaneously or at the time of diagnosis) and cross-validated with droplet digital PCR (ddPCR). Results We were able to identify cfDNA mutations in five out of 18 patients had detectable in at least one timepoint. Overall, NGS sensitivity for detection of cell-free (cf)DNA mutations in plasma was 28.6%, showing high concordance with ddPCR confirmation. We found that GIST had relatively low ctDNA shedding, and mutations were at low allele frequencies. ctDNA was detected only in GIST patients with advanced disease after imatinib failure, predicting tumor dynamics in serial monitoring. KIT secondary mutations were the only mechanism of resistance found across 10 imatinib-resistant GIST patients progressing to sunitinib or regorafenib. Conclusions ctDNA evaluation with amplicon-based NGS detects KIT primary and secondary mutations in metastatic GIST patients, particularly after imatinib progression. GIST exhibits low ctDNA shedding, but ctDNA monitoring, when positive, reflects tumor dynamics.
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Affiliation(s)
- César Serrano
- Medical Oncology Department, Vall d'Hebron University Hospital, P. Vall d'Hebron 119, 08035, Barcelona, Spain. .,Preclinical Research Program, Vall d'Hebron Institute of Oncology, Barcelona, Spain.
| | - Ana Vivancos
- Cancer Genomics Group,
- Vall d'Hebron Institute of Oncology, Natzaret 115, 08035, Barcelona, Spain.
| | | | - Judit Matito
- Cancer Genomics Group,
- Vall d'Hebron Institute of Oncology, Natzaret 115, 08035, Barcelona, Spain
| | - Francesco M Mancuso
- Cancer Genomics Group,
- Vall d'Hebron Institute of Oncology, Natzaret 115, 08035, Barcelona, Spain
| | - Claudia Valverde
- Medical Oncology Department, Vall d'Hebron University Hospital, P. Vall d'Hebron 119, 08035, Barcelona, Spain
| | - Sergi Quiroga
- Radiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Stefania Landolfi
- Pathology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Sandra Castro
- Surgical Oncology Division, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Cristina Dopazo
- Surgical Oncology Division, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Ana Sebio
- Medical Oncology, Sant Pau University Hospital, Barcelona, Spain
| | - Anna C Virgili
- Medical Oncology, Sant Pau University Hospital, Barcelona, Spain
| | - María M Menso
- Radiology Department, Sant Pau University Hospital, Barcelona, Spain
| | | | - Miriam Sansó
- Cancer Genomics Group,
- Vall d'Hebron Institute of Oncology, Natzaret 115, 08035, Barcelona, Spain
| | | | - Jordi Rosell
- Preclinical Research Program, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Jonathan A Fletcher
- Pathology Department, Brigham and Women's Hospital/Harvard Medical School, Boston, USA
| | - Suzanne George
- Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - Joan Carles
- Medical Oncology Department, Vall d'Hebron University Hospital, P. Vall d'Hebron 119, 08035, Barcelona, Spain
| | - Joaquín Arribas
- Preclinical Research Program, Vall d'Hebron Institute of Oncology, Barcelona, Spain.,Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
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211
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Resection of the gastric submucosal tumor (G-SMT) originating from the muscularis propria layer: comparison of efficacy, patients' tolerability, and clinical outcomes between endoscopic full-thickness resection and surgical resection. Surg Endosc 2020; 34:4053-4064. [PMID: 32016516 PMCID: PMC7394934 DOI: 10.1007/s00464-019-07311-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 11/28/2019] [Indexed: 02/06/2023]
Abstract
Background and aims Endoscopic full-thickness resection (EFTR) has been increasingly applied in the treatment of gastric submucosal tumors (G-SMTs) with explorative intention. This study aimed to compare the efficacy, tolerability, and clinical outcomes of EFTR and surgical intervention for the management of muscularis propria (MP)-derived G-SMTs. Methods Between September 2011 and May 2019, the clinical records of patients with MP-derived G-SMTs undergoing EFTR at our endoscopic unit were collected. A cohort of people with primary MP-derived G-SMTs treated by surgery was matched in a 1:1 ratio to EFTR group with regard to patients’ baseline characteristics, clinicopathologic features of the tumor and the procedure date. The perioperative outcomes and follow-up data were analyzed. Results In total, 62 and 62 patients were enrolled into the surgery and EFTR group, respectively, with median follow-up of 786 days. The size of G-SMTs (with ulceration) ranged from 10 to 90 mm. For patients with tumor smaller than 30 mm, surgery and EFTR group presented comparable procedural success rate (both were 100%), en bloc resection rate (100% vs. 94.7%), tumor capsule rupture rate (0% vs. 5.3%), and pathological R0 resection rate (both were 100%). EFTR had a statistically significant advantage over surgery for estimated blood loss (3.12 ± 5.20 vs. 46.97 ± 60.73 ml, p ≤ 0.001), discrepancy between the pre- and postprocedural hemoglobin level (5.18 ± 5.43 vs. 9.84 ± 8.25 g/L, p = 0.005), bowel function restoration [1 (0–5) vs. 3 (1–5) days, p ≤ 0.001], and hospital cost (28,617.09 ± 6720.78 vs. 33,963.10 ± 13,454.52 Yuan, p = 0.033). The patients with tumor larger than 30 mm showed roughly the same outcomes after comparison analysis of the two groups. However, the clinical data revealed lower en bloc resection rate (75.0% vs. 100%, p = 0.022) and higher tumor capsule rupture rate (25.0% vs. 0%, p = 0.022) for EFTR when compared to surgery. The procedure time, duration of postprocedural fasting and antibiotics usage, and hospital stay of the two groups were equivalent. The occurrence rate of adverse events within postoperative day 7 were 74.2% and 72.6% after EFTR and surgery, respectively (p = 1.000). No complications occurred during the follow-up. Conclusion For treatment of MP-derived G-SMTs (with or without ulceration), our study showed the feasibility and safety of EFTR, which also provided better results in terms of procedural blood loss, the postoperative bowel function restoration and cost-effectiveness when compared to surgery, whereas the surgery was superior in en bloc resection rate for G-SMTs larger than 30 mm. The postprocedural clinical outcomes seemed to be equivalent in these two resection methods.
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212
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Kang H, Stiles WR, Baek Y, Nomura S, Bao K, Hu S, Park GK, Jo MJ, Hoseok I, Coll JL, Rubin BP, Choi HS. Renal Clearable Theranostic Nanoplatforms for Gastrointestinal Stromal Tumors. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2020; 32:e1905899. [PMID: 31854033 PMCID: PMC7015778 DOI: 10.1002/adma.201905899] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/13/2019] [Indexed: 05/26/2023]
Abstract
Advances in molecular imaging modalities have accelerated the diagnosis and treatment of human diseases. However, tumors less than 1 cm in size still remain difficult to localize by conventional means because of the difficulty in specific targeting/delivery to the tumor site. Furthermore, high nonspecific uptake in the major organs and persistent background retention results in low tumor-to-background ratio. The targeting and therapy of gastrointestinal stromal tumors (GIST) using nonsticky and renal clearable theranostic nanoparticles (a.k.a. H-Dots) are demonstrated. H-Dots not only target GIST for image-guided surgery, but also tailor the fate of anticancer drugs such as imatinib (IM) to the tumor site resulting in efficient treatment of unresectable GIST. In addition, H-Dots can monitor targetability, pharmacokinetics, and drug delivery, while also showing therapeutic efficacy in GIST-bearing xenograft mice following surgical resection. More importantly, IM loaded H-Dots exhibit lower uptake into the immune system, improved tumor selectivity, and increased tumor suppression compared to free IM, which accumulates in the spleen/liver. Precisely designed H-Dots can be used as a promising theranostic nanoplatform that can potentially reduce the side effects of conventional chemotherapies.
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Affiliation(s)
- Homan Kang
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114 (United States)
| | - Wesley R. Stiles
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114 (United States)
| | - Yoonji Baek
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114 (United States)
| | - Shinsuke Nomura
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114 (United States)
| | - Kai Bao
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114 (United States)
| | | | - G. Kate Park
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114 (United States)
| | - Min Joo Jo
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114 (United States)
| | - I Hoseok
- Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan (Republic of Korea)
| | - Jean-Luc Coll
- Cancer Targets & Experimental Therapeutics, Institute for Advanced Biosciences, University of Grenoble Alpes, INSERM-U1209, CNRS-UMR 5309- Grenoble (France)
| | - Brian P. Rubin
- Departments of Pathology and Cancer Biology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, and Lerner Research Institute and Taussig Cancer Center, Cleveland Clinic, Cleveland, OH 44195 (United States)
| | - Hak Soo Choi
- To whom correspondence should be addressed: HSC at
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Chen Q, Yu M, Lei Y, Zhong C, Liu Z, Zhou X, Li G, Zhou X, Chen Y. Efficacy and safety of endoscopic submucosal dissection for large gastric stromal tumors. Clin Res Hepatol Gastroenterol 2020; 44:90-100. [PMID: 31852630 DOI: 10.1016/j.clinre.2019.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 03/12/2019] [Accepted: 03/15/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIM Endoscopic submucosal dissection (ESD) of gastric stromal tumors is becoming increasingly common. However, there have been few studies analyzing the therapeutic efficacy and safety of this technique on large (≥ 3 cm) gastric stromal tumors (LGSTs). The aim of this study was to determine the feasibility of ESD for the removal of LGSTs and to investigate the clinical safety and efficacy of ESD for this indication. METHODS A retrospective analysis was carried out on 82 patients with LGSTs who underwent an ESD. Data on therapeutic outcomes and follow-up were collected for an analysis of the rates of en block resection and complete resection. A logistic regression model was used to identify potential risk factors for ESD-related complications, and a receiver operating characteristic (ROC) curve was generated for qualifying independent risk factors. RESULTS En bloc resection was achieved in 81 lesions (98.8%), and complete resection was achieved in 80 lesions (97.6%). The rates of intraoperative and postoperative bleeding were 6.1% and 3.7%, respectively. The accidental perforation rate was 12.2%, the postoperative perforation rate was 3.7%, the intentional perforation rate was 28.0%, and the postoperative infection rate was 12.2%. There was no postoperative mortality. LGSTs originating from the deep muscularis propria (MP) layer (OR = 4.905, 95% CI: 1.362-17.658, P = 0.015), located at the gastric fundus (OR = 4.927, 95% CI:1.308-18.558, P = 0.018) and with an irregular shape (OR = 4.842, 95% CI: 1.242-18.870, P = 0.023) increased the rate of complications. The prediction model that incorporated these factors demonstrated an area under the ROC curve of 0.77 (95% CI: 0.66-0.89). No tumor recurrence or distant metastasis was observed during the follow-up period, which ranged from 6-36 months. CONCLUSIONS ESD is a feasible, safe, effective and minimally invasive approach for the resection of LGSTs. Tumors originating from the deep MP layer, located at the fundus and with an irregular shape were identified as risk factors for the development of complications.
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Affiliation(s)
- Qiaofeng Chen
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No. 17, Yongwaizheng street, 330006 Nanchang, Jiangxi Province, PR China
| | - Mingju Yu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No. 17, Yongwaizheng street, 330006 Nanchang, Jiangxi Province, PR China
| | - Yupeng Lei
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No. 17, Yongwaizheng street, 330006 Nanchang, Jiangxi Province, PR China
| | - Chang Zhong
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No. 17, Yongwaizheng street, 330006 Nanchang, Jiangxi Province, PR China
| | - Zhijian Liu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No. 17, Yongwaizheng street, 330006 Nanchang, Jiangxi Province, PR China
| | - Xiaojiang Zhou
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No. 17, Yongwaizheng street, 330006 Nanchang, Jiangxi Province, PR China
| | - Guohua Li
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No. 17, Yongwaizheng street, 330006 Nanchang, Jiangxi Province, PR China
| | - Xiaodong Zhou
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No. 17, Yongwaizheng street, 330006 Nanchang, Jiangxi Province, PR China.
| | - Youxiang Chen
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No. 17, Yongwaizheng street, 330006 Nanchang, Jiangxi Province, PR China.
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Mu J, Sun P, Ma Z, Sun P. Bromodomain and extraterminal domain inhibitor enhances the antitumor effect of imatinib in gastrointestinal stromal tumours. J Cell Mol Med 2020; 24:2519-2530. [PMID: 31957165 PMCID: PMC7028844 DOI: 10.1111/jcmm.14945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 12/12/2022] Open
Abstract
In gastrointestinal stromal tumours (GISTs), the function of bromodomain-containing 4 (BRD4) remains underexplored. BRD4 mRNA abundance was quantified in GISTs. In the current study, we investigated the role of BRD4 in GISTs. Our results show a significant enhancement in BRD4 mRNA and a shift from very low-risk/low-risk to high-risk levels as per NCCN specifications. Overexpression of BRD4 correlated with unfavourable genotype, nongastric location, enhanced risk and decreased disease-free survival, which were predicted independently. Knockout of BRD4 in vitro suppressed KIT expression, which led to inactivation of the KIT/PI3K/AKT/mTOR pathway, impeded migration and cell growth and made the resistant GIST cells sensitive to imatinib. The expression of KIT was repressed by a BRD4 inhibitor JQ1, which also induced myristoylated-AKT-suppressible caspases 3 and 9 activities, induced LC3-II, exhibited dose-dependent therapeutic synergy with imatinib and attenuated the activation of the PI3K/AKT/mTOR pathway. In comparison with their single therapy, the combination of JQ1/imatinib more efficiently suppressed the growth of xenografts and exhibited a reduction in KIT phosphorylation, a decrease in Ki-67 and in the levels of phosphorylated PI3K/AKT/mTOR and enhanced TUNEL staining. Thus, we characterized the biological, prognostic and therapeutic implications of overexpressed BRD4 in GIST and observed that JQ1 suppresses KIT transactivation and nullifies the activation of PI3K/AKT/mTOR, providing a potential strategy for treating imatinib-resistant GIST through dual blockade of KIT and BRD4.
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Affiliation(s)
- Jianfeng Mu
- Department of Gastric and Colorectal SurgeryThe First Hospital of Jilin UniversityChangchunChina
| | - Pengfei Sun
- Changchun Railway Medical Insurance Management OfficeChangchunChina
| | - Zhiming Ma
- Department of Gastrointestinal Nutrition and Hernia SurgeryThe second hospital of Jilin UniversityChangchunChina
| | - Pengda Sun
- Department of Gastrointestinal Nutrition and Hernia SurgeryThe second hospital of Jilin UniversityChangchunChina
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Abstract
The field of third space endoscopy (TSE), also called submucosal endoscopy using a mucosal flap valve, allows secure access to the submucosal and deeper layers of the gastrointestinal tract without the risk of a full-thickness perforation. Since the first description of per-oral endoscopic myotomy (POEM) for the treatment of achalasia cardia 10 years ago, this field has expanded rapidly. Several new procedures, submucosal tunneling endoscopic resection, gastric-POEM, Zenker POEM, per-rectal endoscopic myotomy, diverticular POEM, and recanalization for complete esophageal obstruction (per-oral endoscopic tunneling for restoration of the esophagus), have been performed. All TSE procedures employ a similar technique-after a mucosal incision, a submucosal tunnel is created, a myotomy is performed, or a subepithelial tumor is resected distal to the site of mucosal incision, after which the mucosal incision is closed. Potential indications for TSE include resection of subepithelial tumors in the esophagus, gastroesophageal junction, or stomach; refractory gastroparesis; Zenker diverticulum; Hirschsprung disease or other forms of megacolon; and recanalization for complete esophageal obstruction. Data are currently available for POEM, submucosal tunneling endoscopic resection, and gastric-POEM, although mainly in the form of retrospective studies, and randomized trials and long-term follow-up data are limited. Submucosal endoscopy has an excellent safety profile with very few intraoperative adverse events, the majority being related to insufflation, although bleeding, perforation, and sepsis have been reported. TSE procedures require special training and have demonstrated a learning curve.
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216
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Ren C, Wang S, Zhang S. Development and validation of a nomogram based on CT images and 3D texture analysis for preoperative prediction of the malignant potential in gastrointestinal stromal tumors. Cancer Imaging 2020; 20:5. [PMID: 31931874 PMCID: PMC6958787 DOI: 10.1186/s40644-019-0284-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 12/29/2019] [Indexed: 12/15/2022] Open
Abstract
Background Gastrointestinal stromal tumors (GISTs), which are the most common mesenchymal tumors of the digestive system, are treated varyingly according to the malignancy. The purpose of this study is to develop and validate a nomogram for preoperative prediction of the malignant potential in patients with GIST. Methods A total of 440 patients with pathologically confirmed GIST after surgery in our hospital from January 2011 to July 2019 were retrospectively analyzed. They were randomly divided into the training set (n = 308) and validation set (n = 132). CT signs and texture features of each patient were analyzed and predictive model were developed using the least absolute shrinkage and selection operator (lasso) regression. Then a nomogram based on selected parameters was developed. The predictive effectiveness of nomogram was evaluated by the area under receiver operating characteristic (ROC) curve (AUC). Concordance index (C-index) and calibration plots were formulated to evaluate the reliability and accuracy of the nomogram by bootstrapping based on internal (training set) and external (validation set) validity. The clinical application value of the nomogram was determined through the decision curve analysis (DCA). Results Totally 156 GIST patients with low-malignant (very low and low risk) and 284 ones with high-malignant potential (intermediate and high risk) are enrolled in this study. The prediction nomogram consisting of size, cystoid variation and meanValue had an excellent discrimination both in training and validation sets (AUCs (95% confidence interval(CI)): 0.935 (0.908, 0.961), 0.933 (0.892, 0.974); C-indices (95% CI): 0.941 (0.912, 0.956), 0.935 (0.901, 0.982); sensitivity: 81.4, 90.6%; specificity: 75.0, 75.7%; accuracy: 88.0, 88.6%, respectively). The calibration curves indicated a good consistency between the actual observation and nomogram prediction for differentiating GIST malignancy. Decision curve analysis demonstrated that the nomogram was clinically useful. Conclusion This study presents a prediction nomogram that incorporates the CT signs and texture parameter, which can be conveniently used to facilitate the preoperative individualized prediction of malignancy in GIST patients.
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Affiliation(s)
- Caiyue Ren
- Department of Nuclear Medicine, Shanghai Proton and Heavy Ion Center, Shanghai, 201315, China.,Department of Radiology, Fudan University Shanghai Cancer Center, 270 Dong' an Road, Shanghai, 200032, China
| | - Shengping Wang
- Department of Radiology, Fudan University Shanghai Cancer Center, 270 Dong' an Road, Shanghai, 200032, China
| | - Shengjian Zhang
- Department of Radiology, Fudan University Shanghai Cancer Center, 270 Dong' an Road, Shanghai, 200032, China.
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Sachdev AH, Iqbal S, Ribeiro IB, de Moura DTH. Use of omental patch and endoscopic closure technique as an alternative to surgery after endoscopic full thickness resection of gastric intestinal stromal tumors: A series of cases. World J Clin Cases 2020; 8:120-125. [PMID: 31970177 PMCID: PMC6962076 DOI: 10.12998/wjcc.v8.i1.120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 11/26/2019] [Accepted: 12/13/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Gastrointestinal stromal tumors (GISTs) originate from interstitial cells of Cajal. GISTs can occur anywhere along the gastrointestinal tract. Large lesions have traditionally been removed surgically. However, with recent innovations in advanced endoscopy, GISTs located within the stomach are now removed endoscopically. We describe a new innovative endoscopic technique to close large and hard to access defects after endoscopic full-thickness resection of gastric GISTs.
CASE SUMMARY We present a series of three patients who were diagnosed with a gastric GIST. All patients underwent full-thickness endoscopic resection. In all cases, for closure of the surgical bed, conventional endoscopic techniques including hemoclips, endoloop and suturing were unsuccessful. We performed a new technique in which we pulled omental fat into the gastric lumen and completely closed the defect using endoscopic devices. All patients performed well post-procedure and computed tomography was carried out one day after the procedures which showed no extravasation of contrast.
CONCLUSION The omental plug technique may be used as an alternative to surgery in selected cases of gastric perforation.
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Affiliation(s)
- Amit H Sachdev
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, United States
| | | | - Igor Braga Ribeiro
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, Brazil
| | - Diogo Turiani Hourneaux de Moura
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, United States
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, Brazil
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219
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Wang PC, Wu PS. A retrospective cohort study of 304 patients with gastrointestinal stromal tumors in mackay memorial hospital. JOURNAL OF CANCER RESEARCH AND PRACTICE 2020. [DOI: 10.4103/jcrp.jcrp_10_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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220
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Parthasarathi, Dhawal S, Chittawadagi B, Cumar B, Kumar S, Palanivelu C. Gastrointestinal stromal tumour of stomach: Feasibility of laparoscopic resection in large lesions and its long-term outcomes. J Minim Access Surg 2020; 16:348-354. [PMID: 32098941 PMCID: PMC7597867 DOI: 10.4103/jmas.jmas_311_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background: Gastric gastrointestinal stromal tumours (GISTs) are rare neoplasms that require excision for cure. Although the feasibility of laparoscopic resection of smaller gastric GIST has been established, the feasibility and long-term efficacy of these techniques are unclear in larger lesions. This study is done to assess the feasibility of the laparoscopic resection of gastric GISTs and their long-term outcomes. Methods: Patients who underwent laparoscopic resection of gastric GISTs were identified in a prospectively collected database. Outcome measures included patient demographics, operative findings, morbidity and histopathologic characteristics of the tumour. Patient and tumour characteristics were analysed to identify risk factors for tumour recurrence. Results: There were 42 patients with a mean age of 56.7 years and had a mean tumour size was 4.5 ± 2.7 cm. Laparoscopic wedge resection was the most common procedure done. There were no major perioperative complications or mortalities. All lesions had negative resection margins. At a mean follow-up of 48 months, 36/39 (92.3%) patients were disease free and 3/39 (7.6%) had progressive disease. Univariate analysis showed that there was a statistically significant association of disease progression with tumour size, high mitotic index, tumour ulceration and tumour necrosis. The presence of >10 mitotic figures/50 high-power field was an independent predictor of disease progression. Conclusion: Our study establishes laparoscopic resection is feasible and safe in treating gastric GISTs for tumours >5 cm size. The long-term disease-free survival in our study shows acceptable oncological results in comparison to historical open resections.
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Affiliation(s)
- Parthasarathi
- Division of Upper GI Surgery, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Sharma Dhawal
- Division of Upper GI Surgery, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Bhushan Chittawadagi
- Division of Upper GI Surgery, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Bharath Cumar
- Division of Upper GI Surgery, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Saravana Kumar
- Division of Upper GI Surgery, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Chinnusamy Palanivelu
- Division of Upper GI Surgery, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
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Almaazmi H, Stem M, Lo BD, Taylor JP, Fang SH, Safar B, Efron JE, Atallah C. The Impact of Imatinib on Survival and Treatment Trends for Small Bowel and Colorectal Gastrointestinal Stromal Tumors. J Gastrointest Surg 2020; 24:98-108. [PMID: 31388887 DOI: 10.1007/s11605-019-04344-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/24/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND The aim of this study is to assess treatment trends and overall survival (OS) in small bowel (SB) and colorectal (CR) gastrointestinal stromal tumors (GIST) with respect to the introduction of imatinib in 2008. METHODS Patients diagnosed with SB and CR GIST were identified from the National Cancer Database (2004-2015). The primary outcome was 5- and 10-year OS. Patients were stratified by tumor site, time period (before and after imatinib), and treatment type. OS was analyzed using Kaplan-Meier survival curves, log-rank test, and Cox proportional hazards models. RESULTS A total of 8441 cases were included (SB 81.66%; CR 18.34%). Radical resection was the most common treatment (SB 42.33%; CR 38.69%). The addition of chemotherapy to radical resection for SB GIST increased between the two time periods (31.76 to 40.43%; p < 0.001), and was associated with improved unadjusted and adjusted OS (2009-2015: adjusted HR [AHR] 0.73, 95% CI 0.59-0.89, p = 0.002). Patients with SB GIST had better 5- and 10-year OS compared with CR (SB 69.83% and 47.68%; CR 61.33% and 45.39%; p < 0.001), even after stratifying by treatment type and tumor size and adjusting for other factors (SB 5-year AHR 1.35, 95% CI 1.19-1.53; 10-year AHR 1.23, 95% CI 1.09-1.38; each p < 0.001). CONCLUSION CR GIST are associated with lower OS than SB GIST. Radical resection is the most common treatment type for both sites. Chemotherapy with radical resection offers better OS in SB GIST, but not in CR GIST. Further studies are needed to assess the biology of CR GIST to explain the worse OS.
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Affiliation(s)
- Hamda Almaazmi
- Colorectal Research Unit, Ravitch Colorectal Division, Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 618, Baltimore, MD, 21205, USA
| | - Miloslawa Stem
- Colorectal Research Unit, Ravitch Colorectal Division, Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 618, Baltimore, MD, 21205, USA
| | - Brian D Lo
- Colorectal Research Unit, Ravitch Colorectal Division, Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 618, Baltimore, MD, 21205, USA
| | - James P Taylor
- Colorectal Research Unit, Ravitch Colorectal Division, Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 618, Baltimore, MD, 21205, USA
| | - Sandy H Fang
- Colorectal Research Unit, Ravitch Colorectal Division, Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 618, Baltimore, MD, 21205, USA
| | - Bashar Safar
- Colorectal Research Unit, Ravitch Colorectal Division, Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 618, Baltimore, MD, 21205, USA
| | - Jonathan E Efron
- Colorectal Research Unit, Ravitch Colorectal Division, Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 618, Baltimore, MD, 21205, USA
| | - Chady Atallah
- Colorectal Research Unit, Ravitch Colorectal Division, Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 618, Baltimore, MD, 21205, USA.
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Shubhankar G, Singh R, Vats M, Reddy A, Solanki N. Current Management of Gastrointestinal Stromal Tumor. MAMC JOURNAL OF MEDICAL SCIENCES 2020. [DOI: 10.4103/mamcjms.mamcjms_81_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Adherence to the guidelines and the pathological diagnosis of high-risk gastrointestinal stromal tumors in the real world. Gastric Cancer 2020; 23:118-125. [PMID: 31041650 PMCID: PMC6942594 DOI: 10.1007/s10120-019-00966-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 04/15/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND A multidisciplinary approach based on guidelines and pathological diagnosis by specialized pathologists are important for improving the prognosis and QoL of GIST patients. This study examined the adherence to the guidelines and the concordance of the pathological diagnosis of high-risk GISTs. PATIENTS AND METHODS Among 541 patients with high-risk GISTs recruited to the prospective registry between Dec. 2012 and Dec. 2015, 534 patients were analyzed after central pathology with KIT and DOG1 IHC and genotyping of KIT and PDGFRA. RESULTS Of the 534 patients, 432 (81%) received imatinib adjuvant therapy at a starting dose of 400 or 300 mg/day. Multivariate analysis indicated that age (HR 0.71; 95% CI 0.58-0.88), tumor size (HR for > 10 cm vs < 5 cm, 3.87; 95% CI 1.72-8.74), mitosis (HR for > 10 vs < 5, 3.54; 95% CI 1.84-6.79), tumor rupture (HR 3.69; 95% CI 1.43-9.52) and performance status (HR 0.55; 95% CI 0.31-0.99) were independently related to adjuvant therapy. Among the 534 high-risk GISTs diagnosed locally, 19 tumors (3.6%) were diagnosed as non-GISTs, and the other 93 (18.1%) GISTs were reclassified into lower risk categories by central pathology. Among 10 patients with non-GISTs and 8 patients with PDGFRA D842V mutations, 4 (40%) and 3 (38%) patients, respectively, continued the therapy after receiving the central pathology results. CONCLUSIONS The adherence to guidelines and the concordance of pathological diagnoses were comparatively good for high-risk GISTs. Central pathology may contribute to improved diagnosis, but further refinements may be required.
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Chen Z, Yang J, Sun J, Wang P. Gastric gastrointestinal stromal tumours (2-5 cm): Correlation of CT features with malignancy and differential diagnosis. Eur J Radiol 2019; 123:108783. [PMID: 31841880 DOI: 10.1016/j.ejrad.2019.108783] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/20/2019] [Accepted: 11/24/2019] [Indexed: 01/19/2023]
Abstract
PURPOSE The purpose of this study was to investigate the computed tomography (CT) features of 2-5 cm gastric gastrointestinal stromal tumors (GISTs), schwannomas and leimyomas which have close relationship with malignancy evaluation and differential diagnosis. METHOD Seventy-six patients with pathologically confirmed gastric submucosal tumors (SMTs) between 2-5 cm were included in this study, including 60 GISTs, 10 schwannomas and 6 leiomyomas. CT imaging features were reviewed and quantitative parameters including CT values during nonenhanced phase (CTV-N), portal phase (CTV-P) and delayed phase (CTV-D) were recorded. The association of CT features with mitotic counts of GISTs and the significantly different CT features between GISTs and benign SMTs were analyzed. RESULTS The lobulated contour was significantly more common in GISTs with high mitoses (P < 0.05). The value of CTV-D/CTV-P was significantly lower in GISTs with high mitoses (P < 0.05) and it was an independent predictor for high-mitosis GISTs (P = 0.049, odds ratio [OR] = 186.445) with an area under the curve (AUC) of 0.722. CT features including heterogeneous enhancement and presence of necrosis or cystic degeneration were significantly suggestive of GISTs instead of benign SMTs (P < 0.05). The value of CTV-D/CTV-P was significantly higher in schwannomas than that in GISTs (P < 0.05) with an AUC of 0.853. The value of CTV-P/CTV-N was significantly lower in leiomyomas than that in GISTs (P < 0.05) with an AUC of 0.883. CONCLUSIONS Some qualitative and quantitative parameters on contrast-enhanced CT can be helpful in preoperative diagnosis and risk stratification of 2-5 cm gastric GISTs.
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Affiliation(s)
- Zeyang Chen
- Department of General Surgery, Peking University First Hospital, Peking University, 8 Xi ShiKu Street, Beijing 100034, People's Republic of China
| | - Jiejin Yang
- Department of Radiology, Peking University First Hospital, Peking University, 8 Xi ShiKu Street, Beijing 100034, People's Republic of China
| | - Jiali Sun
- Department of Radiology, Peking University First Hospital, Peking University, 8 Xi ShiKu Street, Beijing 100034, People's Republic of China
| | - Pengyuan Wang
- Department of General Surgery, Peking University First Hospital, Peking University, 8 Xi ShiKu Street, Beijing 100034, People's Republic of China.
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Surgical treatment of primary gastrointestinal stromal tumors (GISTs): Management and prognostic role of R1 resections. Am J Surg 2019; 220:359-364. [PMID: 31862107 DOI: 10.1016/j.amjsurg.2019.12.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 11/24/2019] [Accepted: 12/03/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Surgery represents the best treatment for primary gastrointestinal stromal tumors (GISTs). The aim of this study is to analyse outcomes of surgical management in order to evaluate the influence of microscopically R1 margins on survival and recurrence in patients affected by GISTs. METHODS The study reviewed retrospective data from 74 patients surgically treated for primary GISTs without metastasis at diagnosis. Clinical and pathological findings, surgical procedures, information about follow up and outcomes were analyzed. RESULTS Recurrence rate was low and no patients died in the R1 group during the follow up period. The difference in recurrence free survival for patients undergoing an R0 (n = 54) versus an R1 (n = 20) resections was not statistically significant (76% versus 85% at 3 years, logrank test p-value = 0,14; 63% versus 86% at 5 years, logrank test p-value = 0,48) CONCLUSIONS: Microscopically positive margin has no influence on overall and relapse-free survival in GIST patients. Thus, when R0 surgery implies major functional sequelae, it may be decided to accept possible R1 margins, especially for low risk tumors.
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Merev E, Cicin I. Effect of clinical and pathological features of gastrointestinal stromal tumors on overall survival and prognosis: Single center experience. JOURNAL OF ONCOLOGICAL SCIENCES 2019. [DOI: 10.1016/j.jons.2019.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Mendes JT, Wilson C, Schammel CMG, Scott JD, Schammel DP, Trocha SD. GIST identified during bariatric surgery: to treat or not to treat? Surg Obes Relat Dis 2019; 16:282-287. [PMID: 31843454 DOI: 10.1016/j.soard.2019.10.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/14/2019] [Accepted: 10/21/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Gastrointestinal stromal tumors (GIST) are rare GI tumors that compose 1% of GI tumors. With the rise in obesity, bariatric surgery is becoming an increasingly common procedure and the incidental GISTs in this population have been noted more often than in the general population. OBJECTIVE We evaluated and characterized the incidental GISTs in our bariatric surgical population. SETTING The study was completed at a Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program-accredited academic hospital system. METHODS All GISTs identified during Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy between January 1, 2005 and December 31, 2016 were evaluated. Typical demographic, clinicopathologic, treatment, follow-up, and outcome data were recorded. RESULTS Within the 2655 bariatric surgeries at our institution, 17 GISTs were identified (.64%). Mean age was 54 years; 94% of lesions were identified intraoperatively. Lesions were identified in the fundus (29.4%) or body (70.6%), were unifocal, and <1 cm; 94.1% of resections had clear margins. Histology revealed 88.2% spindle cell and 11.8% mixed histology with <5 mitoses/50 fields, portending a low malignancy potential. Follow-up included the bariatric surgeon and oncology consult; 17.6% were recommended by oncology for computed tomography surveillance. No recurrences were recorded. CONCLUSION We present the largest cohort to date of incidental GISTs in a bariatric population. A diligent intraoperative examination of the serosa in the left-behind portion of the remnant in bypass and the discarded remnant in sleeves allows the bariatric surgeon the opportunity to leave the patient cancer-free after removal of incidental tumor.
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Affiliation(s)
- Jocelyn T Mendes
- University of South Carolina School of Medicine Greenville, Greenville, South Carolina
| | | | | | - John D Scott
- Division of Minimal Access and Bariatric Surgery, Department of Surgery, Prisma Health Upstate, Greenville, South Carolina
| | | | - Steven D Trocha
- GI Liver Division, Department of Surgery, Prisma Health Upstate, Greenville, South Carolina.
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228
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Ge N, Hu JL, Yang F, Yang F, Sun SY. Endoscopic full-thickness resection for treating small tumors originating from the muscularis propria in the gastric fundus: An improvement in technique over 15 years. World J Gastrointest Oncol 2019; 11:1054-1064. [PMID: 31798785 PMCID: PMC6883187 DOI: 10.4251/wjgo.v11.i11.1054] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/31/2019] [Accepted: 09/12/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The fundus of the stomach is regarded as a difficult area for endoscopic resection of small tumors originating from the muscularis propria (MP tumors). Three endoscopic resection techniques have been developed to treat these tumors, including ligation-assisted endoscopic full-thickness resection (L-EFTR), snare-assisted EFTR (S-EFTR), and endoscopic submucosal dissection-assisted EFTR (E-EFTR). To date, no studies have compared these techniques.
AIM We aimed to evaluate and compare S-EFTR with L-EFTR and E-EFTR for treating small MP tumors in the gastric fundus.
METHODS We retrospectively reviewed patients with primary small MP tumors in the gastric fundus and treated by these three techniques between January 2016 and December 2018 at Shengjing Hospital, China. Standard demographic and clinicopathologic data, including sex, age, tumor size, surgeon details, and pathological results, were collected. Data regarding operation duration, cost, en-bloc resection, and severe complications were also extracted and compared.
RESULTS A total of 36 patients (27 women) with a mean age of 55.8 ± 10.20 years were included in this study. The mean tumor size was 9.0 ± 3.98 mm. All the methods showed a 100% en-bloc resection rate and 0% severe complication rate. There was no statistically significant difference among the three groups in the operation duration (P = 0.148). The cost comparison for the whole procedure was as follows: E-EFTR > L-EFTR > S-EFTR (5837.5 ± 7212.96 CNY, 5970.7 ± 3465.27 CNY, 5852.0 ± 6438.25 CNY, respectively, P < 0.001).
CONCLUSION S-EFTR, L-EFT, and E-EFTR are all effective for resection of small MP tumors in the gastric fundus. S-EFTR is superior in terms of cost-effectiveness.
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Affiliation(s)
- Nan Ge
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Jin-Long Hu
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Fei Yang
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Fan Yang
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Si-Yu Sun
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
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229
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Ge N, Hu JL, Yang F, Yang F, Sun SY. Endoscopic full-thickness resection for treating small tumors originating from the muscularis propria in the gastric fundus: An improvement in technique over 15 years. World J Gastrointest Oncol 2019. [DOI: 10.4251/wjo.v11.i11.1054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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230
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Kanner DY, Kim EF, Shveikin AO, Shestakov AL. [Laparoscopic surgery in the treatment of patients with gastric gastrointestinal stromal tumors]. Khirurgiia (Mosk) 2019:76-80. [PMID: 31714534 DOI: 10.17116/hirurgia201911176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare safety and efficiency of conventional open and laparoscopic surgery in patients with gastrointestinal stromal tumors (GIST) of the stomach. MATERIAL AND METHODS A retrospective analysis included 42 patients with gastric GIST who were treated at the Moscow City Oncological Hospital #62 for the period from 2006 to 2018. All patients were divided into two groups depending on surgical approach. RESULTS Laparoscopic surgery is safe and effective in patients with gastric GIST. Short-term results of traditional open and laparoscopic operations in patients with gastric GISTs were compared. CONCLUSION Laparoscopic resection of gastric GIST is justified for tumors less than 5 cm. Laparoscopic procedure for tumors over 5 cm must be done only in high-volume hospitals.
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Affiliation(s)
- D Yu Kanner
- Moscow City Oncological Hospital #62 of the Moscow Healthcare Department, Moscow, Russia
| | - E F Kim
- Moscow City Oncological Hospital #62 of the Moscow Healthcare Department, Moscow, Russia
| | - A O Shveikin
- Moscow City Oncological Hospital #62 of the Moscow Healthcare Department, Moscow, Russia
| | - A L Shestakov
- Petrovsky Russian Research Centre of Surgery, Moscow, Russia
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231
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Clinicopathological Features and Prognosis of Small Gastric Gastrointestinal Stromal Tumors (GISTs). J Gastrointest Surg 2019; 23:2136-2143. [PMID: 31012047 DOI: 10.1007/s11605-018-04070-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 11/26/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of the present study was to evaluate the safety of endoscopic surgery, the clinicopathological features, and prognoses of small gastric gastrointestinal stromal tumors (GISTs). METHODS Small gastric GIST patients (diameter: 0.10-2.00 cm) resected endoscopically in Zhongshan Hospital were retrospectively identified and clinicopathological features and outcomes were collected. The relationship between clinicopathological characteristics and tumor recurrence was analyzed. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal tumor diameter for predicting malignant potential. RESULTS All lesions were completely removed by endoscopy and En bloc resection was 98.5%. The most frequent location was the gastric fundus (60.3%) and the average diameter of all lesions was 1.20 cm (range: 0.10-2.00 cm). Mitoses were calculated as more than 5/50 HPF in 44 (6.8%) patients and nuclear atypia was moderate in 243 (37.5%) patients, severe in 1 (0.2%). Necrosis, mucosal infiltration, and vascular infiltration were detected in 8 (1.2%), 5 (0.7%), and 3 (0.5%) patients, respectively. Tumor size was positively correlated with mitotic index (P < 0.001) and nuclear atypia (P < 0.001). After a median follow-up of 54 months, four patients were confirmed local recurrence. ROC curve analysis identified 1.45 cm as the best cut-off value to predict malignant potential (95% CI: 0·694-0·774). Survival analysis showed that patients with tumor diameters larger than 1.45 cm were associated with more local recurrences after resection (P = 0.011). CONCLUSIONS Endoscopic surgery is feasible and safe for small gastric GISTs, especially those in favorable locations. Small gastric GISTs bear a good prognosis as a whole but those with diameters larger than 1.45 cm should receive more intensive surveillance or undergo endoscopic surgery.
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232
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Ogun GO, Adegoke OO, Rahman A, Egbo OH. Gastrointestinal Stromal Tumours (GIST): A Review of Cases from Nigeria. J Gastrointest Cancer 2019; 51:729-737. [PMID: 31659675 DOI: 10.1007/s12029-019-00318-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE Gastrointestinal stromal tumours (GIST) are rare and studies on GIST in Nigeria are extremely uncommon. This study aims to achieve a comprehensive systematic review of the cases of this tumour in Nigerians. METHODS A systematic search of all available literature on GIST published from Nigeria between January 2000 and December 2018 was done and reviewed. Simple descriptive data on all the cases are presented. RESULTS The search yielded 15 publications but 13 publications with a total of 67 patients were analysed. The other two studies centred on imatinib therapy and overall survival, and molecular characteristics respectively and were therefore reviewed independently. Age at diagnosis ranged from 9 to 75 years, with mean age being in the 50s and 60s across most studies. There is no gender disparity. Anatomical location of primary tumours showed gastric location as the most frequent (61%) followed by large intestine accounting for 15%, the small intestine (9%) and other locations (15%). Tumour size ranged from 5-39.5 cm. Over 85% of patients had tumour size greater than 10 cm at presentation, hence fell into intermediate or high-risk group irrespective of location of tumour. The overall survival of a cohort of 27 patients that had imatinib therapy was 69.5% after 4 years of follow-up. KIT exon 11 mutations were the only mutations detected from a small cohort of 12 patients. CONCLUSIONS Characteristics of GIST in Nigerians are fairly similar to other parts of the world. However, most of our patients present with large masses which are of poor prognostic characteristics.
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Affiliation(s)
- Gabriel O Ogun
- Department of Pathology, College of Medicine, University of Ibadan, Ibadan, Nigeria. .,Department of Pathology, University College Hospital, Ibadan, Nigeria.
| | - Omolade O Adegoke
- Department of Pathology, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Department of Pathology, University College Hospital, Ibadan, Nigeria
| | - Adam Rahman
- Department of Pathology, University College Hospital, Ibadan, Nigeria
| | - Ojevwe H Egbo
- Department of Anatomical Pathology, College of Medical Sciences, Edo University Iyamho, Iyamho, Nigeria
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233
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Guo Y, Jing X, Zhang J, Ding X, Li X, Mao T, Tian Z. Endoscopic Removal of Gastrointestinal Stromal Tumors in the Stomach: A Single-Center Experience. Gastroenterol Res Pract 2019; 2019:3087298. [PMID: 31772569 PMCID: PMC6854245 DOI: 10.1155/2019/3087298] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 08/28/2019] [Accepted: 09/01/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND AIMS Endoscopic removal of GISTs (gastrointestinal stromal tumors) is recently recognized, but less is known about its efficacy and safety. This study is aimed at assessing the feasibility, clinical efficacy, and safety of the endoscopic removal of gastric GISTs. PATIENTS AND METHODS Endoscopic removal (ER) of GISTs was performed in 134 patients at our hospital between January 2015 and January 2019. The clinical features, surgical outcomes, complications, pathological diagnosis, and risk classification were evaluated retrospectively. RESULTS ER was successful in 131 cases (98%), including 58 by ESD (endoscopic submucosal dissection), 43 by ESE (endoscopic submucosal excavation), 25 by EFTR (endoscopic full-thickness resection), and 5 by STER (submucosal tunneling endoscopic resection). In addition, GISTs of two cases were resected using LECS (laparoscopic and luminal endoscopic cooperative surgery) for the extraluminal and intraluminal growth pattern. The average tumor size was 1.89 ± 1.25 cm (range: 0.5-6.0 cm). Of these patients, 26 cases had a large tumor size (range: 2.0-6.0 cm), and endoscopic removal was successful in all of them. During the procedure, endoclips were used to close the perforation in all cases, without conversion to open surgery. The average length of hospital stay was 5.50 ± 2.15 days (range: 3-10 days). In the risk classification, 106 (79.7%) were of a very low risk, 25 (18.8%) of a low risk, and 2 (1.5%) of a moderate risk. The moderate-risk cases were treated with imatinib mesylate after ER. No recurrence or metastasis was observed during the follow-up period of 23 ± 8 months (range: 3-48 months). CONCLUSIONS The endoscopic treatment is feasible, effective, and safe for gastric GISTs, and individualized choice of approaches is recommended for GISTs.
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Affiliation(s)
- Yingjie Guo
- Department of Gastroenterology, The Affiliated Hospital of QingDao University, Qingdao, 266003 Shandong Province, China
| | - Xue Jing
- Department of Gastroenterology, The Affiliated Hospital of QingDao University, Qingdao, 266003 Shandong Province, China
| | - Jian Zhang
- Department of General Surgery, The Affiliated Hospital of QingDao University, Qingdao, 266003 Shandong Province, China
| | - Xueli Ding
- Department of Gastroenterology, The Affiliated Hospital of QingDao University, Qingdao, 266003 Shandong Province, China
| | - Xiaoyu Li
- Department of Gastroenterology, The Affiliated Hospital of QingDao University, Qingdao, 266003 Shandong Province, China
| | - Tao Mao
- Department of Gastroenterology, The Affiliated Hospital of QingDao University, Qingdao, 266003 Shandong Province, China
| | - Zibin Tian
- Department of Gastroenterology, The Affiliated Hospital of QingDao University, Qingdao, 266003 Shandong Province, China
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234
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Mutational inactivation of mTORC1 repressor gene DEPDC5 in human gastrointestinal stromal tumors. Proc Natl Acad Sci U S A 2019; 116:22746-22753. [PMID: 31636198 DOI: 10.1073/pnas.1914542116] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common human sarcoma and are initiated by activating mutations in the KIT or PDGFRA receptor tyrosine kinases. Chromosome 22q deletions are well-recognized frequent abnormalities in GISTs, occurring in ∼50% of GISTs. These deletions are thought to contribute to the pathogenesis of this disease via currently unidentified tumor suppressor mechanisms. Using whole exome sequencing, we report recurrent genomic inactivated DEPDC5 gene mutations in GISTs (16.4%, 9 of 55 patients). The demonstration of clonal DEPDC5 inactivation mutations in longitudinal specimens and in multiple metastases from individual patients suggests that these mutations have tumorigenic roles in GIST progression. DEPDC5 inactivation promotes GIST tumor growth in vitro and in nude mice. DEPDC5 reduces cell proliferation through the mTORC1-signaling pathway and subsequently induces cell-cycle arrest. Furthermore, DEPDC5 modulates the sensitivity of GIST to KIT inhibitors, and the combination therapy with mTOR inhibitor and KIT inhibitor may work better in GIST patients with DEPDC5 inactivation. These findings of recurrent genomic alterations, together with functional data, validate the DEPDC5 as a bona fide tumor suppressor contributing to GIST progression and a biologically relevant target of the frequent chromosome 22q deletions.
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235
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Majinyang S, Ruth YKM, Ahmed S, Sanghvi K, Oo AM, Nath KA, Rao J, Shelat VG. Microscopically Positive Resection Margins in Laparoscopic Gastric GIST Resection May Not Confer a Poorer Prognosis. Surg Laparosc Endosc Percutan Tech 2019; 29:393-398. [PMID: 31498269 DOI: 10.1097/sle.0000000000000714] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Laparoscopic resection of gastrointestinal stromal tumor (GIST) has increased popularity with studies showing good outcomes for patients with tumors <5 cm, with a shorter hospital stay, lower blood loss, and morbidity. Our study aims to audit the clinical profile and surgical outcomes of GISTs, with an evaluation of laparoscopic versus open surgery and the prognostic role of positive R1 margins. In our retrospective study, 62 GIST patients who underwent surgery were included and further analysis was made for the 48 gastric GISTs patients. In total, 33 patients underwent laparoscopic gastric GIST resection, whereas the rest underwent open resection. There was no difference in operative duration but the blood loss was lesser and length of stay shorter in the laparoscopic group. The laparoscopic group had a higher incidence of R1 resection but none developed recurrence or metastasis during follow-up. Laparoscopic resection in the management of gastric GISTs resulted in higher R1 resection rates but this did not affect recurrence rates or overall survival.
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Affiliation(s)
| | | | - Saleem Ahmed
- Department of General Surgery, Tan Tock Seng Hospital, Tan Tock Seng, Singapore
| | - Kaushal Sanghvi
- Department of General Surgery, Tan Tock Seng Hospital, Tan Tock Seng, Singapore
| | - Aung M Oo
- Department of General Surgery, Tan Tock Seng Hospital, Tan Tock Seng, Singapore
| | - Koura A Nath
- Department of General Surgery, Tan Tock Seng Hospital, Tan Tock Seng, Singapore
| | - Jaideepraj Rao
- Department of General Surgery, Tan Tock Seng Hospital, Tan Tock Seng, Singapore
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Tan Tock Seng, Singapore
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Onimaru M, Inoue H, Ikeda H, Abad MRA, Quarta Colosso BM, Shimamura Y, Sumi K, Deguchi Y, Ito H, Yokoyama N. Combination of laparoscopic and endoscopic approaches for neoplasia with non-exposure technique (CLEAN-NET) for gastric submucosal tumors: updated advantages and limitations. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:582. [PMID: 31807563 DOI: 10.21037/atm.2019.09.19] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Laparoscopic and endoscopic cooperative surgery (LECS) for gastric submucosal tumors (SMTs) has been developed under the concept of resecting gastric tumors with both complete curability and preserving organ functions. Precise resection is obtained by classical LECS, however, concerns regarding intraoperative bacterial infection and dissemination of the tumor cells into the abdominal cavity by LECS with exposure technique still remain. To prevent these concerns, several LECS-related procedures with non-exposure techniques, such as combination of laparoscopic and endoscopic approaches for neoplasia with non-exposure technique (CLEAN-NET) and non-exposed endoscopic wall-inversion surgery (NEWS), have been reported to be safe and feasible. Classical LECS, CLEAN-NET, and NEWS have the same concept, however, each has its own different characteristic procedures; exposure or non-exposure technique, inversion of the tumor into or outer the lumen, retrieval of tumor per oral or through the abdominal cavity, and dominance in the role of the endoscopist or the laparoscopic surgeon. Familiarization with these procedure details is important to understand their indications, advantages and limitations, resulting in providing a tailored minimally invasive surgery for patients. The main scope of this review article is to introduce readers to the clinical application, procedure, and results of CLEAN-NET, both from previous literatures and from our experience, as well as to offer a closer look at its advantages and limitations while comparing with other LECS procedures from the viewpoint of introducing CLEAN-NET first.
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Affiliation(s)
- Manabu Onimaru
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Haruhiro Inoue
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Haruo Ikeda
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | | | | | - Yuto Shimamura
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Kazuya Sumi
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Yoshio Deguchi
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Hiroaki Ito
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Noboru Yokoyama
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
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237
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Li L, Khalili M, Johannes G, Baratam P, Morano WF, Styler M, Bowne WB, Hou JS. Case report of rhabdomyosarcomatous transformation of a primary gastrointestinal stromal tumor (GIST). BMC Cancer 2019; 19:913. [PMID: 31514735 PMCID: PMC6743131 DOI: 10.1186/s12885-019-6085-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 08/23/2019] [Indexed: 12/11/2022] Open
Abstract
Background Gastrointestinal stromal tumor (GIST) is the most common primary mesenchymal neoplasm of the gastrointestinal tract. Mutations of KIT and platelet-derived growth factor receptor alpha have been well characterized in GISTs. Patients with KIT mutations are generally sensitive to treatment with tyrosine kinase inhibitors. However, some patients with GIST, while initially sensitive to TKIs, gain resistance in later stages of treatment. Heterologous rhabdomyomsarcomatous dedifferentiation of advanced GISTs after long-term imatinib mesylate (IM) therapy has been reported. In these cases, the underlying molecular mechanism of tumor progression and transformation is unclear. Case presentation We report one such patient with rhabdomyosarcomatous dedifferentiation of a GIST without metastatic disease after brief 3-month therapy with IM. The tumor was composed of two distinct phenotypes, a CD117 negative region with rhabdomyosarcomatous differentiation directly adjacent to a CD117 positive classic GIST region. Molecular analysis identified the activating KIT exon 11 mutation in both regions, indicating a common origin for both phenotypes. Additionally, the dedifferentiated component contained two synonymous variants in platelet-derived growth factor receptor alpha and KIT. The increased number of synonymous variants in the rhabdomyosarcomatous region may reflect increased genetic instability of this tumor that may have resulted in the loss of CD117 expression in the dedifferentiated component. Conclusion This study adds to the growing consensus that rhabdomyosarcomatous GIST progresses from a common GIST primary tumor. The role of IM in this progression is uncertain; however short duration of IM treatment in this study supports the hypothesis that rhabdomyosarcomatous GIST progression is not a consequence of IM therapy. Furthermore, we provide additional information supporting the observation that CD117 negative rhabdomyosarcomatous transformation maintains the activating KIT variant without KIT expression.
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Affiliation(s)
- Li Li
- Department of Pathology and Laboratory Medicine, Drexel University College of Medicine, 245 N. 15th Street, Philadelphia, PA, 19102, USA
| | - Marian Khalili
- Departments of Surgery, Drexel University College of Medicine, 245 N 15th Street, Suite 7150, Philadelphia, PA, 19102, USA.
| | - Gregg Johannes
- Department of Pathology and Laboratory Medicine, Drexel University College of Medicine, 245 N. 15th Street, Philadelphia, PA, 19102, USA
| | - Praneeth Baratam
- Department of Hematology and Oncology, Drexel University College of Medicine, 245 N. 15th Street, Philadelphia, PA, 19102, USA
| | - William F Morano
- Departments of Surgery, Drexel University College of Medicine, 245 N 15th Street, Suite 7150, Philadelphia, PA, 19102, USA
| | - Michael Styler
- Department of Hematology and Oncology, Drexel University College of Medicine, 245 N. 15th Street, Philadelphia, PA, 19102, USA
| | - Wilbur B Bowne
- Departments of Surgery, Drexel University College of Medicine, 245 N 15th Street, Suite 7150, Philadelphia, PA, 19102, USA
| | - J Steve Hou
- Department of Pathology and Laboratory Medicine, Drexel University College of Medicine, 245 N. 15th Street, Philadelphia, PA, 19102, USA
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238
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Miyake K, Kawaguchi K, Kiyuna T, Miyake M, Igarashi K, Zhang Z, Murakami T, Li Y, Nelson SD, Elliott I, Russell T, Singh A, Hiroshima Y, Momiyama M, Matsuyama R, Chishima T, Endo I, Eilber FC, Hoffman RM. Regorafenib regresses an imatinib-resistant recurrent gastrointestinal stromal tumor (GIST) with a mutation in exons 11 and 17 of c-kit in a patient-derived orthotopic xenograft (PDOX) nude mouse model. Cell Cycle 2019; 17:722-727. [PMID: 29334307 DOI: 10.1080/15384101.2017.1423223] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Gastrointestinal stromal tumor (GIST) with a mutation in exons 11 and 17 of c-kit is a rare type of sarcoma. The aim of this study was to determine drug sensitivity for a regionally-recurrent case of GIST using a patient-derived orthotopic xenograft (PDOX) model. The PDOX model was established in the anterior wall of the stomach. GIST PDOX models were randomized into 5 groups of 6 mice each when the tumor volume reached 60 mm3: G1, control group; G2, imatinib group (oral administration (p.o.), daily, for 3 weeks); G3, sunitinib group (p.o., daily, for 3 weeks); G4, regorafenib (p.o., daily, for 3 weeks); G5, pazopanib (p.o., daily, for 3 weeks). All mice were sacrificed on day 22. Tumor volume was evaluated on day 0 and day 22 by laparotomy. Body weight were measured 2 times per week. Though regorafenib is third-line therapy for GIST, it was the most effective drug and regressed the tumor significantly (p < 0.001). Sunitinib suppressed tumor growth compared to the control group (p = 0.002). Imatinib, first-line therapy for GIST, and pazopanib did not have significant efficacy compared to the control group (p = 0.886, p = 0.766). The implications of this result is discussed for GIST patients.
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Affiliation(s)
- Kentaro Miyake
- a AntiCancer Inc. , San Diego , CA.,b Department of Surgery , University of California , San Diego , CA.,c Department of Gastroenterological Surgery , Yokohama City University Graduate School of Medicine , Yokohama , Japan
| | - Kei Kawaguchi
- a AntiCancer Inc. , San Diego , CA.,b Department of Surgery , University of California , San Diego , CA
| | - Tasuku Kiyuna
- a AntiCancer Inc. , San Diego , CA.,b Department of Surgery , University of California , San Diego , CA
| | - Masuyo Miyake
- a AntiCancer Inc. , San Diego , CA.,b Department of Surgery , University of California , San Diego , CA.,c Department of Gastroenterological Surgery , Yokohama City University Graduate School of Medicine , Yokohama , Japan
| | - Kentaro Igarashi
- a AntiCancer Inc. , San Diego , CA.,b Department of Surgery , University of California , San Diego , CA
| | - Zhiying Zhang
- a AntiCancer Inc. , San Diego , CA.,b Department of Surgery , University of California , San Diego , CA
| | - Takashi Murakami
- a AntiCancer Inc. , San Diego , CA.,b Department of Surgery , University of California , San Diego , CA.,c Department of Gastroenterological Surgery , Yokohama City University Graduate School of Medicine , Yokohama , Japan
| | - Yunfeng Li
- e Deparment of Pathology , University of California , Los Angeles , CA
| | - Scott D Nelson
- e Deparment of Pathology , University of California , Los Angeles , CA
| | - Irmina Elliott
- f Division of Surgical Oncology , University of California , Los Angeles , CA
| | - Tara Russell
- f Division of Surgical Oncology , University of California , Los Angeles , CA
| | - Arun Singh
- d Division of Hematology-Oncology , University of California , Los Angeles , CA
| | - Yukihiko Hiroshima
- c Department of Gastroenterological Surgery , Yokohama City University Graduate School of Medicine , Yokohama , Japan
| | - Masashi Momiyama
- c Department of Gastroenterological Surgery , Yokohama City University Graduate School of Medicine , Yokohama , Japan
| | - Ryusei Matsuyama
- c Department of Gastroenterological Surgery , Yokohama City University Graduate School of Medicine , Yokohama , Japan
| | - Takashi Chishima
- c Department of Gastroenterological Surgery , Yokohama City University Graduate School of Medicine , Yokohama , Japan
| | - Itaru Endo
- c Department of Gastroenterological Surgery , Yokohama City University Graduate School of Medicine , Yokohama , Japan
| | - Fritz C Eilber
- f Division of Surgical Oncology , University of California , Los Angeles , CA
| | - Robert M Hoffman
- a AntiCancer Inc. , San Diego , CA.,b Department of Surgery , University of California , San Diego , CA
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Jin XF, Gai W, Du RL, Chai TH, Li L, Auernhammer CJ. Multiband mucosectomy versus endoscopic submucosal dissection and endoscopic submucosal excavation for GI submucosal tumors: short and long term follow-up. BMC Cancer 2019; 19:893. [PMID: 31492157 PMCID: PMC6731551 DOI: 10.1186/s12885-019-6100-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 08/27/2019] [Indexed: 12/14/2022] Open
Abstract
AIMS To evaluate the short- and long-term outcomes of 3 different endoscopic dissection techniques for upper gastrointestinal (GI) submucosal tumours (SMTs). METHODS Data for 135 patients withGI SMTs who underwent multiband mucosectomy (MBM), endoscopic submucosal dissection (ESD), or endoscopic submucosal excavation (ESE) were retrospectively assessed. The en bloc resection rate, endoscopic complete resection rate, operation time, potential complications and local recurrence rate were compared. RESULTS No significant differences were observed in the rate of endoscopic complete resections and pathologic complete resections among the three groups. For SMTs > 15 mm in width, the lowest en bloc resection rate was found for MBM (P = 0.000). MBM was also associated with the shortest procedure time, lowest perforation rate and lowest rate of major bleeding. ESE was the most effective procedure for muscularis propria (MP) lesions but was associated with the longest operation time (P < 0.01). The ESD and ESE groups had similar perforation rates (P > 0.05). No differences were observed in 4-year local recurrence rates among the groups (P = 0.945). CONCLUSIONS MBM is a simple and effective method for the treatment of small SMTs and achieves clinical success rates similar to those of ESD and ESE. However, ESD and ESE are preferable for larger and deep lesions and are associated with a longer operation time. Nonetheless, all 3 techniques resulted in a low 4-year local recurrence rate. Large-scale randomized clinical trials are needed to further investigate these results.
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Affiliation(s)
- Xi-Feng Jin
- Department of Gastroenterology, TengZhou Central People's Hospital, 183 Xingtan Road, Tengzhou, 277500, Shandong Province, China. .,Department of Internal Medicine 4, University-Hospital Campus Grosshadern, Ludwig-Maximilians-University of Munich, Munich, Germany.
| | - Wei Gai
- Department of Gastroenterology, TengZhou Central People's Hospital, 183 Xingtan Road, Tengzhou, 277500, Shandong Province, China
| | - Rong-Lian Du
- Department of Gastroenterology, TengZhou Central People's Hospital, 183 Xingtan Road, Tengzhou, 277500, Shandong Province, China
| | - Tong-Hai Chai
- Department of Gastroenterology, TengZhou Central People's Hospital, 183 Xingtan Road, Tengzhou, 277500, Shandong Province, China
| | - Ling Li
- Department of Gastroenterology, TengZhou Central People's Hospital, 183 Xingtan Road, Tengzhou, 277500, Shandong Province, China
| | - Christoph J Auernhammer
- Department of Internal Medicine 4, University-Hospital Campus Grosshadern, Ludwig-Maximilians-University of Munich, Munich, Germany
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Stuart E, Banerjee S, de la Torre J, Wang Y, Scherzer N, Burgoyne AM, Parry L, Fanta PT, Ramamoorthy S, Sicklick JK. Frequent rectal gastrointestinal stromal tumor recurrences in the imatinib era: Retrospective analysis of an International Patient Registry. J Surg Oncol 2019; 120:715-721. [PMID: 31297829 PMCID: PMC6699886 DOI: 10.1002/jso.25621] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 06/22/2019] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Rectal gastrointestinal stromal tumor (GIST) is rare and comprises about 3% of GIST. METHODS Registry data was collected by the Life Raft Group June 1976 to November 2017. All patients had a histologic GIST diagnosis. Demographic, clinicopathologic, and clinical outcome data were patient reported. Recurrence-free survival (RFS) was analyzed using the Kaplan-Meier method and Cox regression analysis. RESULTS Of 1798 patients in the database, 48 had localized rectal GIST (2.7%). Patients were frequently male (58.3%) and non-Hispanic whites (58.3%). Median age at diagnosis was 52 years. Most patients (77%) were diagnosed in the imatinib era (2001 to current). Over half (54.2%) of the cohort had mutation testing and all profiled tumors possessed KIT mutations (exon 9: 7.7%, exon 11: 88.5%, and exon 13: 3.8%). Most evaluable patients (26/28; 92.9%) had high-risk disease (modified NIH criteria) and nearly all patients (95.8%) received imatinib. Median follow-up was 8.8 years (range, 0.3-30.7) and overall RFS was 8.0 years (95% CI, 2.9-13.1). Thirty-two percent (12/37) of patients in the post-imatinib era developed recurrent disease. Diagnosis in the imatinib era was associated with improved RFS (HR = 0.22, 95% CI, 0.08-0.62; P = .004) in the multivariable model. CONCLUSION We find that disease recurrence remains prevalent in one-third of patients treated during the imatinib-era.
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Affiliation(s)
- Emelia Stuart
- School of Medicine, University of California, San Diego, La Jolla, CA
| | - Sudeep Banerjee
- Division of Surgical Oncology, Department of Surgery, Moores Cancer Center, University of California, San Diego, La Jolla, CA
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Jorge de la Torre
- Division of Surgical Oncology, Department of Surgery, Moores Cancer Center, University of California, San Diego, La Jolla, CA
| | - Yu Wang
- Life Raft Group, Wayne, NJ, United States
| | | | - Adam M. Burgoyne
- School of Medicine, University of California, San Diego, La Jolla, CA
- Division of Hematology Oncology, Department of Medicine, Moores Cancer Center, University of California, San Diego, La Jolla, CA
| | - Lisa Parry
- School of Medicine, University of California, San Diego, La Jolla, CA
- Division of Colorectal Surgery, Department of Surgery, Moores Cancer Center, University of California, San Diego, La Jolla, CA
| | - Paul T. Fanta
- School of Medicine, University of California, San Diego, La Jolla, CA
- Division of Hematology Oncology, Department of Medicine, Moores Cancer Center, University of California, San Diego, La Jolla, CA
| | - Sonia Ramamoorthy
- School of Medicine, University of California, San Diego, La Jolla, CA
- Division of Colorectal Surgery, Department of Surgery, Moores Cancer Center, University of California, San Diego, La Jolla, CA
| | - Jason K. Sicklick
- School of Medicine, University of California, San Diego, La Jolla, CA
- Division of Surgical Oncology, Department of Surgery, Moores Cancer Center, University of California, San Diego, La Jolla, CA
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Lee MW, Kim GH, Kim KB, Kim YH, Park DY, Choi CI, Kim DH, Jeon TY. Digital image analysis-based scoring system for endoscopic ultrasonography is useful in predicting gastrointestinal stromal tumors. Gastric Cancer 2019; 22:980-987. [PMID: 30778798 DOI: 10.1007/s10120-019-00928-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 01/18/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND When gastric mesenchymal tumors (GMTs) measuring 2-5 cm in size are found, whether to undergo further treatment or not is controversial. Endoscopic ultrasonography (EUS) is useful for the evaluation of malignant potential of GMTs, but has limitations, such as subjective interpretation of EUS images. Therefore, we aimed to develop a scoring system based on the digital image analysis of EUS images to predict gastrointestinal stromal tumors (GISTs). METHODS We included 103 patients with histopathologically proven GIST, leiomyoma or schwannoma on surgically resected specimen who underwent EUS examination between January 2007 and June 2018. After standardization of the EUS images, brightness values, including the mean (Tmean), indicative of echogenicity, and the standard deviation (TSD), indicative of heterogeneity, in the tumors were analyzed. RESULTS Age, Tmean, and TSD were significantly higher in GISTs than in non-GISTs. The sensitivity and specificity were almost optimized for differentiating GISTs from non-GISTs when the critical values of age, Tmean, and TSD were 57.5 years, 67.0, and 25.6, respectively. A GIST-predicting scoring system was created by assigning 3 points for Tmean ≥ 67, 2 points for age ≥ 58 years, and 1 point for TSD ≥ 26. When GMTs with 3 points or more were diagnosed as GISTs, the sensitivity, specificity, and accuracy of the scoring system were 86.5%, 75.9%, and 83.5%, respectively. CONCLUSIONS The scoring system based on the information of digital image analysis is useful in predicting GISTs in case of GMTs that are 2-5 cm in size.
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Affiliation(s)
- Moon Won 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
| | - 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.
| | - Kwang Baek Kim
- Division of Computer Engineering, Silla University, Busan, South Korea
| | - Yoon Ho 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
| | - Do Youn Park
- Department of Pathology, Pusan National University School of Medicine, Busan, South Korea
| | - Chang In Choi
- Department of Surgery, 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
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242
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Haddad A, Sebai A, Chaker Y, Daghfous A. Surgical Management of Bleeding Duodenal Stromal Tumours with Shock. J Gastrointest Cancer 2019; 51:347-350. [PMID: 31396883 DOI: 10.1007/s12029-019-00288-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Anis Haddad
- Surgery Department A, La Rabta Hospital, La Rabta Jebbari, 1007, Tunis, Tunisia
| | - Amine Sebai
- Surgery Department A, La Rabta Hospital, La Rabta Jebbari, 1007, Tunis, Tunisia.
| | - Youssef Chaker
- Surgery Department A, La Rabta Hospital, La Rabta Jebbari, 1007, Tunis, Tunisia
| | - Amine Daghfous
- Surgery Department A, La Rabta Hospital, La Rabta Jebbari, 1007, Tunis, Tunisia
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Wei CH, Pettersson J, Campan M, Chopra S, Naritoku W, Martin SE, Ward PM. Gain of TP53 Mutation in Imatinib-treated SDH-Deficient Gastrointestinal Stromal Tumor and Clinical Utilization of Targeted Next-generation Sequencing Panel for Therapeutic Decision Support. Appl Immunohistochem Mol Morphol 2019; 26:573-578. [PMID: 28027118 DOI: 10.1097/pai.0000000000000482] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Patients with succinate dehydrogenase (SDH)-deficient gastrointestinal stromal tumor (GIST) have few therapeutic options. Despite lack of KIT or platelet-derived growth factor receptor A (PDGFRA) driver mutations, SDH-deficient GISTs display strong expression of KIT by immunohistochemistry and these patients are often treated with tyrosine kinase inhibitors, including imatinib as a first-line therapy. Using a targeted next-generation sequencing panel of mutation hotspots of 50-clinically relevant genes, we investigated (1) concurrence of somatic/actionable mutations and (2) tumor molecular evolution by comparing 2 resection specimens 1.5 years apart while the patient was on imatinib adjuvant therapy. We found the tumors did not harbor KIT, PDGFRA, or any other clinically actionable mutations. However, a TP53 mutation (c.422G>A; p.C141Y) was detected in the second recurrent lesion. This represents the first study to monitor the molecular evolution of a SDH-deficient GIST during adjuvant treatment. These findings emphasize the critical need for next-generation sequencing testing before initiating targeted therapy.
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Affiliation(s)
- Christina H Wei
- Department of Pathology, University of Southern California, Keck School of Medicine
| | | | | | - Shefali Chopra
- Department of Pathology, University of Southern California, Keck School of Medicine
| | - Wesley Naritoku
- Department of Pathology, University of Southern California, Keck School of Medicine
| | - Sue E Martin
- Department of Pathology, University of Southern California, Keck School of Medicine
| | - Pamela M Ward
- Department of Pathology, University of Southern California, Keck School of Medicine
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Xie M, Rao W, Zhang P, Zhao Q, Tian Z. Endoscopic full-thickness resection for a gastrointestinal stromal tumor in a liver transplant recipient: A case report. Medicine (Baltimore) 2019; 98:e16669. [PMID: 31374043 PMCID: PMC6708825 DOI: 10.1097/md.0000000000016669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
RATIONALE With the development of endoscopic technique and the improvement of available accessories, endoscopic therapy became to play an important role in the management of gastrointestinal submucosal tumors (SMTs). PATIENTS CONCERNS A gastric SMT which was suspected to be gastrointestinal stroma tumor (GIST) was diagnosed in a liver transplant recipient who received transplanted operation 11 months ago. DIAGNOSIS gastric SMT, post-liver transplantation INTERVENTIONS:: Endoscopic full-thickness resection (EFR) was preformed to remove the tumor. The operation time was 50 minutes and oral immunosuppressant drug was not interrupted in the postoperative period. OUTCOMES The clinical course was uneventful and slightly elevated liver enzyme was observed on the fourth day after operation. The pathological diagnosis was GIST with complete capsule. LESSONS Our successful experience showed that EFR is a feasible, safe and efficacious treatment for small (<2 cm) gastric GIST in liver transplant recipients, providing the advantages of little damage, short operative time, stable graft function, without compromising postoperative outcomes.
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Affiliation(s)
- Man Xie
- Department of Gastroenterology
| | - Wei Rao
- Department of Organ Transplantation Center, The Affiliated Hospital of Qingdao University
- Institute of Transplant Medicine, Qingdao University, Qingdao, China
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Pih GY, Kim DH. Endoscopic Ultrasound-Guided Fine Needle Aspiration and Biopsy in Gastrointestinal Subepithelial Tumors. Clin Endosc 2019; 52:314-320. [PMID: 31370379 PMCID: PMC6680013 DOI: 10.5946/ce.2019.100] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 06/25/2019] [Indexed: 12/12/2022] Open
Abstract
The incidence of asymptomatic and incidentally found upper gastrointestinal subepithelial tumors (SETs) is increasing with the implementation of national cancer screening and the development of high-resolution endoscopy in Korea. However, endoscopy alone cannot be used to determine whether SETs are benign or malignant. Endoscopic ultrasound (EUS) is used to further characterize these lesions through the examination of their layered structure, internal echogenicity, size, and relationship to the extramural structure. These provide additional information on whether the lesion is benign or malignant. Nevertheless, the sensitivity and specificity of EUS alone in predicting malignancy is unsatisfactory. Recent guidelines have recommended deciding the timing of EUS-fine needle aspiration and biopsy (EUS-FNA/B) for SETs based on tumor size, malignant features on endoscopy, and high-risk features on EUS. The diagnostic accuracy of EUS-FNA/B is reportedly influenced by factors including needle size, number of needle passes, use of suction, use of a stylet in the needle assembly, fanning technique, availability of an on-site cytopathologist, and experience of the endosonographer. Therefore, according to the characteristics of the SETs, various subsequent methods and techniques should be appropriately employed to improve the diagnostic yield of EUS-FNA/B.
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Affiliation(s)
- Gyu Young Pih
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Do Hoon Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Wang M, Ni B, Zhuang C, Zhao WY, Tu L, Ma XL, Yang LX, Zhang ZG, Cao H. Aberrant accumulation of Dickkopf 4 promotes tumor progression via forming the immune suppressive microenvironment in gastrointestinal stromal tumor. Cancer Med 2019; 8:5352-5366. [PMID: 31353847 PMCID: PMC6718536 DOI: 10.1002/cam4.2437] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 06/19/2019] [Accepted: 07/11/2019] [Indexed: 12/20/2022] Open
Abstract
Background Drug resistance and tumor recurrence are the major concerns in clinical practices of gastrointestinal stromal tumor (GIST), with the urgent requirement for exploring undiscovered pathways driving malignancy. To deal with these, recent studies have made many efforts to explore prognosis indicators and establish potential therapeutic targets. Methods Expression profiles of different risks of GISTs were described and abundant clinical evidences supported our findings in this study. Following exploration in vitro by cell experiments and verification in vivo using tumor microarray were taken to elucidate the underlying mechanism, which drove the malignancy in GIST. Results Dickkopf 4 (DKK4), as the canonical Wnt pathway antagonist, was unexpectedly and universally upregulated in high‐risk GISTs, and aberrant accumulation of DKK4 was closely correlated with poor prognosis. In addition, tumor‐derived DKK4 could decrease immune cells infiltration and activation in the tumor microenvironment, which decreased the antitumor effects in return. And this phenomenon was recurrent in human tumor specimens. Conclusions Our findings identified DKK4 as a proper tumor biomarker for prognosis predicting and recurrence monitoring, and suggested a novel immune‐escape mechanism driving malignancy in GIST, which might be a potential therapeutic target to improve the effects of canonical RTK therapy and combined immunotherapy.
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Affiliation(s)
- Ming Wang
- Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Bo Ni
- Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Chun Zhuang
- Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wen-Yi Zhao
- Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lin Tu
- Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xin-Li Ma
- Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lin-Xi Yang
- Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhi-Gang Zhang
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Cao
- Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Zuidema S, Desar IME, van Erp NP, Kievit W. Optimizing the dose in patients treated with imatinib as first line treatment for gastrointestinal stromal tumours: A cost-effectiveness study. Br J Clin Pharmacol 2019; 85:1994-2001. [PMID: 31112617 PMCID: PMC6710511 DOI: 10.1111/bcp.13990] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 04/08/2019] [Accepted: 04/29/2019] [Indexed: 12/14/2022] Open
Abstract
Aims Patients with metastatic gastrointestinal stromal tumours (GIST) are treated in first line with the oral tyrosine kinase inhibitor, imatinib, until progressive disease. With this fixed dosing regimen, only approximately 40% of patients reach adequate plasma levels within the therapeutic index. Therapeutic drug monitoring (TDM) is a solution to reach plasma levels within the therapeutic index. However, introducing TDM will also increase costs, due to prolonged imatinib use and laboratory costs. The aim of this study was to evaluate the cost‐effectiveness of TDM in patients with metastatic/unresectable GIST treated with imatinib as a first line treatment, compared with fixed dosing. Methods A survival model was created to simulate progression, mortality and treatment costs over a 5‐year time horizon, comparing fixed dosing vs TDM‐guided dosing. The outcomes measured were treatments costs, life‐years and quality‐adjusted life‐years. Results Total costs over the 5‐year time horizon were estimated to be €106 994.85 and €150 477.08 for fixed dosing vs TDM‐guided dosing, respectively. A quality‐adjusted life year gain of 0.74 (95% confidence interval 0.66–0.90) was estimated with TDM‐guided dosing compared to fixed dosing. An average incremental cost‐effectiveness ratio of €58 785.70 per quality‐adjusted life year gained was found, mainly caused by longer use and higher dosages of imatinib. Conclusion Based on the currently available data, this analysis suggests that TDM‐guided dosing may be a cost‐effective intervention for patients with metastatic/unresectable GIST treated with imatinib which will be improved when imatinib losses its patency.
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Affiliation(s)
- Sander Zuidema
- Radboud Institute for Health Sciences, Radboud UMC, Nijmegen, The Netherlands
| | - Ingrid M E Desar
- Department of Medical Oncology, Radboud UMC, Nijmegen, The Netherlands
| | - Nielka P van Erp
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Wietske Kievit
- Radboud Institute for Health Sciences, Radboud UMC, Nijmegen, The Netherlands
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Pang T, Zhao Y, Fan T, Hu Q, Raymond D, Cao S, Zhang W, Wang Y, Zhang B, Lv Y, Zhang X, Ling T, Zhuge Y, Wang L, Zou X, Huang Q, Xu G. Comparison of Safety and Outcomes between Endoscopic and Surgical Resections of Small (≤ 5 cm) Primary Gastric Gastrointestinal Stromal Tumors. J Cancer 2019; 10:4132-4141. [PMID: 31417658 PMCID: PMC6692613 DOI: 10.7150/jca.29443] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 05/21/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND AND AIMS Endoscopic resection is increasingly performed for gastric gastrointestinal stromal tumors (GIST). However, the safety and outcomes remain elusive. We aimed in this retrospective study to compare operative complications and prognosis between endoscopically and surgically resected small (≤ 5 cm) GIST tumor groups. METHODS In this single-center retrospective study, we compared demographics, clinical outcomes, and the R0 resection rate between the endoscopy (n =268) and surgery (n =141) groups. Only GIST tumors in size of ≤ 5.0 cm were recruited for this comparison study. RESULTS Overall, the mean age of patients was 59.0 years (range: 31.0-83.0). The male-female ratio was 0.68. The most common site of GIST was, in the descending order, the gastric fundus (55%), corpus (27.6%), cardia (10.8%), and antrum (6.6%). Compared with the surgery group, GIST tumors in the endoscopy group were significantly smaller (1.69±0.9 cm, vs. 3.20±1.2 cm in the surgery group; P <0.001) in size; postoperative hospital stay was significantly shorter (4.66±1.5 days, vs. 8.11±5.0; P <0.001); post-resection time to first liquid diet was significantly shorter (1.94±1.1 days, vs. 4.63±2.6; P < 0.001); the incidence of operative and post-operative complications was significantly fewer (p < 0.05), and hospital costs were significantly lower (20115.4±5113.5¥, vs. 43378.4±16795.7¥; P < 0.001). The R0 resection rate was significantly lower in the endoscopy (93.3%) than in the surgery (99.3%) groups (P< 0.01). In the endoscopy group, 176 (65.7%) and 69 (25.7%) patients were found to be at very low and low risk of aggressiveness, respectively, in comparison to 27(19.2%) and 86 (61.0%) patients in the surgery group, respectively (P <0.001). Among 409 cases, 50 (12.2%) were found to be at intermediate or high risk of aggressiveness, 20 of which were treated with adjuvant imatinib therapy and but only 8/20 taking imatinib for 1 to 3 months because of side effects and high costs. No local or distant tumor recurrence was observed over an average of 33.5-month follow-ups. Two patients died of other disease in the surgery group. CONCLUSIONS Endoscopic resection of selected small gastric GISTs (≤ 5cm) was feasible, safe, and associated with better intraoperative results and an equal postoperative course, compared to surgical resection.
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Affiliation(s)
- Taohong Pang
- Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School.,Department of Gastroenterology, Affiliated Chaohu Hospital of Anhui Medical University
| | - Yan Zhao
- Department of Geriatric, Affiliated Drum Tower Hospital of Nanjing University Medical School
| | - Ting Fan
- Department of Gastroenterology, Nanjing Drum Tower Clinical College of Nanjing Medical University
| | - Qingqing Hu
- Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School
| | - Dekusaah Raymond
- Department of Gastroenterology, Nanjing Drum Tower Clinical College of Nanjing Medical University
| | - Shouli Cao
- Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School
| | - Weijie Zhang
- Department of General Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School
| | - Yi Wang
- Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School
| | - Bin Zhang
- Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School
| | - Ying Lv
- Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School
| | - Xiaoqi Zhang
- Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School
| | - Tingsheng Ling
- Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School
| | - Yuzheng Zhuge
- Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School
| | - Lei Wang
- Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School
| | - Xiaoping Zou
- Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School
| | - Qin Huang
- Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School.,VA Boston Healthcare System and Harvard Medical School, West Roxbury, MA 02132, USA
| | - Guifang Xu
- Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School.,Department of Gastroenterology, Nanjing Drum Tower Clinical College of Nanjing Medical University
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Zhang H, Huang X, Qu C, Bian C, Xue H. Comparison between laparoscopic and endoscopic resections for gastric submucosal tumors. Saudi J Gastroenterol 2019; 25:245-250. [PMID: 30618440 PMCID: PMC6714475 DOI: 10.4103/sjg.sjg_412_18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND/AIMS Open resection/laparoscopic resection (LR) is the traditional treatment of gastric submucosal tumor (G-SMT). The endoscopic resection (ER) technology provides good results for G-SMT treatment but lacks sufficient evidence-based evidence. This retrospective study aimed to compare the clinical efficacy of ER [endoscopic submucosal dissection (ESD), endoscopic submucosal excavation (ESE), and endoscopic full-thickness resection (EFR)] and LR [laparoscopic wedge resection (LWR) and laparoscopic subtotal gastrectomy (LSG)] for G-SMT. PATIENTS AND METHODS From January 2013 to January 2017, data of patients with G-SMT with tumor diameter <5 cm were collected from the database of The Affiliated Hospital of Qingdao University and classified based on surgical methods. Demographics, tumor characteristics, surgical outcomes, complications and tumor recurrence were recorded and compared. RESULTS Overall, 275 patients with G-SMT were enrolled: 152 underwent ER (ESD, n = 65; ESE, n = 23; EFR, n = 61) and 123 underwent LR (LWR, n = 93; LSG, n = 30). Age, sex, R0 resection rate, tumor location, type, recurrence and complications were not statistically significant (P > 0.05). The ER group had a significantly higher percentage of intraluminal tumor (94.1% vs 62.4%) and smaller tumor size (1.8 ± 0.8 vs 3.4 ± 1.2 cm) than the LR group. The ER group had less muscular tumors than the LR group (54.6% vs 70.7%). The ER group had no serosal tumor. The ER group had shorter hospitalization time, postoperative hospital stay and diet recovery time. The LR group had shorter operation time, less cost and less blood loss. CONCLUSION ER and LR are safe and effective treatments for SMT. For small intraluminally growing SMT, ER is better than LR.
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Affiliation(s)
- Huaying Zhang
- Medical College of Qingdao University, Qingdao, Shandong, China
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xinyu Huang
- Medical College of Qingdao University, Qingdao, Shandong, China
- Department of Infectious Diseases, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Chao Qu
- Medical College of Qingdao University, Qingdao, Shandong, China
- Hepatobiliary and Pancreatic Surgery Center, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Cheng Bian
- Department of Infectious Diseases, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Huiguang Xue
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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Choi IY, Yeom SK, Cha J, Cha SH, Lee SH, Chung HH, Lee CM, Choi J. Feasibility of using computed tomography texture analysis parameters as imaging biomarkers for predicting risk grade of gastrointestinal stromal tumors: comparison with visual inspection. Abdom Radiol (NY) 2019; 44:2346-2356. [PMID: 30923842 DOI: 10.1007/s00261-019-01995-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To evaluate the feasibility of using computed tomography texture analysis (CTTA) parameters for predicting malignant risk grade and mitosis index of gastrointestinal stromal tumors (GISTs), compared with visual inspection. METHOD AND MATERIALS CTTA was performed on portal phase CT images of 145 surgically confirmed GISTs (mean size: 42.9 ± 37.5 mm), using TexRAD software. Mean, standard deviation, entropy, mean of positive pixels (MPP), skewness, and kurtosis of CTTA parameters, on spatial scaling factor (SSF), 2-6 were compared by risk grade, mitosis rate, and the presence or absence of necrosis on visual inspection. CTTA parameters were correlated with risk grade. Diagnostic performance was evaluated with receiver operating characteristic curve analysis. Enhancement pattern, necrosis, heterogeneity, calcification, growth pattern, and mucosal ulceration were subjectively evaluated by two observers. RESULTS Three to four parameters at different scales were significantly different according to the risk grade, mitosis rate, and the presence or absence of necrosis (p < 0.041). MPP at fine or medium scale (r = - 0.547 to - 393) and kurtosis at coarse scale (r = 0.424-0.454) correlated significantly with risk grade (p < 0.001). HG-GIST was best differentiated from LG-GIST by MPP at SSF 2 (AUC, 0.782), and kurtosis at SSF 4 (AUC, 0.779) (all p < 0.001). CT features predictive of HG-GIST were density lower than or equal to that of the erector spinae muscles on enhanced images (OR 2.1; p = 0.037; AUC, 0.59), necrosis (OR, 6.1; p < 0.001; AUC, 0.70), heterogeneity (OR, 4.3; p < 0.001; AUC, 0.67), and mucosal ulceration (OR, 3.3; p = 0.002; AUC, 0.62). CONCLUSION Using TexRAD, MPP and kurtosis are feasible in predicting risk grade and mitosis index of GISTs. CTTA demonstrated meaningful accuracy in preoperative risk stratification of GISTs.
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Affiliation(s)
- In Young Choi
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-ro, Danwon-gu, Ansan, 15355, Republic of Korea
| | - Suk Keu Yeom
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-ro, Danwon-gu, Ansan, 15355, Republic of Korea.
| | - Jaehyung Cha
- Department of Biostatistics, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-ro, Danwon-gu, Ansan, 15355, Republic of Korea
| | - Sang Hoon Cha
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-ro, Danwon-gu, Ansan, 15355, Republic of Korea
| | - Seung Hwa Lee
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-ro, Danwon-gu, Ansan, 15355, Republic of Korea
| | - Hwan Hoon Chung
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-ro, Danwon-gu, Ansan, 15355, Republic of Korea
| | - Chang Min Lee
- Department of Surgery, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-ro, Danwon-gu, Ansan, 15355, Republic of Korea
| | - Jungwoo Choi
- Department of Pathology, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-ro, Danwon-gu, Ansan, 15355, Republic of Korea
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