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Yi X, Zhou G, Fu Y, Wu J, Chen C, Zai H, He Q, Pang P, Zhou H, Gong G, Lei T, Tan F, Liu H, Li B, Chen BT. CT-based assessment of sarcopenia for differentiating wild-type from mutant-type gastrointestinal stromal tumor. Sci Rep 2023; 13:3216. [PMID: 36828845 PMCID: PMC9958176 DOI: 10.1038/s41598-022-27213-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 12/28/2022] [Indexed: 02/26/2023] Open
Abstract
Non-invasive prediction for KIT/PDGFRA status in GIST is a challenging problem. This study aims to evaluate whether CT based sarcopenia could differentiate KIT/PDGFRA wild-type gastrointestinal stromal tumor (wt-GIST) from the mutant-type GIST (mu-GIST), and to evaluate genetic features of GIST. A total of 174 patients with GIST (wt-GIST = 52) were retrospectively identified between January 2011 to October 2019. A sarcopenia nomogram was constructed by multivariate logistic regression. The performance of the nomogram was evaluated by discrimination, calibration curve, and decision curve. Genomic data was obtained from our own specimens and also from the open databases cBioPortal. Data was analyzed by R version 3.6.1 and clusterProfiler ( http://cbioportal.org/msk-impact ). There were significantly higher incidence (75.0% vs. 48.4%) and more severe sarcopenia in patients with wt-GIST than in patients with mu-GIST. Multivariate logistic regression analysis showed that sarcopenia score (fitted based on age, gender and skeletal muscle index), and muscle fat index were independent predictors for higher risk of wt-GIST (P < 0.05 for both the training and validation cohorts). Our sarcopenia nomogram achieved a promising efficiency with an AUC of 0.879 for the training cohort, and 0.9099 for the validation cohort with a satisfying consistency in the calibration curve. Favorable clinical usefulness was observed using decision curve analysis. The additional gene sequencing analysis based on both our data and the external data demonstrated aberrant signal pathways being closely associated with sarcopenia in the wt-GIST. Our study supported the use of CT-based assessment of sarcopenia in differentiating the wt-GIST from the mu-GIST preoperatively.
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Affiliation(s)
- Xiaoping Yi
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China
- National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Central South University, Changsha, 410008, People's Republic of China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Changsha, 410008, Hunan, People's Republic of China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Changsha, 410008, Hunan, People's Republic of China
| | - Gaofeng Zhou
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China
| | - Yan Fu
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China
| | - Jinchun Wu
- Department of Oncology, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
| | - Changyong Chen
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China
| | - Hongyan Zai
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China
| | - Qiongzhi He
- Geneplus-Beijing Institute, Beijing, People's Republic of China
| | - Peipei Pang
- GE Healthcare, Hangzhou, 310000, People's Republic of China
| | - Haiyan Zhou
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China
| | - Guanghui Gong
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China
| | - Tianxiang Lei
- Department of General Surgery, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
| | - Fengbo Tan
- Department of General Surgery, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
| | - Heli Liu
- Department of General Surgery, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China.
| | - Bin Li
- Department of Oncology, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China.
| | - Bihong T Chen
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA, 91010, USA
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Mirakhor E, Wong MT, Jamil LH. Gastrointestinal stromal tumour masquerading as a diverticular bleed. BMJ Case Rep 2019; 12:12/11/e232169. [PMID: 31791992 DOI: 10.1136/bcr-2019-232169] [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: 11/04/2022] Open
Abstract
Gastrointestinal stromal tumours (GISTs) only account for a small percentage of gastrointestinal malignancies with a wide range of clinical presentations depending on the location and size of the tumour. Herein, we present the case of a 55-year-old woman with occult gastrointestinal bleeding (GIB) despite imaging and two separate oesophagogastroduodenoscopy colonoscopies. On double-balloon enteroscopy, an oozing diverticular-appearing lesion in the ileum was identified which on laparoscopy was connected to a large pelvic GIST. This case highlights the importance of considering GISTs in patients with occult GIB, as a high index of suspicion is required for diagnosis.
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Affiliation(s)
- Ebrahim Mirakhor
- Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Mary T Wong
- Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Laith H Jamil
- Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Liu X, Qiu H, Zhang P, Feng X, Chen T, Li Y, Tao K, Li G, Sun X, Zhou Z. Prognostic factors of primary gastrointestinal stromal tumors: a cohort study based on high-volume centers. Chin J Cancer Res 2018; 30:61-71. [PMID: 29545720 DOI: 10.21147/j.issn.1000-9604.2018.01.07] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective We aimed to evaluate the clinicopathologic characteristics, immunohistochemical expression and prognostic factors of patients with primary gastrointestinal stromal tumors (GISTs). Methods Data from 2,570 consecutive GIST patients from four medical centers in China (January 2001-December 2015) were reviewed. Survival curves were constructed by the Kaplan-Meier method, and Cox regression models were used to identify independent prognostic factors. Results Of the included patients, 1,375 (53.5%) were male, and the patient age range was 18 to 95 (median, 58) years. The tumors were mostly found in the stomach (64.5%), small intestine (25.1%) and colorectal region (5.1%). At the time of diagnosis, the median tumor size was 4.0 (range: 0.1-55.0) cm, and the median mitotic index per 50 high power fields (HPFs) was 3 (range: 0-254). Of the 2,168 resected patients, 2,009 (92.7%) received curative resection. According to the modified National Institutes of Health (NIH) classification, 21.9%, 28.9%, 14.1% and 35.1% were very low-, low-, intermediate- and high-risk tumors, respectively. The rate of positivity was 96.4% for c-Kit, 87.1% for CD34, 96.9% for delay of germination 1 (DOG-1), 8.0% for S-100, 31.0% for smooth muscle actin (SMA) and 5.1% for desmin. However, the prognostic value of each was limited. Multivariate analysis showed that age, tumor size, mitotic index, tumor site, occurrence of curative resection and postoperative imatinib were independent prognostic factors. Furthermore, we found that high-risk patients benefited significantly from postoperative imatinib (P<0.001), whereas intermediate-risk patients did not (P=0.954). Conclusions Age, tumor size, mitotic index, tumor site, occurrence of curative resection and postoperative imatinib were independent prognostic factors in patients with GISTs. Moreover, determining whether intermediate-risk patients can benefit from adjuvant imatinib would be of considerable interest in future studies.
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Affiliation(s)
- Xuechao Liu
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Haibo Qiu
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Peng Zhang
- Department of General Surgery, Union Hospital Tongji Medical College Huazhong University of Science and Technology, Wuhan 430022, China
| | - Xingyu Feng
- Department of General Surgery, Guangdong General Hospital, Guangzhou 510080, China
| | - Tao Chen
- Department of General Surgery, Southern Medical University Nanfang Hospital, Guangzhou 510060, China
| | - Yong Li
- Department of General Surgery, Guangdong General Hospital, Guangzhou 510080, China
| | - Kaixiong Tao
- Department of General Surgery, Union Hospital Tongji Medical College Huazhong University of Science and Technology, Wuhan 430022, China
| | - Guoxin Li
- Department of General Surgery, Southern Medical University Nanfang Hospital, Guangzhou 510060, China
| | - Xiaowei Sun
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Zhiwei Zhou
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
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Gebreyohannes YK, Schöffski P, Van Looy T, Wellens J, Vreys L, Cornillie J, Vanleeuw U, Aftab DT, Debiec-Rychter M, Sciot R, Wozniak A. Cabozantinib Is Active against Human Gastrointestinal Stromal Tumor Xenografts Carrying Different KIT Mutations. Mol Cancer Ther 2016; 15:2845-2852. [DOI: 10.1158/1535-7163.mct-16-0224] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 08/11/2016] [Accepted: 08/17/2016] [Indexed: 01/30/2023]
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Valappil FK, Rajan R, Natesh B, Sindhu RS, Raviram S, Mathew J. Evaluation of Gold's nomogram for predicting recurrence-free survival in gastrointestinal stromal tumors in Indian patients. Indian J Gastroenterol 2016; 35:225-8. [PMID: 27256432 DOI: 10.1007/s12664-016-0667-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 05/01/2016] [Indexed: 02/04/2023]
Abstract
Gold described a nomogram for prediction of recurrence-free survival (RFS) after surgery for gastrointestinal stromal tumors (GIST). This retrospective study was intended to evaluate the utility of this nomogram for predicting a 2-year RFS in our patients. Twenty-eight consecutive eligible patients from January 2009 to January 2013 who underwent R0 resection and had histopathologically proven GIST were included in the study. Nomogram predicted RFS was compared with observed RFS in four groups as in the National Institutes of Health (NIH)-Fletcher classification. Calibration was assessed by plotting the predicted probabilities of RFS against the actual outcome. For validation of the nomogram, the graph obtained should be closer to the 45-degree line. The observed overall 2-year RFS was 85.7 % (24 patients). Four patients had recurrence within 2 years. The observed RFS was 87.5 %, 77.8 %, 90 %, and 100 % in the high, intermediate, low, and very low risk groups, respectively. The nomogram predicted the 2-year RFS was 40 %, 84.8 %, 88.6 %, and 90 % for high, intermediate, low, and very low risk groups, respectively. Thus, the predicted probabilities of the 2-year RFS in intermediate, low, and very low risk groups were similar to the observed outcomes. However, for the high risk group, the observed RFS was better than predicted RFS. This variation in the high risk group may be due to the use of adjuvant imatinib in our study.
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Affiliation(s)
- Fysal Kollanta Valappil
- Department of Surgical Gastroenterology, Government Medical College, Thiruvananthapuram, 695 011, India.
| | - Ramesh Rajan
- Department of Surgical Gastroenterology, Government Medical College, Thiruvananthapuram, 695 011, India
| | - Bonny Natesh
- Department of Surgical Gastroenterology, Government Medical College, Thiruvananthapuram, 695 011, India
| | - R S Sindhu
- Department of Surgical Gastroenterology, Government Medical College, Thiruvananthapuram, 695 011, India
| | - S Raviram
- Department of Surgical Gastroenterology, Government Medical College, Thiruvananthapuram, 695 011, India
| | - Jacob Mathew
- Department of Surgical Gastroenterology, Government Medical College, Thiruvananthapuram, 695 011, India
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Abstract
Adjuvant chemotherapy is not standard treatment in soft tissue sarcoma (STS). However, when the risk of relapse is high, it is an option for shared decision making with the patient in conditions of uncertainty. This is because available evidence is conflicting, even if several randomized clinical trials have been performed for 4 decades and also have been pooled into meta-analyses. Indeed, available meta-analyses point to a benefit in the 5% to 10% range in terms of survival and distant relapse rate. Some local benefit also was suggested by some trials. Placing chemotherapy in the preoperative setting may help gain a local advantage in terms of the quality of surgical margins or decreased sequelae. This may be done within a personalized approach according to the clinical presentation. Attempts to personalize treatment on the basis of the variegated pathology and molecular biology of STS subgroups are ongoing as well, according to what is done in the medical treatment of advanced STS. Thus, decision making for adjuvant and neoadjuvant indications deserves personalization in clinical research and in clinical practice, taking profit from all multidisciplinary clinical skills available at a sarcoma reference center, though with a degree of subjectivity because of the limitations of available evidence.
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Affiliation(s)
- Paolo G Casali
- From the Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
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Tarchouli M, Bounaim A, Essarghini M, Aitidir B, Lomdo M, Benmoussa M, Oukabli M, Ait-Ali A, Sair K. Extra-Gastrointestinal Stromal Tumor of the Greater Omentum: Unusual Case Report. J Gastrointest Cancer 2015; 47:489-493. [PMID: 26596853 DOI: 10.1007/s12029-015-9784-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Gastrointestinal stromal tumors are the most common mesenchymal tumors of the gastrointestinal tract, originating from the interstitial cells of Cajal and most frequently expressing CD-117, a C-kit proto-oncogene, which can be detected immunohistochemically. Extra-gastrointestinal stromal tumors are neoplasms with similar immunohistological features arising outside the gastrointestinal tract with no connection to the gastric or intestinal wall.We report the case of a 61-year-old Moroccan man who presented with chronic abdominal pain along with progressive abdominal distension for the past last year. The clinical examination demonstrated a large abdominal mass and an abdominal computed tomography scan revealed a voluminous intraperitoneal mass measuring 30 cm in its greatest diameter. At laparotomy, this mass seemed to be arising from the greater omentum without continuity to the gastrointestinal tract. The mass was completely removed with clear margins and pathological examination was suggestive for high-risk gastrointestinal stromal tumor of the greater omentum. Due to the aggressive nature of this patient's tumor, he was assigned to receive imatinib as adjuvant chemotherapy for 3 years. He remains alive without any sign of recurrence after 4 years of follow-up.Extra-gastrointestinal stromal tumors of the greater omentum can grow slowly and remain clinically silent despite the large size of the tumor. Complete surgical resection is the only effective treatment approach. Nevertheless, adjuvant therapy following resection with imatinib has become a standard of care in cases of high risk disease.
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Affiliation(s)
- Mohamed Tarchouli
- Department of Digestive Surgery, Faculty of Medicine and Pharmacy, Mohammed V Military Hospital, Mohammed V University, Rabat, Morocco.
| | - Ahmed Bounaim
- Department of Digestive Surgery, Faculty of Medicine and Pharmacy, Mohammed V Military Hospital, Mohammed V University, Rabat, Morocco
| | - Mohamed Essarghini
- Department of Digestive Surgery, Faculty of Medicine and Pharmacy, Mohammed V Military Hospital, Mohammed V University, Rabat, Morocco
| | - Badr Aitidir
- Department of Digestive Surgery, Faculty of Medicine and Pharmacy, Mohammed V Military Hospital, Mohammed V University, Rabat, Morocco
| | - Massama Lomdo
- Department of Digestive Surgery, Faculty of Medicine and Pharmacy, Mohammed V Military Hospital, Mohammed V University, Rabat, Morocco
| | - Mustapha Benmoussa
- Department of Digestive Surgery, Faculty of Medicine and Pharmacy, Mohammed V Military Hospital, Mohammed V University, Rabat, Morocco
| | - Mohamed Oukabli
- Department of Pathology, Faculty of Medicine and Pharmacy, Mohammed V Military Hospital, Mohammed V Military Hospital, Rabat, Morocco
| | - Abdelmounaim Ait-Ali
- Department of Digestive Surgery, Faculty of Medicine and Pharmacy, Mohammed V Military Hospital, Mohammed V University, Rabat, Morocco
| | - Khalid Sair
- Department of Digestive Surgery, Faculty of Medicine and Pharmacy, Mohammed V Military Hospital, Mohammed V University, Rabat, Morocco
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Immunostaining of phospho-histone H3 and Ki-67 improves reproducibility of recurrence risk assessment of gastrointestinal stromal tumors. Virchows Arch 2015; 467:47-54. [PMID: 25823616 DOI: 10.1007/s00428-015-1763-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 02/22/2015] [Accepted: 03/16/2015] [Indexed: 12/20/2022]
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common non-epithelial tumors in the digestive tract. Beyond surgery, therapeutic management depends on risk of recurrence. Risk evaluation of GIST takes into account location and size of the tumor, whether or not the tumor was intact or ruptured and mitotic index. The mitotic index lacks in intra- and interobserver reproducibility. In this study, we evaluated on 61 GISTs, the reproducibility of mitotic counting using classical hematoxylin-eosin-saffron (HES) staining, and its correlation with the mitotic count obtained through immunohistochemical staining for phospho-histone H3 (PHH3) and the proliferation index based upon Ki-67 immunostaining. Mitotic counts by HES and PHH3 staining and Ki-67 proliferation index were evaluated twice by three independent observers taking into account interpretation times per tumor for each technique. HES-based and PHH3-based mitotic counts and Ki-67 proliferation index correlated well and presented good intra- and interobserver reproducibility. PHH3 staining resulted in a slight but statistically significant difference of about two more mitotic figures per 5 mm(2) than the HES-based count, which might have put some borderline tumors in a different risk category. Immunohistochemical staining for PHH3 and Ki-67 allowed more rapid interpretation than mitotic counts based upon HES staining, but only PHH3 staining allows counting of mitoses. Immunostaining using anti-PHH3 and anti-Ki-67 antibodies will eventually provide improved recurrence risk stratification of GIST and may become effective ancillary tools in deciding on optimal therapeutic management.
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Alessiani M, Gianola M, Rossi S, Perfetti V, Serra P, Zelaschi D, Magnani E, Cobianchi L. Peritonitis secondary to spontaneous perforation of a primary gastrointestinal stromal tumour of the small intestine: A case report and a literature review. Int J Surg Case Rep 2014; 6C:58-62. [PMID: 25524303 PMCID: PMC4334641 DOI: 10.1016/j.ijscr.2014.12.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Revised: 12/03/2014] [Accepted: 12/05/2014] [Indexed: 12/12/2022] Open
Abstract
Emergency presentation of a GIST is not uncommon and one of its manifestations is acute abdome. The cases described in the literature are the tip of the iceberg and spontaneous rupture or perforation of GISTs are a far more frequent first presentation of this rare tumour. The jejunum was the more common location of perforation compared to the ileum. Emergency surgery is mandatory and should achieve radical resection.
Introduction A few cases of acute abdomen caused by perforation of small-intestinal gastrointestinal stromal tumours (GISTs) have been reported in the literature. Presentation of case Together with a review of the published cases, here we report a case of an elderly patient with peritonitis due to spontaneous perforation of a GIST of the jejunum. An 82-year-old man was admitted to the emergency unit of our hospital with fever and severe abdominal pain. An abdominal enhanced computed tomography scan detected a 6 cm solid mass in the left upper quadrant adherent to a jejunal loop and surrounded by free fluid and free air. Due to the radiological features of the mass, the diagnosis of a perforation of a GIST arising from the jejunum wall was suspected. The patient underwent emergency laparotomy. Intraoperative findings confirmed diffuse peritonitis secondary to jejunal tumour perforation. A segmental resection of the jejunum containing the mass was performed followed by a mechanical end-to-side anastomosis. The histopathologic examination of the mass confirmed the diagnosis of a perforated GIST of the small intestine (high-risk category). The post-operative course was uneventful and the patient was treated with adjuvant imatinib therapy. Discussion Twenty-one other cases of spontaneous perforation of small intestine GISTs are reported in the literature and are summarized in the present review. Conclusion The described case is the tip of the iceberg and spontaneous rupture or perforation of GISTs are a far more frequent first presentation of this rare tumour.
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Affiliation(s)
- Mario Alessiani
- Department of General Surgery, Varzi Hospital, Italy; Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Italy
| | - Marco Gianola
- Department of General Surgery, Varzi Hospital, Italy
| | | | - Vittorio Perfetti
- Department of Oncology, IRCCS San Matteo Hospital Foundation, Pavia, Italy.
| | - Piero Serra
- Department of General Surgery, Varzi Hospital, Italy.
| | | | - Enzo Magnani
- Department of General Surgery, Varzi Hospital, Italy.
| | - Lorenzo Cobianchi
- Unit of General Surgery 1, IRCCS San Matteo Hospital Foundation, Pavia, Italy; Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Italy.
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Wang M, Xu J, Zhang Y, Tu L, Qiu WQ, Wang CJ, Shen YY, Liu Q, Cao H. Gastrointestinal stromal tumor: 15-years' experience in a single center. BMC Surg 2014; 14:93. [PMID: 25403624 PMCID: PMC4254179 DOI: 10.1186/1471-2482-14-93] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 09/16/2014] [Indexed: 12/11/2022] Open
Abstract
Background Gastrointestinal stromal tumor (GIST) is known for its wide variability in biological behaviors and it is difficult to predict its malignant potential. The aim of this study is to explore the characteristics and prognostic factors of GIST. Methods Clinical and pathological data of 497 GIST patients in our center between 1997 and 2012 were reviewed. Results Patients were categorized into very low-, low-, intermediate- and high-risk groups according to modified National Institutes of Health (NIH) consensus classification system. Among the 401 patients untreated with imatinib mesylate (IM), 5-year overall survival (OS) in very low-, low-, intermediate- and high-risk groups was 100%, 100%, 89.6% and 65.9%; and 5-year relapse-free survival (RFS) was 100%, 98.1%, 90.9% and 44.5%, respectively. Univariate analysis revealed that sex, tumor size, mitotic rate, risk grade, CD34 expression, and adjacent involvement were predictors of OS or RFS. COX hazard proportional model (Forward LR) showed that large tumor size, high mitotic rate, and high risk grade were independent risk factors to OS, whereas high mitotic rate, high risk grade and adjacent organ involvement were independent risk factors to RFS. The intermediate-high risk patients who received IM adjuvant therapy (n = 87) had better 5-year OS and RFS than those who did not (n = 188) (94.9% vs. 72.1; 82.3% vs. 56.3%, respectively). Similarly, advanced GIST patients underwent IM therapy (n = 45) had better 3-year OS and 1-year progression-free survival (PFS) than those who didn’t (n = 42) (75.6% vs. 6.8%; 87.6% vs. 12.4%, respectively). Conclusions Very low- and low-risk GISTs can be treated with surgery alone. Large tumor size, high mitotic rate, high risk grade, and adjacent organ involvement contribute to the poor outcome. IM therapy significantly improves the survival of intermediate-high risk or advanced GIST patients. Electronic supplementary material The online version of this article (doi:10.1186/1471-2482-14-93) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Hui Cao
- Department of General Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Floor 11, Building 7, NO, 1630, Dongfang Road, Shanghai 200127, China.
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Pinto A. Adjuvant therapy for renal cell carcinoma. Clin Genitourin Cancer 2014; 12:408-12. [PMID: 25048688 DOI: 10.1016/j.clgc.2014.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 06/12/2014] [Accepted: 06/17/2014] [Indexed: 11/30/2022]
Abstract
In the past few years, several targeted therapies have been approved by the U.S. Food and Drug Administration for the treatment of advanced renal cell carcinoma. This has led to an improvement in the progression-free survival and quality of life for these patients. Nevertheless, the use of these and other therapies in the adjuvant setting has failed to demonstrate a clear benefit. Immune therapies and hormonal or targeted therapies have been studied in this indication, and there are clinical trials currently enrolling patients with high risk of relapse. This article reviews the available data and the ongoing trials exploring the role of adjuvant therapy for kidney cancer.
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Affiliation(s)
- Alvaro Pinto
- Medical Oncology Department, University Hospital La Paz - IdiPAZ, Madrid, Spain.
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Demir L, Ekinci N, Erten C, Kucukzeybek Y, Alacacioglu A, Somali I, Can A, Dirican A, Bayoglu V, Akyol M, Cakalagaoglu F, Tarhan MO. Does immunohistochemistry provide additional prognostic data in gastrointestinal stromal tumors? Asian Pac J Cancer Prev 2014; 14:4751-8. [PMID: 24083738 DOI: 10.7314/apjcp.2013.14.8.4751] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND To investigate the predictive and prognostic effects of clinicopathologic and immunohistochemical (IHC) features in patients with gastrointestinal stromal tumours (GISTs). MATERIALS AND METHODS Fifty-six patients who were diagnosed with GIST between 2002 and 2012 were retrospectively evaluated. Relationships between clinicopathologic/immunohistochemical factors and prognosis were investigated. RESULTS Median overall survival (OS) of the whole study group was 74.9 months (42.8-107.1 months), while it was 95.2 months in resectable and 44.7 months in metastatic patients respectively (p=0.007). Epitheliolid tumor morphology was significantly associated with shortened OS as compared to other histologies (p=0.001). SMA(+) tumours were significantly correlated with low (<10/50HPF) mitotic activity (p=0.034). Moreover, SMA(+) patients tended to survive longer and had significantly longer disease-free survival (DFS) times than SMA (-) patients (37.7 months vs 15.9 months; p=0.002). High Ki-67 level (≥30%) was significantly associated with shorter OS (34 vs 95.2 months; 95%CI; p=0.001). CD34 (-) tumours were significantly associated with low proliferative tumours (Ki-67<%10) (p=0.026). Median PFS (progression-free survival) of the patients who received imatinib was 36 months (27.7-44.2 months). CD34 (-) patients had significantly longer PFS times than that of negative tumours; (50.8 vs 29.8 months; p=0.045). S100 and desmin expression did not play any role in predicting the prognosis of GISTs. Multivariate analysis demonstrated that ≥10/50HPF mitotic activity/HPF was the only independent factor for risk of death in GIST patients. CONCLUSIONS Despite the negative prognostic and predictive effect of high Ki-67 and CD34 expression, mitotic activity remains the strongest prognostic factor in GIST patients. SMA positivity seems to affect GIST prognosis positively. However, large-scale, multicenter studies are required to provide supportive data for these findings.
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Affiliation(s)
- Lutfiye Demir
- Department of Medical Oncology, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Turkey E-mail :
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Corbin KS, Kindler HL, Liauw SL. Considering the role of radiation therapy for gastrointestinal stromal tumor. Onco Targets Ther 2014; 7:713-8. [PMID: 24872712 PMCID: PMC4026585 DOI: 10.2147/ott.s36873] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are rare mesenchymal tumors arising in the gastrointestinal tract. Over the last decade, the management and prognosis of GISTs has changed dramatically with molecular characterization of the c-kit mutation and the adoption of targeted systemic therapy. Currently, the standard of care for resectable tumors is surgery, followed by adjuvant imatinib for tumors at high risk for recurrence. Inoperable or metastatic tumors are treated primarily with imatinib. Despite excellent initial response rates, resistance to targeted therapy has emerged as a common clinical problem, with relatively few therapeutic solutions. While the treatment of GISTs does not commonly include radiotherapy, radiation therapy could be a valuable contributing modality. Several case reports indicate that radiation can control locally progressive, drug-resistant disease. Further study is necessary to define whether radiation could potentially prevent or delay the onset of drug resistance, or improve outcomes when given in combination with imatinib.
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Affiliation(s)
- Kimberly S Corbin
- Department of Radiation Oncology, Memorial Medical Center, Springfield, IL, USA
| | - Hedy L Kindler
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Stanley L Liauw
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA
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Linch M, Claus J, Benson C. Update on imatinib for gastrointestinal stromal tumors: duration of treatment. Onco Targets Ther 2013; 6:1011-23. [PMID: 23935374 PMCID: PMC3735340 DOI: 10.2147/ott.s31260] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common sarcoma of the gastrointestinal tract, with transformation typically driven by activating mutations of c-KIT and less commonly platelet-derived growth factor receptor alpha (PDGFRA). Successful targeting of c-KIT and PDGFRA with imatinib, a tyrosine kinase inhibitor (TKI), has had a major impact in advanced GIST and as an adjuvant and neoadjuvant treatment. If treatment with imatinib fails, further lines of TKI therapy have a role, but disease response is usually only measured in months, so strategies to maximize the benefit from imatinib are paramount. Here, we provide an overview of the structure and signaling of c-KIT coupled with a review of the clinical trials of imatinib in GIST. In doing so, we make recommendations about the duration of imatinib therapy and suggest how best to utilize imatinib in order to improve patient outcomes in the future.
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Affiliation(s)
- Mark Linch
- Sarcoma Unit, Royal Marsden Hospital, United Kingdom ; Protein Phosphorylation Laboratory, Cancer Research UK London Research Institute, London, United Kingdom
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Morotti M, Becker CM, Menada MV, Ferrero S. Targeting tyrosine-kinases in ovarian cancer. Expert Opin Investig Drugs 2013; 22:1265-79. [PMID: 23815710 DOI: 10.1517/13543784.2013.816282] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Epithelial ovarian cancer (EOC) is the leading cause of gynaecologic cancer death. Although in some cases initial treatment is effective, most of the women diagnosed with EOC will probably need medical treatment for their disease. There is a critical need to develop effective new strategies for the management of patients with advanced or recurrent EOC, and targeted therapy with tyrosine kinase inhibitors (TKIs) has continued to be an area of active research and development in this setting. AREAS COVERED This review summarises the available evidence on the use of TKIs in the clinical management of women with EOC. This article consists of material obtained via Medline, PubMed and EMBASE literature searches up to March 2013. EXPERT OPINION Several Phase I/II and III trials evaluated TKIs in EOC; however, it is difficult to draw conclusions on the efficacy of TKI regimens in these patients. TKIs seem to be better tolerated than conventional chemotherapy with a different toxicity profile. A better understanding of the signalling pathways, the toxicity profiles, the potential pharmacokinetic interactions as well as the identification of predictive biomarkers are needed to better identify a targeted patient population before these agents become part of routine treatment.
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Affiliation(s)
- Matteo Morotti
- University of Genoa, San Martino Hospital, Department of Obstetrics and Gynaecology , Largo R. Benzi 1, 16132 Genoa , Italy +01139010511525 ; +01139010511525 ;
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Abstract
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumor of the gastrointestinal tract. Soon after GIST was recognized as a tumor driven by a KIT or platelet-derived growth factor receptor mutation, it became the first solid tumor target for tyrosine kinase inhibitor therapies. More recently, alternative molecular mechanisms for GIST pathogenesis have been discovered. These are related to deficiencies in the succinate dehydrogenase complex, NF1-gene alterations in connection with neurofibromatosis type 1 tumor syndrome, and mutational activation of the BRAF oncogene in very rare cases.
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Affiliation(s)
- Markku Miettinen
- Laboratory of Pathology, NCI/NIH, 9000 Rockville Pike, Building 10, Rm. 2B50, Bethesda, Maryland 20892,
| | - Jerzy Lasota
- Laboratory of Pathology, NCI/NIH, 9000 Rockville Pike, Building 10, Rm. 2B50, Bethesda, Maryland 20892,
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