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Hatai S, Nagai S, Yoshida T, Matsuoka M, Shinkawa T, Oyama Y, Tanabe Y, Kitahara D, Tamiya S, Amada S, Nishihara K, Nakano T. Transvaginal resection of a gastrointestinal stromal tumor of the rectum: a case report. Surg Case Rep 2024; 10:150. [PMID: 38886293 PMCID: PMC11183011 DOI: 10.1186/s40792-024-01949-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 06/11/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND The most common curative treatment for gastrointestinal stromal tumors (GISTs) is local excision. For rectal GISTs, however, local excision is difficult because of the anatomical features of the rectum. The optimal surgical approach is still under debate, and less invasive methods are desired. We herein report a case of transvaginal resection of a rectal GIST in a young woman. CASE PRESENTATION A 21-year-old woman was diagnosed with a resectable GIST in the anterior rectal wall and underwent transvaginal tumor resection. The posterior vaginal wall was incised, revealing the tumor fully covered by the rectal mucosa. The rectal adventitia and muscular layer were incised, and the tumor was resected en bloc without rupture. The postoperative course was favorable, and the patient was discharged on postoperative day 12. No findings consistent with recurrence were present 6 months postoperatively. CONCLUSION Transvaginal tumor resection is a treatment option as a minimally invasive procedure for GISTs in the anterior rectal wall in female patients.
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Affiliation(s)
- Sanshiro Hatai
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Basyaku, Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0077, Japan
| | - Shuntaro Nagai
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Basyaku, Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0077, Japan.
| | - Taiki Yoshida
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Basyaku, Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0077, Japan
| | - Masaru Matsuoka
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Basyaku, Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0077, Japan
| | - Tomohiko Shinkawa
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Basyaku, Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0077, Japan
| | - Yasuhiro Oyama
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Basyaku, Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0077, Japan
| | - Yoshitaka Tanabe
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Basyaku, Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0077, Japan
| | - Daichi Kitahara
- Department of Pathology, Kitakyushu Municipal Medical Center, Fukuoka, Japan
| | - Sadafumi Tamiya
- Department of Pathology, Kitakyushu Municipal Medical Center, Fukuoka, Japan
| | - Satoshi Amada
- Department of Obstetrics and Gynecology, Kitakyushu Municipal Medical Center, Fukuoka, Japan
| | - Kazuyoshi Nishihara
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Basyaku, Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0077, Japan
| | - Toru Nakano
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Basyaku, Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0077, Japan
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Hirota S, Tateishi U, Nakamoto Y, Yamamoto H, Sakurai S, Kikuchi H, Kanda T, Kurokawa Y, Cho H, Nishida T, Sawaki A, Ozaka M, Komatsu Y, Naito Y, Honma Y, Takahashi F, Hashimoto H, Udo M, Araki M, Nishidate S. English version of Japanese Clinical Practice Guidelines 2022 for gastrointestinal stromal tumor (GIST) issued by the Japan Society of Clinical Oncology. Int J Clin Oncol 2024; 29:647-680. [PMID: 38609732 PMCID: PMC11130037 DOI: 10.1007/s10147-024-02488-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 02/12/2024] [Indexed: 04/14/2024]
Abstract
The Japan Society of Clinical Oncology Clinical Practice Guidelines 2022 for gastrointestinal stromal tumor (GIST) have been published in accordance with the Minds Manual for Guideline Development 2014 and 2017. A specialized team independent of the working group for the revision performed a systematic review. Since GIST is a rare type of tumor, clinical evidence is not sufficient to answer several clinical and background questions. Thus, in these guidelines, we considered that consensus among the experts who manage GIST, the balance between benefits and harms, patients' wishes, medical economic perspective, etc. are important considerations in addition to the evidence. Although guidelines for the treatment of GIST have also been published by the National Comprehensive Cancer Network (NCCN) and the European Society for Medical Oncology (ESMO), there are some differences between the treatments proposed in those guidelines and the treatments in the present guidelines because of the differences in health insurance systems among countries.
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Affiliation(s)
- Seiichi Hirota
- Department of Surgical Pathology, Hyogo Medical University School of Medicine, Nishinomiya, Japan.
| | - Ukihide Tateishi
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hidetaka Yamamoto
- Department of Pathology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Shinji Sakurai
- Department of Diagnostic Pathology, Japan Community Healthcare Organization Gunma Central Hospital, Maebashi, Japan
| | - Hirotoshi Kikuchi
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tatsuo Kanda
- Department of Gastroenterology, Southern TOHOKU General Hospital, Koriyama, Japan
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Haruhiko Cho
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Toshirou Nishida
- Department of Surgery, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan
| | - Akira Sawaki
- Department of Medical Oncology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Masato Ozaka
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yoshito Komatsu
- Department of Cancer Chemotherapy, Hokkaido University Hospital Cancer Center, Sapporo, Japan
| | - Yoichi Naito
- Department of General Internal Medicine, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yoshitaka Honma
- Department of Head and Neck, Esophageal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Fumiaki Takahashi
- Department of Information Science, Iwate Medical University, Morioka, Japan
| | | | - Midori Udo
- Nursing Department, Osaka Police Hospital, Osaka, Japan
| | - Minako Araki
- Association of Chubu GIST Patients and Their Families, Nagoya, Japan
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Thibaut F, Veziant J, Warlaumont M, Gauthier V, Lefèvre J, Gronnier C, Bonnet S, Mabrut JY, Regimbeau JM, Benhaim L, Tiberio GAM, Mathonnet M, Regenet N, Chirica M, Glehen O, Mariani P, Panis Y, Genser L, Mutter D, Théreaux J, Bergeat D, Le Roy B, Brigand C, Eveno C, Guillaume P. Prognostic impact of positive microscopic margins (R1 resection) in patients with GIST (gastrointestinal stromal tumours): Results of a multicenter European study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108310. [PMID: 38598874 DOI: 10.1016/j.ejso.2024.108310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 02/28/2024] [Accepted: 03/24/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Although several prognostic factors in GIST have been well studied such as tumour size, mitotic rate, or localization, the influence of microscopic margins or R1 resection remains controversial. The aim of this study was to evaluate the influence of R1 resection on the prognosis of GIST in a large multicentre retrospective series of patients. METHODS From 2001 to 2013, 1413 patients who underwent surgery for any site of GIST were identified from 61 European centers. 1098 patients were included, excluding synchronous metastases, concurrent malignancies, R2 resection or GIST recurrence. Tumour rupture (TR) was reclassified according to the Oslo sarcoma classification. Cox proportional hazards ratio and Kaplan-Meier survival estimates were used to analyse 5-year recurrence-free survival (RFS). RESULTS Of 1098 patients, 38 (3%) underwent R1 resection with a risk of TR of 11%. The 5-year RFS was 89.6% with a median follow-up of 81 months [range: 31.2-152 months]. On univariate analysis, lower RFS was significantly associated with R1 resection [HR = 2.13; p = 0.04], high risk score according to the modified NIH classification, administration of adjuvant therapy [HR = 2.24; p < 0.001] and intraoperative complications [HR = 2.82; p < 0.001]. Only intraoperative complications [HR = 1.79; p = 0.02] and high risk according to the modified NIH classification including the updated definition of TR [HR = 3.43; p = 0.04] remained significant on multivariate analysis. CONCLUSION This study shows that positive microscopic margins are not an independent predictive factor for RFS in GIST when taking into account the up-dated classification of TR. R1 resection may be considered a reasonable alternative to avoid major functional sequelae and should not lead to reoperation.
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Affiliation(s)
- Flore Thibaut
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, F-59000, Lille, France; Department of General and Digestive Surgery, Seclin Hospital, rue d'Apolda, 59471, Seclin, France.
| | - Julie Veziant
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, F-59000, Lille, France; Univ. Lille, CNRS, Inserm, CHU Lille, UMR9020-U1277 - CANTHER - Cancer Heterogeneity Plasticity and Resistance to Therapies, F-59000, Lille, France
| | - Maxime Warlaumont
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, F-59000, Lille, France; Department of General and Digestive Surgery, Cambrai Hospital, 516 Avenue de Paris, 59400, Cambrai, France
| | - Victoria Gauthier
- Univ Lille, INSERM, CHU Lille, Institut Pasteur de Lille, U1167 - RID-AGE- Facteurs de risque et déterminants moléculaires des maladies liées au vieillissement, F59-000, LILLE, France
| | - Jérémie Lefèvre
- Department of Digestive Surgery, Sorbonne Université, AP-HP, Saint-Antoine Hospital, Paris, France
| | - Caroline Gronnier
- Oeso-Gastric Surgery Unit, Department of Digestive Surgery, Magellan Center, Bordeaux University Hospital, 33600, Pessac, France; Faculty of Medicine, Bordeaux Ségalen University, 33000, Bordeaux, France
| | - Stephane Bonnet
- Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, Paris, France
| | - Jean-Yves Mabrut
- Department of Digestive Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices CIVils de Lyon, Lyon, France
| | - Jean-Marc Regimbeau
- Department of Digestive Surgery, Amiens University Hospital, Amiens, France; UR UPJV 7518, SSPC (Simplification of Surgical Patients Care), Picardie Jules Verne University, Amiens, France
| | - Léonor Benhaim
- Department of Digestive Surgery, Gustave Roussy Institute, Villejuif, France
| | - G A M Tiberio
- Surgical Unit, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Muriel Mathonnet
- Department of Digestive Surgery, Dupuytren University Hospital, Limoges, France
| | - Nicolas Regenet
- Department of Digestive Surgery, Nantes University Hospital, Nantes, France
| | - Mircea Chirica
- Department of Digestive Surgery, Grenoble University Hospital, Grenoble, France
| | - Olivier Glehen
- Department of Surgical Oncology, Lyon Sud University Hospital, Lyon, France
| | | | - Yves Panis
- Department of Colorectal Surgery, Groupe Hospitalier Privé Ambroise Paré-Hartmann, Neuilly-sur-Seine, France
| | - Laurent Genser
- Sorbonne Université, Assistance Publique - Hôpitaux de Paris, AP-HP, Department of Hepato-Biliary and Pancreatic Surgery, liver transplantation, Pitié-Salpêtrière University Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France; INSERM, Nutrition and Obesities Systemic Approaches, NutriOmics Research Unit, Sorbonne Université, 91 Boulevard de l'Hôpital, Paris, France
| | - Didier Mutter
- Department of Digestive and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France; Research Institute Against Digestive Cancer, IRCAD, Strasbourg, France
| | - Jérémie Théreaux
- Department of Visceral and Digestive Surgery, Cavale Blanche University Hospital, Brest, France; Inrae, Inserm, Univ Rennes, Nutrition Metabolisms and Cancer, NuMeCan, Rennes, St Gilles, France
| | | | - Bertrand Le Roy
- Department of Digestive and Oncologic Surgery, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Cécile Brigand
- Department of General and Digestive Surgery, University Hospital of Hautepierre, Strasbourg, France
| | - Clarisse Eveno
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, F-59000, Lille, France; Univ. Lille, CNRS, Inserm, CHU Lille, UMR9020-U1277 - CANTHER - Cancer Heterogeneity Plasticity and Resistance to Therapies, F-59000, Lille, France
| | - Piessen Guillaume
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, F-59000, Lille, France; Univ. Lille, CNRS, Inserm, CHU Lille, UMR9020-U1277 - CANTHER - Cancer Heterogeneity Plasticity and Resistance to Therapies, F-59000, Lille, France
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Wu X, Iwatsuki M, Takaki M, Saito T, Hayashi T, Kondo M, Sakai Y, Gotohda N, Tanaka E, Nishida T, Baba H. FBXW7 regulates the sensitivity of imatinib in gastrointestinal stromal tumors by targeting MCL1. Gastric Cancer 2024; 27:235-247. [PMID: 38142463 DOI: 10.1007/s10120-023-01454-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/23/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Imatinib contributes to improving prognosis of high-risk or unresectable gastrointestinal stromal tumors (GISTs). As therapeutic efficacy is limited by imatinib resistance and toxicity, the exploration of predictive markers of imatinib therapeutic efficacy that enables patients to utilize more effective therapeutic strategies remains urgent. METHODS The correlation between FBXW7 and imatinib resistance via FBXW7-MCL1 axis was evaluated in vitro and in vivo experiments. The significance of FBXW7 as a predictor of imatinib treatment efficacy was examined in 140 high-risk patients with GISTs. RESULTS The ability of FBXW7 to predict therapeutic efficacy of adjuvant imatinib in high-risk GIST patients was determined through 5-year recurrence-free survival (RFS) rates analysis and multivariate analysis. FBXW7 affects imatinib sensitivity by regulating apoptosis in GIST-T1 cells. FBXW7 targets MCL1 to regulate apoptosis. MCL1 involves in the regulation of imatinib sensitivity through inhibiting apoptosis in GIST-T1 cells. FBXW7 regulates imatinib sensitivity by down-regulating MCL1 to enhance imatinib-induced apoptosis in vitro. FBXW7 regulates imatinib sensitivity of GIST cells by targeting MCL1 to predict efficacy of imatinib treatment in vivo. CONCLUSIONS FBXW7 regulates imatinib sensitivity by inhibiting MCL1 to enhance imatinib-induced apoptosis in GIST, and predicts efficacy of imatinib treatment in high-risk GIST patients treated with imatinib.
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Affiliation(s)
- Xiyu Wu
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Masaaki Iwatsuki
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan.
| | - Masakazu Takaki
- Department of Rehabilitation, Hospitality Care Garden Seisei Rehabilitation Hospital, Kasuga, Japan
| | - Takuro Saito
- Department of Gastroenterological Surgery, Osaka University, Suita, Japan
| | - Tsutomu Hayashi
- Gastric Surgery Division, National Cancer Center Hospital, Tokyo, Japan
| | - Masato Kondo
- Department of Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yoshiharu Sakai
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Naoto Gotohda
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital East, Tokyo, Japan
| | - Eiji Tanaka
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Toshirou Nishida
- Department of Surgery, Japan Community Health-Care Organization Osaka Hospital, Osaka, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan
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Teranishi R, Takahashi T, Sato S, Sakurai K, Kishi K, Hosogi H, Nakai T, Kurokawa Y, Fujita J, Nishida T, Hirota S, Tsujinaka T. The impact of contour maps on estimating the risk of gastrointestinal stromal tumor recurrence: indications for adjuvant therapy: an analysis of the Kinki GIST registry. Gastric Cancer 2024; 27:355-365. [PMID: 38146035 PMCID: PMC10896809 DOI: 10.1007/s10120-023-01444-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/19/2023] [Indexed: 12/27/2023]
Abstract
INTRODUCTION Contour maps enable risk classification of GIST recurrence in individual patients within 10 postoperative years. Although contour maps have been referred to in Japanese guidelines, their usefulness and role in determining indications for adjuvant therapy is still unclear in Japanese patients. The aims of this study are to investigate the validity of contour maps in Japanese patients with GIST and explore the new strategy for adjuvant therapy. MATERIALS AND METHODS A total of 1426 Japanese GIST patients who were registered to the registry by the Kinki GIST Study Group between 2003 and 2012 were analyzed. Patients who had R0 surgery without perioperative therapy were included in this study. The accuracy of contour maps was validated. RESULTS Overall, 994 patients have concluded this study. Using contour maps, we validated the patients. The 5-year recurrence-free survival rates of patients within the GIST classification groups of 0-10%, 10-20%, 20-40%, 40-60%, 60-80%, 80-90%, and 90-100% were 98.1%, 96.6%, 92.3%, 48.0%, 37.3%, 41.0% and 42.4%, respectively. We confirmed that this classification by contour maps was well reflected recurrence prediction. Further, in the high-risk group stratified by the modified National Institutes of Health consensus criteria (m-NIHC), the 10-year RFS rate was remarkably changed at a cutoff of 40% (0-40% group vs. 40-100% group: 88.7% vs. 50.3%, p < 0.001). CONCLUSION Contour maps are effective in predicting individual recurrence rates. And it may be useful for the decision of individual strategy for high-risk patients combined with m-NIHC.
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Affiliation(s)
- Ryugo Teranishi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Tsuyoshi Takahashi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita City, Osaka, 565-0871, Japan.
| | - Shinsuke Sato
- Department of Gastroenterological Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Katsunobu Sakurai
- Department of Gastroenterological Surgery, Osaka City General Hospital, Osaka, Japan
| | - Kentaro Kishi
- Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | - Hisahiro Hosogi
- Department of Surgery, Japanese Red Cross Osaka Hospital, Osaka, Japan
| | - Takuya Nakai
- Department of Surgery, Faculty of Medicine, Kindai University, Higashiosaka, Osaka, Japan
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Junya Fujita
- Department of Surgery, Yao Municipal Hospital, Osaka, Japan
| | - Toshirou Nishida
- Department of Surgery, Japan Community Health Care Organization Osaka Hospital, Osaka, Japan
| | - Seiichi Hirota
- Department of Surgical Pathology, Hyogo Medical University, Nishinomiya, Japan
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Gotohda N, Nishida T, Sato S, Ozaka M, Nakahara Y, Komatsu Y, Kondo M, Cho H, Kurokawa Y, Kitagawa Y. Re-appraisal of the universal definition of tumor rupture among patients with high-risk gastrointestinal stromal tumors. Ann Gastroenterol Surg 2023; 7:1021-1031. [PMID: 37927930 PMCID: PMC10623932 DOI: 10.1002/ags3.12684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/06/2023] [Accepted: 04/12/2023] [Indexed: 11/07/2023] Open
Abstract
Aim Tumor rupture has been indicated as a risk factor for recurrence of gastrointestinal stromal tumors (GISTs). The universal definition of tumor rupture was proposed. This study evaluated whether the universal definition was more accurate in identification of GISTs with high recurrent risk than subjective judgment. Methods The study included 507 patients with high-risk GISTs who underwent complete resection between December 2012 and December 2015. We conducted a questionnaire survey in participating institutes to re-diagnose tumor rupture based on the universal definition according to their surgical and pathological findings. We compared the clinical outcomes of tumor rupture based on the definition to those based on the surgeon's judgment and clarified the clinical importance of the rupture. Results Sixty-four patients were initially registered to have tumor rupture by surgeon's judgment, and it became 90 patients who had tumor rupture after reevaluation. Although there were significant differences in recurrence-free survival (RFS) between no rupture and rupture for both initial registration and reevaluation (p = 0.002, <0.001, respectively), a significant difference in overall survival was only observed after reevaluation (p = 0.011). Tumor rupture was significantly associated with large tumor size, mixed cell type in histology, R1 resection, frequent adjuvant therapy and recurrence, but not with location, mitosis, and genotype. Adjuvant therapy more than 3 years improved RFS of patients with tumor rupture. Conclusion This study suggested that tumor rupture based on the universal definition more accurately identified GISTs with poor prognostic outcomes than the subjective judgment.
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Affiliation(s)
- Naoto Gotohda
- Department of Hepatobiliary and Pancreatic SurgeryNational Cancer Center Hospital EastKashiwaJapan
| | | | - Shinsuke Sato
- Department of Gastroenterological SurgeryShizuoka General HospitalShizuokaJapan
| | - Masato Ozaka
- Department of Hepato‐Biliary‐Pancreatic Medicine, Gastroenterology CenterCancer Institute Hospital Japanese Foundation for Cancer ResearchTokyoJapan
| | - Yujiro Nakahara
- Department of Gastroenterological SurgeryOsaka Police HospitalOsakaJapan
| | - Yoshito Komatsu
- Department of Gastroenterology and HepatologyHokkaido University HospitalHokkaidoJapan
| | - Masato Kondo
- Department of SurgeryKobe City Medical Center General HospitalKobeJapan
| | - Haruhiko Cho
- Department of SurgeryTokyo Metropolitan Cancer and Infectious Diseases Center Komagome HospitalTokyoJapan
| | - Yukinori Kurokawa
- Department of Gastroenterological SurgeryOsaka University Graduate School of MedicineOsakaJapan
| | - Yuko Kitagawa
- Department of SurgeryKeio University HospitalTokyoJapan
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Peparini N. Impact of tumour rupture risk on the oncological rationale for the surgical treatment choice of gastrointestinal stromal tumours. World J Gastrointest Surg 2023; 15:1559-1563. [PMID: 37701682 PMCID: PMC10494585 DOI: 10.4240/wjgs.v15.i8.1559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/25/2023] [Accepted: 06/19/2023] [Indexed: 08/25/2023] Open
Abstract
Tumour rupture of gastrointestinal stromal tumours (GISTs) has been considered to be a remarkable risk factor because of its unfavourable impact on the oncological outcome. Although tumour rupture has not yet been included in the current tumor-node-metastasis classification of GISTs as a prognostic factor, it may change the natural history of a low-risk GIST to a high-risk GIST. Originally, tumour rupture was defined as the spillage or fracture of a tumour into a body cavity, but recently, new definitions have been proposed. These definitions distinguished from the prognostic point of view between the major defects of tumour integrity, which are considered tumour rupture, and the minor defects of tumour integrity, which are not considered tumour rupture. Moreover, it has been demonstrated that the risk of disease recurrence in R1 patients is largely modulated by the presence of tumour rupture. Therefore, after excluding tumour rupture, R1 may not be an unfavourable prognostic factor for GISTs. Additionally, after the standard adjuvant treatment of imatinib for GIST with rupture, a high recurrence rate persists. This review highlights the prognostic value of tumour rupture in GISTs and emphasizes the need to carefully take into account and minimize the risk of tumour rupture when choosing surgical strategies for GISTs.
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Affiliation(s)
- Nadia Peparini
- Azienda Sanitaria Locale Roma 6, Ciampino, Rome 00043, Italy
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Joensuu H. KIT and PDGFRA Variants and the Survival of Patients with Gastrointestinal Stromal Tumor Treated with Adjuvant Imatinib. Cancers (Basel) 2023; 15:3879. [PMID: 37568695 PMCID: PMC10417000 DOI: 10.3390/cancers15153879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/22/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
Adjuvant imatinib improves the recurrence-free survival and overall survival (OS) of patients with gastrointestinal stromal tumors (GISTs) who have a high risk of recurrence after surgery and is now considered standard treatment. Yet, OS benefit has been demonstrated in only one randomized study, the Scandinavian Sarcoma Group XVIII/AIO trial, where patients with high-risk GISTs were allocated to either 1 year or 3 years of adjuvant imatinib. SSGXVIII/AIO is also the only randomized trial in which adjuvant imatinib duration exceeding 2 years was evaluated. In this trial, the 3-year treatment led to a 45% reduction in the risk of death during the first 10 years that followed random allocation even though some of the patients did not have GISTs at tumor histology review, had mutations now known to be imatinib-resistant or had non-localized disease at study entry. In the subgroup of patients who had KIT exon 11 deletion/indel mutation, the reduction in the risk of death was 66% in favor of the longer treatment. Proper patient selection is of crucial importance since many patients are cured with surgery. Little evidence for OS benefit is available from randomized trials for patients whose GIST harbors KIT exon 9 mutation, KIT insertion mutation, PDGFRA D842V mutation, or lacks KIT and PDGFRA mutations. Adjuvant imatinib improves OS substantially if high-risk GISTs can be identified, treatment duration is long enough, and GISTs harbor an imatinib-sensitive mutation.
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Affiliation(s)
- Heikki Joensuu
- Department of Oncology, Helsinki University Hospital and University of Helsinki, 00029 Helsinki, Finland
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Ohshima K, Nagashima T, Fujiya K, Hatakeyama K, Watanabe Y, Morimoto K, Kamada F, Shimoda Y, Ohnami S, Naruoka A, Serizawa M, Ohnami S, Kenmotsu H, Shiomi A, Tsubosa Y, Bando E, Sugiura T, Sugino T, Terashima M, Uesaka K, Urakami K, Akiyama Y, Yamaguchi K. Whole-genome and Epigenomic Landscapes of Malignant Gastrointestinal Stromal Tumors Harboring KIT Exon 11 557-558 Deletion Mutations. CANCER RESEARCH COMMUNICATIONS 2023; 3:684-696. [PMID: 37377752 PMCID: PMC10124575 DOI: 10.1158/2767-9764.crc-22-0364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 12/12/2022] [Accepted: 03/17/2023] [Indexed: 06/29/2023]
Abstract
Gastrointestinal stromal tumors (GIST) with KIT exon 11 deletions involving in codons 557-558 (KIT Δ557-558) exhibit higher proliferation rates and shorter disease-free survival times compared with GISTs with other KIT exon 11 mutations. We analyzed 30 GIST cases and observed genomic instability and global DNA hypomethylation only in high-risk malignant GISTs with KIT Δ557-558. Whole-genome sequencing revealed that the high-risk malignant GISTs with KIT Δ557-558 (12 cases) had more structural variations (SV), single-nucleotide variants, and insertions and deletions compared with the low-risk, less malignant GISTs with KIT Δ557-558 (six cases) and the high-risk (six cases) or low-risk (6 cases) GISTs with other KIT exon 11 mutations. The malignant GISTs with KIT Δ557-558 showed higher frequency and significance in copy number (CN) reduction on chromosome arms 9p and 22q, and 50% of them had LOH or CN-dependent expression reduction in CDKN2A. In addition, SVs with driver potential were detected in 75% of them, in which AKT3 and MGMT were recurrently identified. Genome-wide DNA methylation and gene expression analyses showed global intergenic DNA hypomethylation, SNAI2 upregulation, and higher expression signatures, including p53 inactivation and chromosomal instability, as characteristics of malignant GISTs with KIT Δ557-558 that distinguished them from other GISTs. These genomic and epigenomic profiling results revealed that KIT Δ557-558 mutations are associated with increased genomic instability in malignant GISTs. Significance We present genomic and epigenomic insights into the malignant progression of GISTs with KIT exon 11 deletions involving in 557-558, demonstrating their unique chromosomal instability and global intergenic DNA hypomethylation.
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Affiliation(s)
- Keiichi Ohshima
- Medical Genetics Division, Shizuoka Cancer Center Research Institute, Shizuoka, Japan
| | - Takeshi Nagashima
- Cancer Diagnostics Research Division, Shizuoka Cancer Center Research Institute, Shizuoka, Japan
- SRL, Inc., Tokyo, Japan
| | - Keiichi Fujiya
- Division of Gastric Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Keiichi Hatakeyama
- Cancer Multiomics Division, Shizuoka Cancer Center Research Institute, Shizuoka, Japan
| | - Yuko Watanabe
- Medical Genetics Division, Shizuoka Cancer Center Research Institute, Shizuoka, Japan
| | - Kimiko Morimoto
- Medical Genetics Division, Shizuoka Cancer Center Research Institute, Shizuoka, Japan
| | - Fukumi Kamada
- Cancer Diagnostics Research Division, Shizuoka Cancer Center Research Institute, Shizuoka, Japan
| | - Yuji Shimoda
- Cancer Diagnostics Research Division, Shizuoka Cancer Center Research Institute, Shizuoka, Japan
| | - Sumiko Ohnami
- Cancer Diagnostics Research Division, Shizuoka Cancer Center Research Institute, Shizuoka, Japan
| | - Akane Naruoka
- Drug Discovery and Development Division, Shizuoka Cancer Center Research Institute, Shizuoka, Japan
| | - Masakuni Serizawa
- Drug Discovery and Development Division, Shizuoka Cancer Center Research Institute, Shizuoka, Japan
| | - Shumpei Ohnami
- Cancer Diagnostics Research Division, Shizuoka Cancer Center Research Institute, Shizuoka, Japan
| | - Hirotsugu Kenmotsu
- Division of Genetic Medicine Promotion, Shizuoka Cancer Center Hospital, Shizuoka, Japan
- Division of Thoracic Oncology, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Akio Shiomi
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Yasuhiro Tsubosa
- Division of Esophageal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Etsuro Bando
- Division of Gastric Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Teiichi Sugiura
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Takashi Sugino
- Division of Pathology, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Masanori Terashima
- Division of Gastric Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Katsuhiko Uesaka
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Kenichi Urakami
- Cancer Diagnostics Research Division, Shizuoka Cancer Center Research Institute, Shizuoka, Japan
| | - Yasuto Akiyama
- Immunotherapy Division, Shizuoka Cancer Center Research Institute, Shizuoka, Japan
| | - Ken Yamaguchi
- Shizuoka Cancer Center Hospital and Research Institute, Shizuoka, Japan
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Bleckman R, Roets E, IJzerman NS, Mohammadi M, Bonenkamp HJ, Gelderblom H, Mathijssen RH, Steeghs N, Reyners AK, van Etten B. Local recurrence in primary localized resected gastro-intestinal stromal tumors A registry observational national cohort study including 912 patients. Eur J Cancer 2023; 186:113-121. [PMID: 37062209 DOI: 10.1016/j.ejca.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/10/2023] [Accepted: 03/10/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND AND OBJECTIVES Previous literature showed a high risk of recurrence following surgical treatment in patients with gastrointestinal stromal tumours (GISTs). However, little is known about the patient- and treatment characteristics of local recurrences (LRs) in GIST patients. Therefore, this study aimed to better understand patterns of LR in surgically treated localised GIST and to describe treatment options based on our Dutch GIST Registry (DGR). METHODS Data of primary surgically treated localised GIST between January 2009 until July 2021 were retrospectively retrieved from the DGR. RESULTS Of 1452 patients registered in the DGR, 912 patients were included in this study. Only 3.8% (35/912) of patients developed LR, including 20 patients with LR only and 15 patients with simultaneous LR and distant metastases (DM). Median time to LR was 30 (interquartile range 8-53) months from date of surgery. Eleven percent (100/912) of patients developed only DM. A total of 2.3% (6/259) of patients treated with adjuvant treatment developed an LR during adjuvant therapy. Seventy percent of patients with LR only (14/20) were treated with surgery (85.7% R0), which was mostly combined with systemic treatment. CONCLUSIONS Patients with primary surgically treated localised GIST have a limited risk of developing recurrence. Fifteen percent developed recurrence, of which one quarter developed an LR. Therefore, less intensified follow-up schedules could be considered, especially during treatment with adjuvant imatinib. In patients with LR only, potentially curative treatment strategies, including surgical (re-)resection, are often possible as treatment for LR.
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Laparoscopic resection for spontaneously ruptured primary extragastrointestinal stromal tumor of the greater omentum: A case report. Int J Surg Case Rep 2022; 99:107567. [PMID: 36096080 PMCID: PMC9568711 DOI: 10.1016/j.ijscr.2022.107567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 08/18/2022] [Accepted: 08/26/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Ruptured extragastrointestinal stromal tumor (EGIST) are rare; therefore, there are no standard guidelines for its treatment. Herein, we report the successful laparoscopic resection of a ruptured EGIST. Presentation of case The patient was a 59-year-old man, a Jehovah's Witness, who presented with sudden onset of left-sided abdominal pain. Contrast-enhanced computed tomography (CECT) performed from a previous hospital revealed intra-abdominal hemorrhage. Repeat CECT at our institution revealed extravasation and serum ascites. A hematoma was found anterior to the omentum, and a tumor was detected which did not have continuity with the surrounding organs of the gastrointestinal tract. Complete tumor resection via laparoscopic surgery was performed and the specimen was sent for histopathology, which revealed bundle-like proliferation of spindle-shaped cells. Immunohistochemical staining was completed, which was positive for KIT and CD34. Based on surgical and pathological findings, the final diagnosis was extragastrointestinal stromal tumor originating from the omentum. Discussion EGISTs have a similar morphology to that of gastrointestinal stromal tumors, but instead, arise outside the gastrointestinal tract. A significant differentiation and key to the diagnosis of EGIST is the absence of continuity with the gastrointestinal tract. The preferred treatment for EGIST is complete surgical resection, and the use of laparoscopy has not been well studied. Postoperative histopathological examination, along with immunohistochemical staining, aid confirmatory diagnosis. Conclusion Laparoscopic removal of EGISTs is a minimally invasive and potentially useful technique for the management of this tumor type. Diagnosis and treatment of a spontaneously ruptured tumor is complicated. Religion restrictions in management should be respected and followed. First line of treatment of EGISTs is complete surgical resection. Laparoscopic removal of EGISTs is minimally invasive and potentially useful.
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Li W, Li X, Yu K, Xiao B, Peng J, Zhang R, Zhang L, Wang K, Pan Z, Li C, Wu X. Efficacy and safety of neoadjuvant imatinib therapy for patients with locally advanced rectal gastrointestinal stromal tumors: A multi-center cohort study. Front Pharmacol 2022; 13:950101. [PMID: 36238544 PMCID: PMC9552070 DOI: 10.3389/fphar.2022.950101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/30/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Several issues on neoadjuvant imatinib therapy remain controversial despite its widespread application for rectal gastrointestinal stromal tumors (GIST). We aimed to describe the clinicopathological characteristics of this specific population, and compare the surgical and oncologic outcomes between patients with or without neoadjuvant imatinib therapy. Patients and methods: A cohort of 58 consecutive locally advanced rectal GIST patients receiving surgical treatment between January 2007 and July 2019 at Sun Yat-sen University Cancer Center and Yunnan Cancer Hospital was retrospectively analyzed. Recurrence-free survival (RFS) and overall survival (OS) were estimated using Kaplan-Meier method. Results: There were 33 (56.9%) patients who received neoadjuvant imatinib therapy. Among them, 20 (60.6%) patients had partial response (PR) as their best response, 11 (33.3%) patients had stable disease (SD), and 2 (6.1%) patients had progressive disease (PD). The median tumor size reduced from 5.2 to 4.0 cm after treatment (p < 0.001), and an attained “maximal response” was primarily achieved (32/33) on the 12th month after treatment. The most common adverse event was anemia. There were 27 adverse events occurred, most of which were grade 1 (19/27). With respect to intraoperative and postoperative surgical outcomes, no significant difference was found between patients with or without neoadjuvant Imatinib therapy except that patients with neoadjuvant treatment had a significant higher rate of preventive ileostomy (p = 0.004). Patients received neoadjuvant treatment had a superior 2-years RFS outcome than those without, though the difference was no significant (91.7% vs. 78.9%, p = 0.203). There were no significant differences in the 2-years OS rates (95.2% vs. 91.3%, p = 0.441). Conclusion: Neoadjuvant imatinib therapy is an effective and safe treatment for locally advanced rectal GISTs. Further studies are warranted to validate the long-term prognostic benefit for patients with rectal GISTs receiving neoadjuvant imatinib therapy.
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Affiliation(s)
- Weihao Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xinyue Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Kun Yu
- Department of Colorectal Cancer Surgery, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Binyi Xiao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jianhong Peng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Rongxin Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Lingfang Zhang
- Department of Colorectal Cancer Surgery, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Kun Wang
- Department of Colorectal Cancer Surgery, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhizhong Pan
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
- *Correspondence: Zhizhong Pan, ; Cong Li, ; Xiaojun Wu,
| | - Cong Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
- *Correspondence: Zhizhong Pan, ; Cong Li, ; Xiaojun Wu,
| | - Xiaojun Wu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
- *Correspondence: Zhizhong Pan, ; Cong Li, ; Xiaojun Wu,
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13
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Harada H, Ohashi M, Hiki N, Fujisaki J, Hirasawa T, Yamamoto Y, Makuuchi R, Ida S, Hayami M, Kumagai K, Sano T, Nunobe S. Excellent oncological outcomes besides short-term safety of laparoscopic and endoscopic cooperative surgery for gastric gastrointestinal stromal tumor. Endosc Int Open 2022; 10:E1254-E1260. [PMID: 36118650 PMCID: PMC9473822 DOI: 10.1055/a-1895-9507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 07/05/2022] [Indexed: 10/27/2022] Open
Abstract
Background and study aims Laparoscopic and endoscopic cooperative surgery (LECS) for gastric submucosal tumor was developed as a type of minimal local resection and is now widely used in Asian countries. However, the oncological safety of LECS for gastric gastrointestinal stromal tumor (GIST) remains unclear. LECS has potential oncology-related problems that may influence survival outcomes. Furthermore, the feasibility and safety of LECS have not yet been fully established. Patients and methods Patients who were intended to undergo LECS for gastric GIST from 2006 to 2020 were retrospectively selected. The indication for LECS was determined according to the guidelines. The completion of LECS, complications, and survival outcomes of the patients were analyzed. Results Two hundred fifty-nine patients were eligible in this study. According to intraoperative findings, 44 patients underwent local resection without luminal endoscopic procedures. Of the remaining 215 patients, 213 completely underwent LECS, which corresponds to a completion rate of 99.1 %. Six patients (2.8 %) had postoperative complications of Clavien-Dindo classification grade II or higher. Delayed gastric emptying was most commonly found in four patients (1.9 %). Old age ( P = 0.0349), female sex ( P = 0.0095), tumor located in the lesser curvature ( P = 0.0015), and large tumor diameter ( P = 0.0232) were significantly more common in patients with complications. The 3-year overall and disease-specific survival rates were 99 % and 100 %, respectively, in 215 patients who were intended to undergo LECS. Conclusions Despite several oncological concerns, LECS for gastric GIST is oncologically safe besides a feasible and safe procedure in the short-term.
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Affiliation(s)
- Hiroki Harada
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan,Department of Upper-gastrointestinal Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Manabu Ohashi
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Naoki Hiki
- Department of Upper-gastrointestinal Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Junko Fujisaki
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Toshiaki Hirasawa
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yorimasa Yamamoto
- Division of Gastroenterology, Endoscopy Center, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Rie Makuuchi
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Satoshi Ida
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masaru Hayami
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Koshi Kumagai
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takeshi Sano
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Souya Nunobe
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
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Yang J, Liu Y, Sun XJ, Ai ZW, Liu S. A rare rectal gastrointestinal stromal tumor with indolent biological behavior: A case study. Exp Ther Med 2022; 24:641. [PMID: 36160900 PMCID: PMC9468906 DOI: 10.3892/etm.2022.11578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/27/2022] [Indexed: 11/27/2022] Open
Abstract
The overall incidence of rectal gastrointestinal stromal tumor (RGIST) has risen, but it remains a rare disease. Furthermore, tumor rupture is associated with poor prognosis. The present study reported a rare case of RGIST with indolent biological behavior. The biological behavior of this RGIST was analyzed and its malignant potential was evaluated using a guideline-based risk stratification assessment. The patient was diagnosed with a rectal tumor at the Third Affiliated Hospital of Qiqihar Medical University (Qiqihar, China) in April 2020 and a partial resection biopsy was then performed. This resection counts as a rupture. The biopsy confirmed RGIST and the patient refused further examination and treatment due to economic concerns. However, the patient survives with no tumor progression and metastasis until now, May 2022. In conclusion, based on the present case, tumor rupture in indolent RGIST is not necessarily associated with poor outcome.
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Affiliation(s)
- Jian Yang
- Department of General Surgery, The First Affiliated Hospital of Jiamusi University, Jiamusi, Heilongjiang 154003, P.R. China
| | - Ying Liu
- Department of Medical Oncology, The Third Affiliated Hospital of Qiqihar Medical University, Qiqihar, Heilongjiang 161000, P.R. China
| | - Xue-Jia Sun
- Department of Radiology, The Third Affiliated Hospital of Qiqihar Medical University, Qiqihar, Heilongjiang 161000, P.R. China
| | - Zhong-Wei Ai
- Pathology Center, Qiqihar Medical University, Qiqihar, Heilongjiang 161003, P.R. China
| | - Shi Liu
- Central Laboratory, The Third Affiliated Hospital of Qiqihar Medical University, Qiqihar, Heilongjiang 161000, P.R. China
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15
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Wong LH, Sutton TL, Sheppard BC, Corless CL, Heinrich MC, Mayo SC. Neoadjuvant tyrosine kinase inhibitor therapy for patients with gastrointestinal stromal tumor: A propensity-matched analysis. Am J Surg 2022; 224:624-628. [PMID: 35382931 PMCID: PMC10005816 DOI: 10.1016/j.amjsurg.2022.03.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 02/05/2022] [Accepted: 03/25/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Tyrosine kinase inhibitor (TKI) neoadjuvant therapy (NAT) is often given in gastrointestinal stromal tumors (GISTs) with the goal to facilitate less morbid resections and improve oncologic outcomes; however, the use of NAT for GIST is poorly studied. METHODS We reviewed patients with resected nonmetastatic GIST from 2003 to 2019. Overall (OS) and recurrence-free survival (RFS) were assessed with Kaplan-Meier modeling. We performed 1:1 propensity-matching for relevant clinicopathologic variables for receipt of NAT. RESULTS We identified 254 patients. Propensity 1:1 matching resulted in 33 patients per group. The median follow-up was 77 months with no difference in 10-year OS (68% vs. 73%), 5-year RFS (13% vs. 10%), or median RFS (24 vs. 27 months) for patients treated with NAT versus upfront resection (all P > 0.9). Hospital length-of-stay (both median 7 days) and Clavien-Dindo ≥ III complications (12% vs. 3%) were not different between groups (both P ≥ 0.35). DISCUSSION TKI NAT can be used to facilitate resection in select patients with surgically higher-risk GIST, however it does not result in an independent oncologic benefit.
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Affiliation(s)
- Liam H Wong
- Oregon Health & Science University (OHSU), School of Medicine, Portland, OR, 97239, USA
| | - Thomas L Sutton
- OHSU Department of Surgery, Division of General Surgery, Portland, OR, 97239, USA
| | - Brett C Sheppard
- OHSU Department of Surgery, Division of General Surgery, Portland, OR, 97239, USA
| | | | - Michael C Heinrich
- Portland VA Health Care System, Portland, OR, 97239, USA; OHSU Department of Medicine, Division of Hematology and Oncology, Knight Cancer Institute, Portland, OR, 97239, USA
| | - Skye C Mayo
- OHSU Department of Surgery, Division of Surgical Oncology, Knight Cancer Institute, Portland, OR, 97239, USA.
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Qu H, Xu Z, Ren Y, Gong Z, Ju RH, Zhang F, Shao S, Chen X, Chen X. The analysis of prognostic factors of primary small intestinal gastrointestinal stromal tumors with R0 resection: A single-center retrospective study. Medicine (Baltimore) 2022; 101:e29487. [PMID: 35758385 PMCID: PMC9276149 DOI: 10.1097/md.0000000000029487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 05/05/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE We aim to assess factors that affect overall survival in patients with primary small intestinal gastrointestinal stromal tumors (GISTs) who had undergone R0 resection. METHOD A retrospective analysis reviewed the data of 82 consecutive confirmed GIST patients at a single medical center in China from January 2012 to June 2020. The survival curve was estimated using the Kaplan-Meier method, and independent prognostic factors were confirmed using the Cox regression model. RESULTS A total of 82 patients were included in the study: 42 men and 40 women, the mean age was 59 years old (23-83 years old). Tumors were commonly found in the jejunum (46.3%), ileum (20.7%), and duodenum (32.9%). The median tumor size was 6.0 cm (range: 1.0-15.0 cm). The number of mitoses per one 50 high-power field was used to define the mitotic rates. In our present study, 56 patients presented a mitotic rate ≤5 (68.3%) and 26 patients showed a rate >5 (31.7%) at the time of diagnosis. All patients accepted tumor resection without lymph node resection. The positivity rate was 97.6% for CD117, 96.3% for delay of germination 1, 65.9% for CD34, 6.1% for S-100, and 59.8% for smooth muscle actin using immunohistochemistry. Tumor size, tumor rupture, Ki67 index, mitotic index, and postoperative imatinib were independent prognostic factors for small intestinal GISTs. CONCLUSIONS In this study, larger tumor size, high Ki67 index, high mitotic index, the occurrence of tumor rupture, and use of imatinib were independent unfavorable prognostic indicators.
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Affiliation(s)
- Hui Qu
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, Dalian, People's Republic of China
- Dalian Medical University, Dalian, People's Republic of China
| | - ZhaoHui Xu
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, Dalian, People's Republic of China
- Dalian Medical University, Dalian, People's Republic of China
| | - YanYing Ren
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, Dalian, People's Republic of China
| | - ZeZhong Gong
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, Dalian, People's Republic of China
- Dalian Medical University, Dalian, People's Republic of China
| | - Ri Hyok Ju
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, Dalian, People's Republic of China
- Dalian Medical University, Dalian, People's Republic of China
| | - Fan Zhang
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, Dalian, People's Republic of China
| | - Shuai Shao
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, Dalian, People's Republic of China
| | - XiaoLiang Chen
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, Dalian, People's Republic of China
| | - Xin Chen
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, Dalian, People's Republic of China
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17
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Bang YH, Ryu MH, Kim HD, Lee HE, Kang YK. Clinical outcomes and prognostic factors for patients with high-risk gastrointestinal stromal tumors treated with 3-year adjuvant imatinib. Int J Cancer 2022; 151:1770-1777. [PMID: 35678337 DOI: 10.1002/ijc.34157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/02/2022] [Accepted: 05/11/2022] [Indexed: 11/07/2022]
Abstract
Three years of adjuvant imatinib is the current standard for patients with high-risk gastrointestinal stromal tumors (GIST). We aimed to investigate the safety and efficacy profiles of 3-year imatinib, focusing on the prognostic value of various factors. In this registry-based study, 222 patients with high-risk GIST who underwent surgical resection followed by 3 years of adjuvant imatinib between 2010 and 2018 were included. The imatinib dose was reduced in 39 (17.6%), and 13 (5.9%) discontinued imatinib due to toxicity. With a median follow-up duration of 65.7 months, 5-year recurrence-free survival (RFS) and overall survival (OS) were 73.2% and 93.9%, respectively. Tumor rupture, tumor size of > 10 cm, mitotic index of > 10/50 high power fields (HPF) were independent factors for short RFS. Patient subgroups stratified by the risk factors showed distinct RFS (P < 0.001): patients without the above risk factors or those with only a tumor size of >10 cm showed favorable RFS (5-year RFS 83.8% and 92.3%, respectively), whereas those with tumor rupture or those with tumor size of > 10 cm and mitotic index of >10/50 HPF showed prominently poor RFS (5-year RFS of 54.8% and 47.9%, respectively). Three years of adjuvant imatinib treatment was generally tolerable and effective, which were consistent with the clinical outcomes of previous reports. The presence of tumor rupture, large tumor, and high mitotic count was independently associated with poor RFS. Based on these risk factors, different management strategies, such as different durations of adjuvant imatinib, deserve further investigation. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Yeong Hak Bang
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Min-Hee Ryu
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hyung-Don Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hyung Eun Lee
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yoon-Koo Kang
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Gao F, Wang J, Li C, Xie C, Su M, Zou C, Xie X, Zhao D. Risk-Related Genes and Associated Signaling Pathways of Gastrointestinal Stromal Tumors. Int J Gen Med 2022; 15:3839-3849. [PMID: 35431569 PMCID: PMC9005359 DOI: 10.2147/ijgm.s357224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/28/2022] [Indexed: 12/27/2022] Open
Abstract
Purpose Knowledge on the potential association between differential gene expression and risk of gastrointestinal stromal tumors (GISTs) is currently limited. We used bioinformatics tools to identify differentially expressed genes in GIST samples and the related signaling pathways of these genes. Patients and Methods The GSE136755 dataset was obtained from the GEO database and differentially expressed genes (CENPA, CDK1, TPX2, CCNB1, CCNA2, BUB1, AURKA, KIF11, NDC80) were screened using String and Cytoscape bioinformatics tools. Then, three groups of eight patients at high, intermediate and low risk of GIST were selected from patients diagnosed with GIST by immunohistochemistry in our hospital from October 2020 to March 2021. Differential expression of CDK1 and BUB1 was verified by comparing the amount of expressed p21-Activated kinase 4 (PAK4) protein in pathological sections. Results SPSS26.0 analysis showed that the expression level of PAK4 in GISTs was significantly higher than in normal tissues and paratumoral tissues and there was significant difference among the three groups of patients (P < 0.01). PAK4 levels in paratumoral and normal tissues were negligible with no significant difference between the tissues. Conclusion CENPA, CDK1, TPX2, CCNB1, CCNA2, BUB1, AURKA, KIF11 and NDC80 gene expression can be used as biomarkers to assess the risk of gastrointestinal stromal tumors whereby expression increases gradually with the increased risk of GIST formation. The genes encode proteins that regulate the division, proliferation and apoptosis of gastrointestinal stromal tumors mainly through PI3K/AKT, MARK, P53, WNT and other signaling pathways.
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Affiliation(s)
- Fulai Gao
- Department of Gastroenterology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, People’s Republic of China
- Department of Gastroenterology, The First Hospital of Qinhuangdao, Qinhuangdao, 066000, People’s Republic of China
| | - Jiaqi Wang
- Basic Medical College, Hebei Medical University, Shijiazhuang, 050000, People’s Republic of China
| | - Changjuan Li
- Department of Gastroenterology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, People’s Republic of China
| | - Changshun Xie
- Department of Gastroenterology, The First Hospital of Qinhuangdao, Qinhuangdao, 066000, People’s Republic of China
| | - Miao Su
- Department of Gastroenterology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, People’s Republic of China
| | - Chunyan Zou
- Department of Gastroenterology, The First Hospital of Qinhuangdao, Qinhuangdao, 066000, People’s Republic of China
| | - Xiaoli Xie
- Department of Gastroenterology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, People’s Republic of China
| | - Dongqiang Zhao
- Department of Gastroenterology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, People’s Republic of China
- Correspondence: Dongqiang Zhao, Department of Gastroenterology, The Second Hospital of Hebei Medical University, No. 215, He Ping West Road, Xinhua District, Shijiazhuang, 050000, People’s Republic of China, Tel +86 0311 66636179, Email
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Real-world data on the efficacy and safety of adjuvant chemotherapy in Japanese patients with a high-risk of gastrointestinal stromal tumor recurrence. Int J Clin Oncol 2022; 27:921-929. [DOI: 10.1007/s10147-022-02135-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 02/01/2022] [Indexed: 12/15/2022]
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Chiguchi G, Cho H, Sato S, Takahashi T, Nabeshima K, Maruyama T, Kataoka M, Katayanagi S, Kikuchi H. Impact of preoperative tumor rupture timing on gastrointestinal stromal tumor prognosis: a retrospective multicentric cohort study. Jpn J Clin Oncol 2021; 52:237-243. [PMID: 34933335 DOI: 10.1093/jjco/hyab200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/01/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND A gastrointestinal stromal tumor rupture entails a high risk of recurrence even after curative surgery. However, the definition of rupture is unclear, and the question of whether patients with a minor rupture should be treated with adjuvant imatinib remains controversial. METHODS The present, retrospective, multicentric study enrolled 57 patients with gastrointestinal stromal tumor with a minor/major tumor rupture, of whom 46 were finally found to be eligible for analysis. Tumor ruptures were subclassified by their degree, timing and cause. Multivariate analysis was performed to identify the risk factors of all types of recurrence as well as of peritoneal recurrence only. RESULTS The study cohort included minor (n = 24), intraoperative (n = 19) and iatrogenic (n = 20) ruptures besides the typical types (major, preoperative and spontaneous). All intraoperative ruptures were iatrogenic. In total, 27 patients (58.7%) had a recurrence in the peritoneum (n = 17) and/or the liver (n = 13) during a median follow-up period of 5.8 years, but no recurrence was observed in patients with tumor rupture as a single, high-risk factor. Multivariate analysis found the timing of tumor rupture to be an independent risk factor of poor recurrence-free survival (hazard ratio: 2.37; 95% confidence interval: 1.02-5.49; P = 0.045). CONCLUSIONS Preoperative tumor rupture in patients with a ruptured gastrointestinal stromal tumor was associated with poor recurrence-free survival. Our results suggested that a distinction should be made between preoperative and intraoperative tumor ruptures when considering the indications for adjuvant imatinib therapy for gastrointestinal stromal tumor patients with tumor rupture as a single, high-risk factor of recurrence.
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Affiliation(s)
- Gaku Chiguchi
- Department of Gastroenterology, Japan Labour Health and Welfare Organization, Yokohama Rosai Hospital, Yokohama, Japan
| | - Haruhiko Cho
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, Tokyo, Japan.,Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Shinsuke Sato
- Department of Gastroenterological Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Tsuyoshi Takahashi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | | | | | - Mikinori Kataoka
- Department of Gastroenterology and Hepatology, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - Sou Katayanagi
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Hirotoshi Kikuchi
- Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
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21
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Kang S, Ryu MH, Bang YH, Kim HD, Lee HE, Kang YK. Adjuvant Imatinib Treatment for 5-Years vs 3-Years in Patients with Ruptured Localized Gastrointestinal Stromal Tumor: A Retrospective Analysis. Cancer Res Treat 2021; 54:1167-1174. [PMID: 34883555 PMCID: PMC9582464 DOI: 10.4143/crt.2021.1040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/03/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose Three years of adjuvant imatinib is the standard treatment for resected gastrointestinal stromal tumors (GISTs) with rupture, but the recurrence rate is prominently high. We aimed to investigate the efficacy and safety of 5-year adjuvant imatinib compared with 3-year treatment in patients with a ruptured GIST following surgical resection. Materials and Methods A total of 51 patients were included in the analysis. The assessment of GIST rupture was based on Nishida’s classification. Twenty patients who were diagnosed before November 2013 were treated with 5 years of imatinib, and 31 patients who were diagnosed after November 2013 were treated with 3 years of imatinib. We retrospectively compared the clinical outcomes of the two groups. Results Baseline characteristics and the incidence of the adverse events were generally comparable between the two groups. During a median follow-up duration of 43.8 months and 104.2 months in the 3- and 5-year group, 8 and 9 patients had a disease recurrence, respectively. The 5-year group showed better recurrence-free survival (RFS) than the 3-year group. In multivariate analysis, low mitotic index was a significant independent favorable prognostic factor for RFS, while 5-year imatinib treatment was marginally associated with a favorable RFS. Conclusion Five years of adjuvant imatinib treatment in patients with ruptured GIST was associated with favorable survival outcomes with manageable toxicity profiles. Our findings warrant validation and confirmation in future studies.
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Affiliation(s)
- Sora Kang
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min-Hee Ryu
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yeong Hak Bang
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyung-Don Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyung Eun Lee
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yoon-Koo Kang
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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22
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Ceccarelli G, Costa G, De Rosa M, Codacci Pisanelli M, Frezza B, De Prizio M, Bravi I, Scacchi A, Gallo G, Amato B, Bugiantella W, Tacchi P, Bartoli A, Patriti A, Cappuccio M, Komici K, Mariani L, Avella P, Rocca A. Minimally Invasive Approach to Gastric GISTs: Analysis of a Multicenter Robotic and Laparoscopic Experience with Literature Review. Cancers (Basel) 2021; 13:cancers13174351. [PMID: 34503161 PMCID: PMC8431126 DOI: 10.3390/cancers13174351] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/04/2021] [Accepted: 08/24/2021] [Indexed: 01/07/2023] Open
Abstract
Simple Summary Gastrointestinal stromal tumors (GISTs) represent about 1–3% of all gastrointestinal malignancies, of which 50–60% are gastric GISTs (GGs). To the date, surgery represents the best therapeutic option, and the robotic gastric surgery could gain an important role, overcoming many laparoscopic drawbacks. The aim of this study is to evaluate safety and effectiveness of minimally invasive surgery (MIS) for GGs, reporting 10-year experience of three different centers. We included a population of 81 patients who underwent MIS approaches (36 laparoscopy vs. 45 robotic surgery). Seventy-two (72) patients were enrolled in a follow-up program to evaluate the long-term oncological outcomes. Furthermore, we discussed some technical notes and also we analyzed the operative and peri-operative outcomes. In conclusion, our results suggest that the robotic approach might be a suitable treatment, especially for GISTs >5 cm, even located in unfavorable places, despite longer operative time and costs than laparoscopic approach. Abstract Background: Gastrointestinal stromal tumors (GISTs) are most frequently located in the stomach. In the setting of a multidisciplinary approach, surgery represents the best therapeutic option, consisting mainly in a wedge gastric resection. (1) Materials and methods: Between January 2010 to September 2020, 105 patients with a primary gastrointestinal stromal tumor (GISTs) located in the stomach, underwent surgery at three surgical units. (2) Results: A multi-institutional analysis of minimally invasive series including 81 cases (36 laparoscopic and 45 robotic) from 3 referral centers was performed. Males were 35 (43.2%), the average age was 66.64 years old. ASA score ≥3 was 6 (13.3%) in the RS and 4 (11.1%) in the LS and the average tumor size was 4.4 cm. Most of the procedures were wedge resections (N = 76; 93.8%) and the main operative time was 151 min in the RS and 97 min in the LS. Conversion was necessary in five cases (6.2%). (3) Conclusions: Minimal invasive approaches for gastric GISTs performed in selected patients and experienced centers are safe. A robotic approach represents a useful option, especially for GISTs that are more than 5 cm, even located in unfavorable places.
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Affiliation(s)
- Graziano Ceccarelli
- General Surgery Department, ASL 2 Umbria, San Giovanni Battista Hospital, 06034 Foligno, Italy; (G.C.); (G.C.); (W.B.); (P.T.); (A.B.); (A.P.); (L.M.)
- General, Minimally Invasive and Robotic Surgery, Department of Surgery, ASL 2 Umbria, San Matteo Hospital, 06049 Spoleto, Italy
- General Surgery Unit, San Donato Hospital, 52100 Arezzo, Italy; (B.F.); (M.D.P.)
| | - Gianluca Costa
- General Surgery Department, ASL 2 Umbria, San Giovanni Battista Hospital, 06034 Foligno, Italy; (G.C.); (G.C.); (W.B.); (P.T.); (A.B.); (A.P.); (L.M.)
- General, Minimally Invasive and Robotic Surgery, Department of Surgery, ASL 2 Umbria, San Matteo Hospital, 06049 Spoleto, Italy
- Surgery Center, University Campus Bio-Medico of Rome, 00128 Rome, Italy
| | - Michele De Rosa
- Department of General Surgery, San Giovanni Battista Hospital, 06034 Perugia, Italy;
| | - Massimo Codacci Pisanelli
- UOC General Surgery and Laparoscopic Surgery, Department of Surgery P. Valdoni, Policlinic Umberto I, Sapienza University of Study of Rome, 00161 Rome, Italy;
| | - Barbara Frezza
- General Surgery Unit, San Donato Hospital, 52100 Arezzo, Italy; (B.F.); (M.D.P.)
| | - Marco De Prizio
- General Surgery Unit, San Donato Hospital, 52100 Arezzo, Italy; (B.F.); (M.D.P.)
| | - Ilaria Bravi
- Histopathology Department, Usl Umbria 2, San Giovanni Battista Hospital, 06034 Foligno, Italy;
| | - Andrea Scacchi
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy; (A.S.); (M.C.); (K.K.); (P.A.)
| | - Gaetano Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, 88100 Catanzaro, Italy;
- Department of Colorectal Surgery, S. Rita Clinic, 13100 Vercelli, Italy
| | - Bruno Amato
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80126 Naples, Italy;
| | - Walter Bugiantella
- General Surgery Department, ASL 2 Umbria, San Giovanni Battista Hospital, 06034 Foligno, Italy; (G.C.); (G.C.); (W.B.); (P.T.); (A.B.); (A.P.); (L.M.)
- General, Minimally Invasive and Robotic Surgery, Department of Surgery, ASL 2 Umbria, San Matteo Hospital, 06049 Spoleto, Italy
| | - Piergiorgio Tacchi
- General Surgery Department, ASL 2 Umbria, San Giovanni Battista Hospital, 06034 Foligno, Italy; (G.C.); (G.C.); (W.B.); (P.T.); (A.B.); (A.P.); (L.M.)
- General, Minimally Invasive and Robotic Surgery, Department of Surgery, ASL 2 Umbria, San Matteo Hospital, 06049 Spoleto, Italy
| | - Alberto Bartoli
- General Surgery Department, ASL 2 Umbria, San Giovanni Battista Hospital, 06034 Foligno, Italy; (G.C.); (G.C.); (W.B.); (P.T.); (A.B.); (A.P.); (L.M.)
- General, Minimally Invasive and Robotic Surgery, Department of Surgery, ASL 2 Umbria, San Matteo Hospital, 06049 Spoleto, Italy
| | - Alberto Patriti
- General Surgery Department, ASL 2 Umbria, San Giovanni Battista Hospital, 06034 Foligno, Italy; (G.C.); (G.C.); (W.B.); (P.T.); (A.B.); (A.P.); (L.M.)
- General, Minimally Invasive and Robotic Surgery, Department of Surgery, ASL 2 Umbria, San Matteo Hospital, 06049 Spoleto, Italy
- Division of General Surgery, Ospedali Riuniti Marche Nord, 61121 Pesaro, Italy
| | - Micaela Cappuccio
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy; (A.S.); (M.C.); (K.K.); (P.A.)
| | - Klara Komici
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy; (A.S.); (M.C.); (K.K.); (P.A.)
| | - Lorenzo Mariani
- General Surgery Department, ASL 2 Umbria, San Giovanni Battista Hospital, 06034 Foligno, Italy; (G.C.); (G.C.); (W.B.); (P.T.); (A.B.); (A.P.); (L.M.)
- General, Minimally Invasive and Robotic Surgery, Department of Surgery, ASL 2 Umbria, San Matteo Hospital, 06049 Spoleto, Italy
| | - Pasquale Avella
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy; (A.S.); (M.C.); (K.K.); (P.A.)
| | - Aldo Rocca
- General Surgery Unit, San Donato Hospital, 52100 Arezzo, Italy; (B.F.); (M.D.P.)
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy; (A.S.); (M.C.); (K.K.); (P.A.)
- Correspondence:
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23
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Delayed adjuvant imatinib in patients with high risk of recurrence of gastrointestinal stromal tumor after radical surgery: a retrospective cohort study. J Cancer Res Clin Oncol 2021; 148:1493-1500. [PMID: 34319443 DOI: 10.1007/s00432-021-03749-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 07/26/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE To investigate the impact of delayed adjuvant imatinib on GIST patients with high risk of recurrence. METHOD Adult GIST patients were retrospectively collected from our hospital between 2011 and 2018, and patients having high risk of recurrence were included for subsequent analyses. The primary endpoint was recurrence-free survival (RFS). RESULTS According to the interval between the radical surgery and the beginning of adjuvant imatinib, 222 patients were divided into three groups: group A (≤ 2 months, n = 41), group B (2-≤ 4 months, n = 113), and group C (4-≤ 6 months, n = 68). Univariate, multivariate, and survival analyses all showed that patients in group A had significantly more favorable RFS than those in group C but not group B, and patients taking adjuvant imatinib for over 12 months were also associated with longer RFS comparing to adjuvant imatinib of ≤ 12 months. When stratified by the duration of adjuvant imatinib, no significant differences were found in RFS among groups A, B, and C for adjuvant imatinib of ≤ 12 months. While for adjuvant imatinib of over 12 months, both groups A and B had significantly more favorable RFS than group C, and no significant difference in RFS was found between group A and B. CONCLUSION Delayed postoperative adjuvant imatinib for over 4 months in patients with high risk of recurrence of GIST may lead to worse RFS, and longer treatment with shorter delay has best results.
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Nishiyama R, Ogasawara T, Mamuro N, Kamei Y, Yamada M, Furukawa D, Suzuki T, Nishi T, Shimada H. Coexistence of gastric cancer and gastric GIST with intra-tumor bleeding: successful embolization with subsequent total gastrectomy. Surg Case Rep 2021; 7:160. [PMID: 34241722 PMCID: PMC8271045 DOI: 10.1186/s40792-021-01244-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/03/2021] [Indexed: 12/31/2022] Open
Abstract
Background Gastrointestinal stromal tumor (GIST) is a rare tumor, however, simultaneous development of gastric cancer and gastric GIST has been documented more frequently in recent years. Rupture of gastric GIST is even more rare and occurred in 7% of all GISTs. Although ruptured GIST might be occasionally difficult to be managed by endoscopy, transcatheter arterial embolization (TAE) was reported to control bleeding from GIST effectively. We report herein a case of coexistence of gastric cancer and gastric GIST with progressing intra-tumor bleeding managed successfully by TAE and review the clinicopathological characteristics of this rare condition reported previously in the Japanese literature. Case presentation A 75-year-old woman with dyspnea and systemic edema was diagnosed as simultaneous occurrence of gastric cancer (histopathologically detected tubular adenocarcinoma pT2N1M0 fStageIIA) and gastric GIST (65 × 92 mm in diameter at the anterior wall of the fornix) with intra-tumor hemorrhage. Perceiving the progress of bleeding from tumor growth and exacerbating anemia, TAE of left gastric artery was performed. Then remission of anemia has been obtained, the patient underwent an elective radical surgery. Conclusions Simultaneous occurrence of gastric cancer and gastric GIST was speculated to be more common. TAE for ruptured GIST may be effective for hemostasis and reduction of tumor burden, which could facilitate minimal invasive surgery.
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Affiliation(s)
- Raisuke Nishiyama
- Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Oiso Hospital, 21-1 Gakkyo, Oiso, Naka-Gun Kanagawa, 259-1198, Japan.
| | - Toshihito Ogasawara
- Department of Surgery, Tokai University School of Medicine, Oiso Hospital, 21-1 Gakkyo, Oiso, Naka-Gun Kanagawa, 259-1198, Japan
| | - Nana Mamuro
- Department of Surgery, Tokai University School of Medicine, Oiso Hospital, 21-1 Gakkyo, Oiso, Naka-Gun Kanagawa, 259-1198, Japan
| | - Yutarou Kamei
- Department of Surgery, Tokai University School of Medicine, Oiso Hospital, 21-1 Gakkyo, Oiso, Naka-Gun Kanagawa, 259-1198, Japan
| | - Misuzu Yamada
- Department of Surgery, Tokai University School of Medicine, Oiso Hospital, 21-1 Gakkyo, Oiso, Naka-Gun Kanagawa, 259-1198, Japan
| | - Daisuke Furukawa
- Department of Surgery, Tokai University School of Medicine, Oiso Hospital, 21-1 Gakkyo, Oiso, Naka-Gun Kanagawa, 259-1198, Japan
| | - Toshiyuki Suzuki
- Department of Surgery, Tokai University School of Medicine, Oiso Hospital, 21-1 Gakkyo, Oiso, Naka-Gun Kanagawa, 259-1198, Japan
| | - Takayuki Nishi
- Department of Surgery, Tokai University School of Medicine, Oiso Hospital, 21-1 Gakkyo, Oiso, Naka-Gun Kanagawa, 259-1198, Japan
| | - Hideo Shimada
- Department of Surgery, Tokai University School of Medicine, Oiso Hospital, 21-1 Gakkyo, Oiso, Naka-Gun Kanagawa, 259-1198, Japan
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Liu Y, Chang W, Tang W, Wei Y, Liu T, Chen Y, Ji M, Liang F, Ren L, Xu J. The Combination of Neoadjuvant Therapy and Surgical Resection: A Safe and Effective Treatment for Rectal Gastrointestinal Stromal Tumors. Cancer Manag Res 2021; 13:4671-4678. [PMID: 34163242 PMCID: PMC8213965 DOI: 10.2147/cmar.s307426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/07/2021] [Indexed: 12/21/2022] Open
Abstract
Background Rectal gastrointestinal stromal tumors (GISTs) are rare digestive tumors. The treatment methods of rectal GISTs are diverse, while no standardized treatment was recommended. The aim of this study was to report the treatment mode of rectal GISTs in our center. Methods Patients with pathologically confirmed rectal GISTs who received neoadjuvant therapy and surgical resection were retrospectively collected. Perioperative complications and long-term prognosis were evaluated. Results From January 2010 to December 2019, 36 patients were pathologically diagnosed with primary rectal GISTs. After excluding patients who were treated with surgery or imatinib alone, 21 patients received neoadjuvant therapy and surgery was enrolled. During neoadjuvant treatment, tumors shrank significantly (6.53cm to 4.68cm, p<0.001) without toxicities over grade 2. The total postoperative complication rate was 42.9% (all grade). R0 resection was achieved in 76.2% patients. Transanal resection had advantages on anus preservation and postoperative recovery. No patients died during the follow-up period, 4 patients relapsed and the relapse-free survival was 81.0%. Conclusion The combination of neoadjuvant therapy and surgical resection was a safe and effective treatment for rectal gastrointestinal stromal tumors.
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Affiliation(s)
- Yu Liu
- Colorectal Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Wenju Chang
- Colorectal Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive, Shanghai, People's Republic of China
| | - Wentao Tang
- Colorectal Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive, Shanghai, People's Republic of China
| | - Ye Wei
- Colorectal Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive, Shanghai, People's Republic of China
| | - Tianyu Liu
- Colorectal Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Yijiao Chen
- Colorectal Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Meiling Ji
- Colorectal Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive, Shanghai, People's Republic of China
| | - Fei Liang
- Department of Biostatistics, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Li Ren
- Colorectal Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive, Shanghai, People's Republic of China
| | - Jianmin Xu
- Colorectal Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive, Shanghai, People's Republic of China
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26
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Sutton TL, Walker BS, Billingsley KG, Sheppard BC, Corless CL, Heinrich MC, Mayo SC. Disease-free Interval Is Associated with Oncologic Outcomes in Patients with Recurrent Gastrointestinal Stromal Tumor. Ann Surg Oncol 2021; 28:7912-7920. [PMID: 33969462 DOI: 10.1245/s10434-021-10062-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 04/04/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Gastrointestinal stromal tumors (GIST) commonly recur following curative-intent resection. Patients with recurrent GIST display heterogeneous outcomes with limited prognostic tools. We investigated factors associated with post-recurrence survival (PRS) and progression-free survival (PFS). METHODS We performed a review of our institutional cancer registry from 2003 to 2018 for patients with GIST. Clinicopathologic and outcome data were collected. The disease-free interval (DFI) was calculated from the end of curative-intent oncologic therapy until recurrence. Outcomes were evaluated using Kaplan-Meier and Cox proportional hazards modeling. RESULTS Overall, 254 patients underwent resection of primary, non-metastatic GIST, with 81 (32%) recurrences. The median age was 58 years and more than half of the patients with recurrence (n = 44; 54%) received adjuvant imatinib. Recurrence was most common in the liver (n = 34, 42%), peritoneum (n = 31, 38%), or liver plus peritoneum (n = 10, 12%). The median DFI was 14 months (interquartile range 2-26 months); 51 (63%) patients had a DFI ≤24 months and 30 (37%) had a DFI > 24 months. The median post-recurrence follow-up was 46 months. Compared with a DFI ≤24 months, patients with a DFI >24 months had increased 10-year PRS (77% vs. 41%, p < 0.05) and 10-year PFS (73% vs. 19%, p < 0.001). On multivariable analysis controlling for mutational and clinicopathologic features, a DFI >24 months was independently associated with increased PRS (hazard ratio [HR] 0.24, p < 0.01) and PFS (HR 0.18, p < 0.001). CONCLUSIONS The DFI is independently associated with oncologic outcomes in recurrent GIST and may be useful in treatment planning. Recurrence after 24 months may signify indolent disease biology that may benefit from additional treatment, including metastasectomy.
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Affiliation(s)
- Thomas L Sutton
- Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Brett S Walker
- Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | | | - Brett C Sheppard
- Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | | | - Michael C Heinrich
- Portland VA Health Care System, Portland, OR, USA.,Division of Surgical Oncology, The Knight Cancer Institute at Oregon Health and Science University, Portland, OR, USA
| | - Skye C Mayo
- Division of Surgical Oncology, The Knight Cancer Institute at Oregon Health and Science University, Portland, OR, USA. .,Department of Surgery, Division of Surgical Oncology, Oregon Health and Science University, Portland, OR, USA.
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Hølmebakk T, Wiedswang AM, Meza-Zepeda LA, Hompland I, Lobmaier IVK, Berner JM, Stoldt S, Boye K. Integrating Anatomical, Molecular and Clinical Risk Factors in Gastrointestinal Stromal Tumor of the Stomach. Ann Surg Oncol 2021; 28:6837-6845. [PMID: 33651216 PMCID: PMC8460510 DOI: 10.1245/s10434-021-09605-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/07/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Adjuvant imatinib for 3 years is recommended to patients with high-risk gastrointestinal stromal tumor (GIST). Risk stratification is inaccurate, and risk assessments are further complicated by the increased use of neoadjuvant treatment. Anatomical criteria for prognostication have not been investigated. METHODS Clinical, molecular, and anatomical variables were retrospectively studied in a population-based cohort of 295 patients with gastric GIST resected between 2000 and 2018. Gastric subsite was divided into the upper, middle, and lower thirds. Growth pattern was classified as luminal, exophytic, or transmural based on imaging and surgical reports. RESULTS Of 113 tumors in the upper third of the stomach, 103 (91.2%) were KIT mutated, 7 (6.2%) were PDGFRA mutated, and 104 (92.0%) harbored genotypes sensitive to imatinib. Transmural tumors were strongly associated with a high mitotic index. Five-year recurrence-free survival (RFS) was 71% for patients with transmural tumors versus 96% with luminal or exophytic tumors (hazard ratio [HR] 8.45, 95% confidence interval [CI] 3.69-19.36; p < 0.001), and, in high-risk patients, 5-year RFS was 46% for patients with transmural tumors versus 83% with luminal or exophytic tumors (HR 4.47, 95% CI 1.71-11.66; p = 0.001). Among 134 patients with tumors > 5 cm, there were 29 recurrences. Only five patients with exophytic or luminal tumors had recurrent disease, of whom four had tumor rupture. Five-year RFS for patients with exophytic/luminal tumors >5 cm without rupture was 98%. CONCLUSIONS In the upper third, over 90% of tumors were sensitive to imatinib. Patients with exophytic or luminal tumors without rupture, irrespective of size, had an excellent prognosis and may not benefit from adjuvant therapy.
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Affiliation(s)
- Toto Hølmebakk
- Department of Abdominal and Pediatric Surgery, Oslo University Hospital, The Norwegian Radium Hospital, Nydalen, Oslo, Norway.
| | - Anne Marit Wiedswang
- Department of Radiology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - Leonardo A Meza-Zepeda
- Department of Tumor Biology, Institute for Cancer Research, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway.,Genomics Core Facility, Department of Core Facilities, Institute for Cancer Research, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - Ivar Hompland
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - Ingvild V K Lobmaier
- Department of Pathology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - Jeanne-Marie Berner
- Department of Pathology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - Stephan Stoldt
- Department of Abdominal and Pediatric Surgery, Oslo University Hospital, The Norwegian Radium Hospital, Nydalen, Oslo, Norway
| | - Kjetil Boye
- Department of Tumor Biology, Institute for Cancer Research, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway.,Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
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Rutkowski P. Why We Still Need the Better Risk Classification for GIST. Ann Surg Oncol 2021; 28:2425-2427. [PMID: 33625633 DOI: 10.1245/s10434-021-09620-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/09/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.
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Whooley P, Correa E, von Mehren M. Deciding on the duration of adjuvant therapy in gastrointestinal stromal tumor. Expert Rev Anticancer Ther 2020; 21:547-556. [PMID: 33353442 DOI: 10.1080/14737140.2021.1863149] [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: 10/22/2022]
Abstract
Introduction: The benefit of the tyrosine kinase inhibitor (TKI) imatinib mesylate in metastatic Gastrointestinal Stromal Tumors (GIST) leads to improved progression-free survival (PFS) and overall survival (OS). Clinical trials of adjuvant imatinib have provided data on the utility in management of primary GIST. There still remains uncertainty regarding the optimal duration of therapy.Areas covered: Here, we review the literature on the pivotal clinical trials evaluating adjuvant imatinib: ACOSOG Z9000/Z9001, EORTC 62024, Scandinavian Sarcoma Group XVIII, and PERSIST-5. The data from these studies that were analyzed included the patient population, length of therapy, and outcomes.Expert opinion: Clinical trial data demonstrate that adjuvant imatinib delays recurrence and appears to improve survival when taken for 3 years in high-risk patients; treatment for 5 years has been found to be safe, although difficult for patients to maintain adherence. These studies all incorporated slightly different patient populations based upon eligibility criteria for risk of recurrence, but support the use in patients with intermediate to high risk of disease recurrence. Data from these studies does not support treating those with low risk of recurrence or imatinib-insensitive mutations.
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Affiliation(s)
- Peter Whooley
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Erika Correa
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Margaret von Mehren
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
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30
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Li C, Yang KL, Wang Q, Tian JH, Li Y, Gao ZD, Yang XD, Ye YJ, Jiang KW. Clinical features of multiple gastrointestinal stromal tumors: A pooling analysis combined with evidence and gap map. World J Gastroenterol 2020; 26:7550-7567. [PMID: 33384554 PMCID: PMC7754550 DOI: 10.3748/wjg.v26.i47.7550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 11/09/2020] [Accepted: 11/21/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Multiple gastrointestinal stromal tumors (MGISTs) are a very rare type of gastrointestinal stromal tumor (GIST) and are usually observed in syndrome.
AIM The paper aimed to describe the clinical and oncological features of MGISTs and to offer evidence for the diagnosis and treatment.
METHODS Data of consecutive patients with MGISTs who were diagnosed at Peking University People’s Hospital (PKUPH) from 2008 to 2019 were retrospectively evaluated. Further, a literature search was conducted by retrieving data from PubMed, EMBASE, and the Cochrane library databases from inception up to November 30, 2019.
RESULTS In all, 12 patients were diagnosed with MGISTs at PKUPH, and 43 published records were ultimately included following the literature review. Combined analysis of the whole individual patient data showed that female (59.30%), young (14.45%), and syndromic GIST (63.95%) patients comprised a large proportion of the total patient population. Tumors were mainly located in the small intestine (58.92%), and both CD117 and CD34 were generally positive. After a mean 78.32-mo follow-up, the estimated median overall survival duration (11.5 years) was similar to single GISTs, but recurrence-free survival was relatively poorer.
CONCLUSION The clinical and oncological features are potentially different between MGISTs and single GIST. Further studies are needed to explore appropriate surgical approach and adjuvant therapy.
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Affiliation(s)
- Chen Li
- Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing 100044, China
| | - Ke-Lu Yang
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Quan Wang
- Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing 100044, China
| | - Jin-Hui Tian
- Evidence Based Medicine Center, School of Basic Medical Science of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Yang Li
- Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing 100044, China
| | - Zhi-Dong Gao
- Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing 100044, China
| | - Xiao-Dong Yang
- Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing 100044, China
| | - Ying-Jiang Ye
- Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing 100044, China
| | - Ke-Wei Jiang
- Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing 100044, China
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31
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Rivera AKU, Jabiles AG, Passiuri IC, Leon EG, Quiroga MG, Baca RC, Figueroa JE, Rosillo NP, Meza EP. Gastrointestinal stromal tumour of the rectum and intestinal obstruction: case report. Ecancermedicalscience 2020; 14:1139. [PMID: 33281931 PMCID: PMC7685769 DOI: 10.3332/ecancer.2020.1139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Indexed: 12/12/2022] Open
Abstract
We report the case of a 75-year-old female patient with a big tumour in the lower rectum with intestinal obstruction and lower gastrointestinal bleeding history who underwent a tumour biopsy under laparotomy and end colostomy at another hospital in Peru. She came to our institution for clinical evaluation with a pathology result of a rectal gastrointestinal stromal tumour. An extra elevator abdominoperineal resection was performed with tumour-free margins. The histology confirmed a high-grade (G2) rectal gastrointestinal stromal tumour with a mitotic index of 27/50. DOC-1 (+) and CD117 (+) in immunohistochemistry. Genomic DNA was extracted from the paraffin-fixed tumour sample, and c.1504_1509dupGCCTAT (p.Ala502_Tyr503dup) mutation was detected in exon 9 of the KIT gene. Imatinib 400 mg per day for 3 years was indicated as adjuvant treatment. Currently, she has a disease-free survival of 12 months.
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Affiliation(s)
| | | | - Ivan Chavez Passiuri
- Department of Abdominal Surgery at National Cancer Institute (INEN), Lima 34, Peru
| | - Elica Garcia Leon
- Department of Medical Oncology at Regional Hospital of Lambayeque, Lambayeque, Peru
| | | | - Renier Cruz Baca
- Fellow of Oncological Pathology at National Cancer Institute (INEN), Lima 34, Peru
| | | | | | - Eduardo Payet Meza
- Department of Abdominal Surgery at National Cancer Institute (INEN), Lima 34, Peru
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Rutkowski P, Ziętek M, Cybulska-Stopa B, Streb J, Głuszek S, Jankowski M, Łopacka-Szatan K, Las-Jankowska M, Hudziec P, Klimczak A, Olesiński T, Świtaj T, Koseła-Paterczyk H, Bylina E, Osuch C. The analysis of 3-year adjuvant therapy with imatinib in patients with high-risk molecular profiled gastrointestinal stromal tumors (GIST) treated in routine practice. Eur J Surg Oncol 2020; 47:1191-1195. [PMID: 32826113 DOI: 10.1016/j.ejso.2020.08.004] [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] [Received: 06/07/2020] [Revised: 07/29/2020] [Accepted: 08/06/2020] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION The real-world data on adjuvant imatinib therapy in high-risk primary GIST are scarce. METHODS We have analysed the data of 107 consecutive patients with gastrointestinal stromal tumour (GIST) after resection treated with adjuvant imatinib (for planned 3 years with initial dose 400 mg daily, started not later than 4 months after operation) in 6 oncological centres in 2013-2018. All patients were required to have high risk of recurrence (at least 50% according to NCCN/AFIP criteria), known mutational status to exclude PDGFRA D842V mutants and KIT/PDGFRA-wild type cases from therapy without any further selection. Median follow-up time was 27 months. RESULTS The most common primary localization of GIST was small bowel (63 patients; 59%), followed by the stomach (40 patients; 37%). The majority of GIST cases harboured exon 11 KIT mutations (88 cases, 82%), 11 cases had exon 9 KIT mutations (10%), 8 had other KIT/PDGFRA mutations potentially sensitive to imatinib. Forty patients (37%) finished 3-year adjuvant imatinib therapy as planned, 48 (45%) still continue therapy, 5 (4.5%) patients had finished adjuvant therapy prematurely due to toxicity, 6 (6%) due to disease progression on treatment and 8 (7.5%) due to other reasons. The disease relapse was detected in 19 patients, of them in 5 cases in exon 9 KIT mutants (45%), and 14 cases in patients with exon 11 KIT mutations (11%) [p < 0.01]. Estimated 4-year relapse-free survival (RFS) rate is 78%. CONCLUSIONS The early results of adjuvant therapy with imatinib in routine practice outside clinical trials in high-risk mutation-driven GIST patients only confirm high efficacy of this therapy with better tolerability than in clinical trials. We found overrepresentation of exon 9 KIT mutants and ruptured tumors in a group of patients with disease relapse.
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Affiliation(s)
- Piotr Rutkowski
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.
| | | | - Bożena Cybulska-Stopa
- Maria Sklodowska-Curie National Research Institute of Oncology, Cracow Branch, Cracow, Poland
| | | | | | | | | | | | | | - Anna Klimczak
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Tomasz Olesiński
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Tomasz Świtaj
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | | | - Elżbieta Bylina
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
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33
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Lino-Silva LS, Segales-Rojas P, Aguilar-Cruz E, Salcedo-Hernández RA, Zepeda-Najar C. Gastrointestinal Stromal Tumors Risk of Recurrence Stratification by Tumor Volume is a Best Predictor Compared with Risk Based on Mitosis and Tumor Size. J Gastrointest Cancer 2020; 50:513-518. [PMID: 29766411 DOI: 10.1007/s12029-018-0115-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Gastrointestinal stromal tumors (GIST) have the potential to recur and metastasize. Several prognostic schemes have been developed, mostly based on the mitotic count, diameter, and tumor site. However, these systems are not precise enough. The research question was whether the tumor size determined by volumetry allows a better risk stratification than the traditional system, and our aim was to determine the value of tumor volumetry, a feasible and simple parameter, in the recurrence of GIST. METHODS Seventy-four cases of GIST were studied. The cases presented with non-metastatic disease, which were resected and did not receive imatinib. We compared the clinico-pathologic features of the cases with recurrence against those with non-recurrence and compared the tumor volumetry against the classification system based on tumor size and mitosis. RESULTS The median age was 58 years (range: 25 to 91 years). Half of the cases were presented in the stomach. The tumor size had a median of 8 cm (range of 1-30 cm). The median mitosis count for 50 HPF was 4 (range 0-92). During the period of study, 16 (21.6%) patients suffered recurrence. The significant differences were that patients with recurrence accounted for more deaths and the follow-up period was larger. The area under the curve (AUC) of the volumetry classification was superior to the AUC of the classification system based on tumor size and mitosis (NIH-criteria) (p = .05). CONCLUSION Tumor volumetry calculated in the surgical specimen and/or pre-operative tomography was superior to the NIH consensus in stratifying the risk of recurrence in GIST.
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Affiliation(s)
- Leonardo S Lino-Silva
- Surgical Pathology, Instituto Nacional de Cancerología, Mexico City, Mexico. .,Anatomic Pathology, Gastrointestinal Pathology Division, Instituto Nacional de Cancerología de México (Mexico's National Cancer Institute), Av. San Fernando # 22, Sección XVI, Tlalpan, 14080, Mexico City, Mexico.
| | | | - Eduardo Aguilar-Cruz
- Anatomic Pathology, Gastrointestinal Pathology Division, Instituto Nacional de Cancerología de México (Mexico's National Cancer Institute), Av. San Fernando # 22, Sección XVI, Tlalpan, 14080, Mexico City, Mexico
| | | | - César Zepeda-Najar
- Surgical Oncology, Hospital Ángeles Tijuana, Tijuana, Baja California Norte, Mexico
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Multi-institutional re-evaluation of prognostic factors in chromophobe renal cell carcinoma: proposal of a novel two-tiered grading scheme. Virchows Arch 2019; 476:409-418. [PMID: 31760491 DOI: 10.1007/s00428-019-02710-w] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 10/10/2019] [Accepted: 10/25/2019] [Indexed: 12/20/2022]
Abstract
A histological grading system of chromophobe renal cell carcinoma (chRCC) is highly desirable to identify approximately 5-10% of tumors at risk for progression. Validation studies failed to demonstrate a correlation between the four-tiered WHO/ISUP grade and outcome. Previous proposals with three-tiered chromophobe grading systems could not be validated. In this study, the presence of sarcomatoid differentiation, necrosis, and mitosis was analyzed in a Swiss cohort (n = 42), an Italian cohort (n = 103), a German cohort (n = 54), a Japanese cohort (n = 119), and The Cancer Genome Atlas cohort (n = 64). All 3 histological parameters were significantly associated with shorter time to tumor progression and overall survival in univariate analysis. Interobserver variability for identification of these parameters was measured by Krippendorff's alpha coefficient and showed high concordance for the identification of sarcomatoid differentiation and tumor necrosis, but only low to medium concordance for the identification of mitosis. Therefore, we tested a two-tiered tumor grading system (low versus high grade) based only on the presence of sarcomatoid differentiation and/or necrosis finding in the combined cohorts (n = 382). pT stage, patient's age (> 65 vs ≤ 65), lymph node and/or distant metastasis, and the two-tiered grading system (low versus high grade) were significantly associated with overall survival and were independent prognostic parameters in multivariate analysis (Cox proportional hazard). This multi-institutional evaluation of prognostic parameters suggests tumor necrosis and sarcomatoid differentiation as reproducible components of a two-tiered chromophobe tumor grading system.
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The role of FBXW7, a cell-cycle regulator, as a predictive marker of recurrence of gastrointestinal stromal tumors. Gastric Cancer 2019; 22:1100-1108. [PMID: 30854619 DOI: 10.1007/s10120-019-00950-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 03/03/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Few reliable prognostic markers have been established despite elucidation of the molecular mechanisms of gastrointestinal stromal tumor (GIST) development. We evaluated F-box and WD repeat domain-containing 7 (FBXW7), a cell-cycle-regulating and tumor suppressor, in GISTs. We aimed to determine the clinical relevance of FBXW7 in GISTs and characterize the molecular mechanism of FBXW7 in a GIST cell line. METHODS We measured FBXW7 expression in 182 GIST cases, correlated the expression levels with clinicopathological features, and characterized the molecular mechanism underlying suppressed FBXW7 expression in GIST cells in vitro. RESULTS Of the 182 GISTs, 98 (53.8%) and 84 (46.2%) were categorized in the high and low FBXW7 expression groups, respectively. Compared with the high FBXW7 expression group, the low expression group showed a significantly poorer prognosis in terms of recurrence-free (P = 0.01) and overall (P = 0.03) survival. FBXW7 expression was a significant independent factor affecting the 10-year recurrence-free survival rate (P = 0.04). In vitro, FBXW7-specific siRNAs enhanced c-myc and Notch 1 protein expression and upregulated cell proliferation, invasion, and migration. CONCLUSION FBXW7 is a potential predictive marker of recurrence after curative resection of GISTs. FBXW7 expression may help identify patients benefitting from adjuvant therapy more precisely compared with a conventional risk stratification model.
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Ohshima K, Fujiya K, Nagashima T, Ohnami S, Hatakeyama K, Urakami K, Naruoka A, Watanabe Y, Moromizato S, Shimoda Y, Ohnami S, Serizawa M, Akiyama Y, Kusuhara M, Mochizuki T, Sugino T, Shiomi A, Tsubosa Y, Uesaka K, Terashima M, Yamaguchi K. Driver gene alterations and activated signaling pathways toward malignant progression of gastrointestinal stromal tumors. Cancer Sci 2019; 110:3821-3833. [PMID: 31553483 PMCID: PMC6890443 DOI: 10.1111/cas.14202] [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: 06/24/2019] [Revised: 09/17/2019] [Accepted: 09/22/2019] [Indexed: 12/28/2022] Open
Abstract
Mutually exclusive KIT and PDGFRA mutations are considered to be the earliest events in gastrointestinal stromal tumors (GIST), but insufficient for their malignant progression. Herein, we aimed to identify driver genes and signaling pathways relevant to GIST progression. We investigated genetic profiles of 707 driver genes, including mutations, gene fusions, copy number gain or loss, and gene expression for 65 clinical specimens of surgically dissected GIST, consisting of six metastatic tumors and 59 primary tumors from stomach, small intestine, rectum, and esophagus. Genetic alterations included oncogenic mutations and amplification‐dependent expression enhancement for oncogenes (OG), and loss of heterozygosity (LOH) and expression reduction for tumor suppressor genes (TSG). We assigned activated OG and inactivated TSG to 27 signaling pathways, the activation of which was compared between malignant GIST (metastasis and high‐risk GIST) and less malignant GIST (low‐ and very low‐risk GIST). Integrative molecular profiling indicated that a greater incidence of genetic alterations of driver genes was detected in malignant GIST (96%, 22 of 23) than in less malignant GIST (73%, 24 of 33). Malignant GIST samples groups showed mutations, LOH, and aberrant expression dominantly in driver genes associated with signaling pathways of PI3K (PIK3CA, AKT1, and PTEN) and the cell cycle (RB1, CDK4, and CDKN1B). Additionally, we identified potential PI3K‐related genes, the expression of which was upregulated (SNAI1 and TPX2) or downregulated (BANK1) in malignant GIST. Based on our observations, we propose that inhibition of PI3K pathway signals might potentially be an effective therapeutic strategy against malignant progression of GIST.
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Affiliation(s)
- Keiichi Ohshima
- Medical Genetics Division, Shizuoka Cancer Center Research Institute, Shizuoka, Japan.,Drug Discovery and Development Division, Shizuoka Cancer Center Research Institute, Shizuoka, Japan
| | - Keiichi Fujiya
- Division of Gastric Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Takeshi Nagashima
- Cancer Diagnostics Research Division, Shizuoka Cancer Center Research Institute, Shizuoka, Japan.,SRL, Inc., Tokyo, Japan
| | - Sumiko Ohnami
- Cancer Diagnostics Research Division, Shizuoka Cancer Center Research Institute, Shizuoka, Japan
| | - Keiichi Hatakeyama
- Medical Genetics Division, Shizuoka Cancer Center Research Institute, Shizuoka, Japan
| | - Kenichi Urakami
- Cancer Diagnostics Research Division, Shizuoka Cancer Center Research Institute, Shizuoka, Japan.,Region Resources Division, Shizuoka Cancer Center Research Institute, Shizuoka, Japan
| | - Akane Naruoka
- Drug Discovery and Development Division, Shizuoka Cancer Center Research Institute, Shizuoka, Japan
| | - Yuko Watanabe
- Medical Genetics Division, Shizuoka Cancer Center Research Institute, Shizuoka, Japan
| | - Sachi Moromizato
- Medical Genetics Division, Shizuoka Cancer Center Research Institute, Shizuoka, Japan
| | - Yuji Shimoda
- Cancer Diagnostics Research Division, Shizuoka Cancer Center Research Institute, Shizuoka, Japan.,SRL, Inc., Tokyo, Japan
| | - Shumpei Ohnami
- Cancer Diagnostics Research Division, Shizuoka Cancer Center Research Institute, Shizuoka, Japan
| | - Masakuni Serizawa
- Drug Discovery and Development Division, Shizuoka Cancer Center Research Institute, Shizuoka, Japan
| | - Yasuto Akiyama
- Immunotherapy Division, Shizuoka Cancer Center Research Institute, Shizuoka, Japan
| | - Masatoshi Kusuhara
- Drug Discovery and Development Division, Shizuoka Cancer Center Research Institute, Shizuoka, Japan.,Region Resources Division, Shizuoka Cancer Center Research Institute, Shizuoka, Japan
| | - Tohru Mochizuki
- Medical Genetics Division, Shizuoka Cancer Center Research Institute, Shizuoka, Japan
| | - Takashi Sugino
- Division of Pathology, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Akio Shiomi
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Yasuhiro Tsubosa
- Division of Esophageal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Katsuhiko Uesaka
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Masanori Terashima
- Division of Gastric Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Ken Yamaguchi
- Shizuoka Cancer Center Hospital and Research Institute, Shizuoka, Japan
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Optimal thresholds of risk parameters for gastrointestinal stromal tumors. Eur J Surg Oncol 2019; 46:180-188. [PMID: 31431322 DOI: 10.1016/j.ejso.2019.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 08/10/2019] [Accepted: 08/12/2019] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Gastrointestinal stromal tumors (GIST) are the most frequent mesenchymal neoplasms of the gastrointestinal tract with highly variable potential for relapse. Tumor size and mitotic index (MI) are major risk factors that predict the outcome of GIST patients. Recent risk stratification schemes include some or all of the empirical size thresholds of 2 cm, 5 cm, and 10 cm and MI thresholds of 5 per 50 high-power fields (hpf) and 10 per 50 hpf. However, data that verify these numbers are sparse. METHODS By exhaustive regression tree analysis, maximally selected rank statistics and survival difference analysis with bootstrap sampling on a naive GIST population of 161 patients with a mean follow-up of 44 months, current stratification schemes using tumor size and MI were analyzed herein. RESULTS /Conclusions: Thresholds that optimally stratify the risk of recurrence are observed at tumor sizes of 4-5 cm and 10-11 cm and at mitotic indices of about 5 per 50 hpf and 10 per 50 hpf, respectively. While these data validate the canonical thresholds for size and MI used in risk stratification of GIST, transition regions as well as differences in the implementation of these thresholds between the different classification schemes proposed in the recent years should be considered when classifying GIST.
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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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Alessandrino F, Tirumani SH, Jagannathan JP, Ramaiya NH. Imaging surveillance of gastrointestinal stromal tumour: current recommendation by National Comprehensive Cancer Network and European Society of Medical Oncology-European Reference Network for rare adult solid cancers. Clin Radiol 2019; 74:746-755. [PMID: 31345555 DOI: 10.1016/j.crad.2019.06.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 06/24/2019] [Indexed: 12/23/2022]
Abstract
Imaging plays an active role in the surveillance of gastrointestinal stromal tumours (GISTs). Risk stratification schemes, based on size, mitotic count, and anatomical site of origin of the GIST, help in planning preoperative and postoperative imaging strategies especially in determining the frequency and duration of surveillance; however, there is no clear consensus on the optimal imaging strategies in patients with GISTs who are completely cured by surgery and patients who are at risk of recurrence. In addition, current surveillance protocols depend on the resectability of the primary tumour and presence of metastatic disease. The objective of this article is to provide a comprehensive review of the role of the different imaging methods for surveillance of GISTs, focusing on the guidelines recommended by National Comprehensive Cancer Network and European Society of Medical Oncology - European Network for Rare adult solid Cancers, and to propose practical guidelines for surveillance of GISTs for various risk categories.
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Affiliation(s)
- F Alessandrino
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02215, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
| | - S H Tirumani
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02215, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; Department of Radiology, UH Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH 44106, USA
| | - J P Jagannathan
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02215, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - N H Ramaiya
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02215, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; Department of Radiology, UH Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH 44106, USA
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40
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Li YS, Li W, Zeng QS, Fu WH. Effect of the imatinib treatment regimen on the postoperative prognosis of patients with high-risk gastrointestinal stromal tumors. Onco Targets Ther 2019; 12:4713-4719. [PMID: 31354302 PMCID: PMC6590845 DOI: 10.2147/ott.s198129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 04/26/2019] [Indexed: 12/11/2022] Open
Abstract
Background: Surgical resection is the standard treatment for localized and potentially resectable gastrointestinal stromal tumors (GISTs), If the postoperative pathology diagnosis indicates that patients are at high risk of recurrence, they should be treated with imatinib. Even though the introduction of imatinib substantially improved the outcome of GIST patients, it is unclear whether different imatinib treatment regimens affect patients' survival. Methods: This retrospective study included 120 patients who underwent tumor resection for high-risk GISTs between January 2009 and October 2018. The patients were divided into three groups: one group of patients received postoperative imatinib adjuvant therapy regularly (regular treatment group); the second group was not treated with imatinib until they were found to have disease progression (observation group); the third group was treated with postoperative imatinib adjuvant therapy irregularly (irregularly treatment group). The progression-free survival (PFS) and overall survival (OS) were compared between the three groups, and the prognostic risk factors were analysed by the Cox regression model. Results: The median PFS was 45 months (range: 25-59). The 3- and 5-year PFS values were 71.3% and 49.9%, respectively. The PFS in the regular group was longer than in the observation group and irregular group (P<0.001). The median OS was 59 months (range:47-78). The 3- and 5-year OS values were 91.6% and 84.2%, respectively. There were no differences in OS among the three groups (P=0.150). The extent of radical resection (P<0.001) and intraoperative tumor rupture (P=0.005) were independent prognostic factors influencing OS. Conclusions: Irregular administration of imatinib was associated with a worse PFS, but it did not affect the OS of patients with high-risk GISTs. Avoiding intraoperative tumor rupture and R0 resection were associated with better survival.
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Affiliation(s)
- Yan-Shu Li
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, People's Republic of China.,Department of General Surgery, Huabei Petroleum General Hospital, Renqiu, Hebei, People's Republic of China
| | - Wei Li
- Department of General Surgery, Cang Zhou Central Hospital, Cangzhou, Hebei, People's Republic of China
| | - Qing-Sheng Zeng
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Wei-Hua Fu
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
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Abstract
Gastrointestinal stromal tumors (GISTs) arise anywhere along the gastrointestinal tract, most commonly as a result of c-kit or PDGFRA proto-oncogene mutations. Surgical resection is an important component of treatment. However, molecular profiling of GISTs has provided many insights into adjuvant and neoadjuvant therapy options. Imatinib, the most frequently studied medical therapy, has been shown in numerous studies to provide benefit to patients in both the neoadjuvant and adjuvant setting. Interval imaging is an important component of the treatment of GISTs and national surveillance recommendations should be followed.
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Affiliation(s)
- Lauren Theiss
- Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
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42
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Varshney VK, Gupta RK, Saluja SS, Tyagi I, Mishra PK, Batra VV. Analysis of clinicopathological and immunohistochemical parameters and correlation of outcomes in gastrointestinal stromal tumors. Indian J Cancer 2019; 56:135-143. [PMID: 31062732 DOI: 10.4103/ijc.ijc_352_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. We analyzed the clinicopathological features, resectability, immunohistochemical markers, and various factors predictive of disease recurrence and survival. MATERIALS AND METHODS Retrospective analysis of prospectively maintained database of GIST patients managed from 2005 to 2016 was done. Size, site, malignant potential, nuclear pleomorphism, histopathological variety, immunohistochemical markers, type of surgery, and adjuvant imatinib therapy were analyzed. RESULTS Ninety-two patients with GIST were analyzed. Immunohistochemistry showed positivity for c-kit (82.4%), DOG1 (75%), and PDGFR-α (79%). Among 16 patients with c-kit-negative tumors, 10 patients were positive for DOG1, PDGFR-α, or both. The most common primary site was stomach (44, 47.8%) followed by small bowel (17, 18.5%) and duodenum (14, 15.2%). Of 92 patients, 80 (87%) underwent R0 resection with organ sparing resection in 56 (70%) patients. Seventeen (21.3%) patients showed recurrence at a median follow-up of 6 years. Median and 5-year overall survival (OS) was 36 months (12-120) and 75%, respectively, and 5-year RFS was 81.8%. On univariate analysis, size, mitotic activity, malignant potential, and nuclear pleomorphism were predictors of recurrence. However, on multivariate analysis, only nuclear pleomorphism was significant. CONCLUSIONS GISTs had a wide spectrum of presentation, and immunohistopathological features with organ sparing resection were conceivable in maximum. Nuclear pleomorphism may be considered as an important variable to predict recurrence in addition to malignant potential of tumors.
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Affiliation(s)
- Vaibhav Kumar Varshney
- Department of Gastrointestinal Surgery, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Rakesh Kumar Gupta
- Department of Pathology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Sundeep Singh Saluja
- Department of Gastrointestinal Surgery, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Ila Tyagi
- Department of Pathology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Pramod Kumar Mishra
- Department of Gastrointestinal Surgery, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Vineeta V Batra
- Department of Pathology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
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Zhao B, Zhang J, Mei D, Zhang J, Luo R, Xu H, Huang B. The assessment of different risk classification systems for gastrointestinal stromal tumors (GISTs): the analytic results from the SEER database. Scand J Gastroenterol 2019; 53:1319-1327. [PMID: 30353759 DOI: 10.1080/00365521.2018.1515319] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Although various risk classification systems for GISTs have been proposed, the optimum one remains uncertain. In the present study, we compared the prognostic stratification of different risk classification systems for GIST patients. METHODS We reviewed those patients who were pathologically diagnosed with GISTs in the SEER database between 2009 and 2014. All patients were classified into different risk groups according to the NIH criteria, AFIP criteria and AJCC staging system, respectively. The prognostic differences between different risk groups were compared and clinicopathologic features were analyzed. RESULTS The prognosis of small intestinal GISTs was not significantly different from that of gastric GISTs. For gastric GIST patients, there was no significant prognostic difference between very low risk and low risk group according to the NIH and AFIP criteria. However, the prognostic stratification for two groups could be improved by the AJCC staging system. For small intestinal GIST patients, the prognostic difference between low risk and intermediate risk group was not stratified properly by the NIH and AFIP criteria. However, the prognostic difference between two groups could reach statistical significance according to the AJCC staging system. Unlike gastric GISTs, tumor size was not identified as an independent factor influencing the prognosis of small intestinal GISTs. CONCLUSIONS The AJCC staging system could provide a better prognostic stratification for GIST patients compared with the NIH and AFIP criteria, regardless of gastric or small intestinal tumor. However, primary tumor location and tumor size may be reconsidered and revised in the risk classification system.
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Affiliation(s)
- Bochao Zhao
- a Department of Surgical Oncology , First Affiliated Hospital of China Medical University , Shenyang , P.R. China
| | - Jingting Zhang
- a Department of Surgical Oncology , First Affiliated Hospital of China Medical University , Shenyang , P.R. China
| | - Di Mei
- a Department of Surgical Oncology , First Affiliated Hospital of China Medical University , Shenyang , P.R. China
| | - Jiale Zhang
- a Department of Surgical Oncology , First Affiliated Hospital of China Medical University , Shenyang , P.R. China
| | - Rui Luo
- a Department of Surgical Oncology , First Affiliated Hospital of China Medical University , Shenyang , P.R. China
| | - Huimian Xu
- a Department of Surgical Oncology , First Affiliated Hospital of China Medical University , Shenyang , P.R. China
| | - Baojun Huang
- a Department of Surgical Oncology , First Affiliated Hospital of China Medical University , Shenyang , P.R. China
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Etherington MS, DeMatteo RP. Tailored management of primary gastrointestinal stromal tumors. Cancer 2019; 125:2164-2171. [PMID: 30933313 DOI: 10.1002/cncr.32067] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/10/2019] [Accepted: 02/14/2019] [Indexed: 12/17/2022]
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common human sarcoma and can form along the entire gastrointestinal tract. Over the last 20 years, considerable advances have been made in our understanding of the biology of GISTs. The advent of tyrosine kinase inhibitors has provided effective medical therapy for the first time. In fact, given that GIST typically is driven by either a KIT or PDGFRA gene mutation, it has become a paradigm of targeted molecular therapy. In addition, diagnostic and surgical techniques have been refined. Here, the critical aspects of primary GISTs and how they are now managed with an integrated approach are summarized. Treatment plans are developed based on specific pathologic and molecular features of the tumor. The authors outline the general principles of therapy and highlight some of the nuances. Particular focus is given to diagnosis, surgical considerations, and the use of preoperative and postoperative tyrosine kinase inhibitors.
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Affiliation(s)
- Mark S Etherington
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ronald P DeMatteo
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Asare EA, Feig BW. Raining Frogs, Flying Horses, and Defining Tumor Rupture in GIST. Ann Surg Oncol 2019; 26:1601-1603. [PMID: 30903324 DOI: 10.1245/s10434-019-07307-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Indexed: 01/03/2023]
Affiliation(s)
- E A Asare
- Department of Surgical Oncology, University of Texas, M. D. Anderson Cancer Center, 1400 Pressler Street, Unit 1484, Houston, TX, 77030, USA
| | - B W Feig
- Department of Surgical Oncology, University of Texas, M. D. Anderson Cancer Center, 1400 Pressler Street, Unit 1484, Houston, TX, 77030, USA.
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Nishida T, Hølmebakk T, Raut CP, Rutkowski P. Defining Tumor Rupture in Gastrointestinal Stromal Tumor. Ann Surg Oncol 2019; 26:1669-1675. [PMID: 30868512 PMCID: PMC6510879 DOI: 10.1245/s10434-019-07297-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Indexed: 12/25/2022]
Abstract
Tumor rupture is an important risk factor predictive of recurrence after macroscopically complete resection of gastrointestinal stromal tumors (GISTs), and an indication for defined interval or even lifelong adjuvant therapy with imatinib according to guidelines. However, there is no consensus or universally accepted definition of the term ‘tumor rupture’, and, consequently, its incidence varies greatly across reported series. Without predefined criteria, the clinical significance of rupture has also been difficult to assess on multivariate analysis of retrospective data. We reviewed the relevant literature and international guidelines, and, based on the Oslo criteria, proposed the following six definitions for ‘tumor rupture’: (1) tumor fracture or spillage; (2) blood-stained ascites; (3) gastrointestinal perforation at the tumor site; (4) microscopic infiltration of an adjacent organ; (5) intralesional dissection or piecemeal resection; or (6) incisional biopsy. Not all minor defects of tumor integrity should not be classified as rupture, i.e. mucosal defects or spillage contained within the gastrointestinal lumen, microscopic tumor penetration of the peritoneum or iatrogenic damage only to the peritoneal lining, uncomplicated transperitoneal needle biopsy, and R1 resection. This broad definition identifies GIST patients at particularly high risk of recurrence in population-based cohorts; however, its applicability in other sarcomas has not been investigated. As the proposed definition of tumor rupture in GIST has limited evidence based on the small number of patients with rupture in each retrospective study, we recommend validating the proposed definition of tumor rupture in GIST in prospective studies and considering it in clinical practice.
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Affiliation(s)
- Toshirou Nishida
- Department of Surgery, National Cancer Center Hospital, Chuoku, Tokyo, Japan.
| | - Toto Hølmebakk
- Department of Abdominal and Pediatric Surgery, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - Chandrajit P Raut
- Division of Surgical Oncology, Department of Surgery, Brigham and Women's Hospital, Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Institute - Oncology Center, Warsaw, Poland
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47
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Liu Y, Li Z, Xu Z, Jin X, Gong Y, Xia X, Yao Y, Xu Z, Zhou Y, Xu H, Li S, Peng Y, Wu X, Dai L. Proteomic Maps of Human Gastrointestinal Stromal Tumor Subgroups. Mol Cell Proteomics 2019; 18:923-935. [PMID: 30804049 DOI: 10.1074/mcp.ra119.001361] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 02/18/2019] [Indexed: 02/05/2023] Open
Abstract
Gastrointestinal stromal tumor (GIST) is a common sarcoma of gastrointestinal tract (GIT) with high metastatic and recurrence rates, but the proteomic features are still less understood. Here we performed systematic quantitative proteome profiling of GIST from 13 patients classified into very low/low, intermediate and high risk subgroups. An extended cohort of GIST (n = 131) was used for immunohistochemical validation of proteins of interest. In total, 9177 proteins were quantified, covering 55.9% of the GIT transcriptome from The Human Protein Altas. Out of the 9177 quantified proteins, 4930 proteins were observed in all 13 cases with 517 upregulated and 187 downregulated proteins in tumorous tissues independent of risk stage. Pathway analysis showed that the downregulated proteins were mostly enriched in metabolic pathway, whereas the upregulated proteins mainly belonged to spliceosome pathway. In addition, 131 proteins showed differentially expressed patterns among GIST subgroups with statistical significance. The 13 GIST cases were classified into 3 subgroups perfectly based on the expression of these proteins. The intensive comparison of molecular phenotypes and possible functions of quantified oncoproteins, tumor suppressors, phosphatases and kinases between GIST subgroups was carried out. Immunohistochemical analysis of the phosphatase PTPN1 (n = 117) revealed that the GIST patients with high PTPN1 expression had low chances of developing metastasis. Collectively, this work provides valuable information for understanding the inherent biology and evolution of GIST.
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Affiliation(s)
- Yu Liu
- From the ‡Department of General Practice and Department of Gastrointestinal Surgery, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, and Collaborative Innovation Center of Biotherapy, Chengdu 610041, China
| | - Zhigui Li
- From the ‡Department of General Practice and Department of Gastrointestinal Surgery, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, and Collaborative Innovation Center of Biotherapy, Chengdu 610041, China
| | - Zhiqiang Xu
- From the ‡Department of General Practice and Department of Gastrointestinal Surgery, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, and Collaborative Innovation Center of Biotherapy, Chengdu 610041, China
| | - Xiuxiu Jin
- From the ‡Department of General Practice and Department of Gastrointestinal Surgery, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, and Collaborative Innovation Center of Biotherapy, Chengdu 610041, China
| | - Yanqiu Gong
- From the ‡Department of General Practice and Department of Gastrointestinal Surgery, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, and Collaborative Innovation Center of Biotherapy, Chengdu 610041, China
| | - Xuyang Xia
- From the ‡Department of General Practice and Department of Gastrointestinal Surgery, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, and Collaborative Innovation Center of Biotherapy, Chengdu 610041, China
| | - Yuqin Yao
- From the ‡Department of General Practice and Department of Gastrointestinal Surgery, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, and Collaborative Innovation Center of Biotherapy, Chengdu 610041, China
| | - Zhaofen Xu
- §Department of Pathology, The Second People's Hospital of Neijiang City, Sichuan province, Neijiang 641000, China
| | - Yong Zhou
- From the ‡Department of General Practice and Department of Gastrointestinal Surgery, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, and Collaborative Innovation Center of Biotherapy, Chengdu 610041, China
| | - Heng Xu
- From the ‡Department of General Practice and Department of Gastrointestinal Surgery, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, and Collaborative Innovation Center of Biotherapy, Chengdu 610041, China
| | - Shuangqing Li
- From the ‡Department of General Practice and Department of Gastrointestinal Surgery, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, and Collaborative Innovation Center of Biotherapy, Chengdu 610041, China
| | - Yong Peng
- From the ‡Department of General Practice and Department of Gastrointestinal Surgery, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, and Collaborative Innovation Center of Biotherapy, Chengdu 610041, China
| | - Xiaoting Wu
- From the ‡Department of General Practice and Department of Gastrointestinal Surgery, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, and Collaborative Innovation Center of Biotherapy, Chengdu 610041, China;.
| | - Lunzhi Dai
- From the ‡Department of General Practice and Department of Gastrointestinal Surgery, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, and Collaborative Innovation Center of Biotherapy, Chengdu 610041, China;.
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Lu J, Dai Y, Zheng HL, Xie JW, Wang JB, Lin JX, Chen QY, Cao LL, Lin M, Tu RH, Huang ZN, Lin JL, Li P, Huang CM, Zheng CH. What is the appropriate duration of adjuvant imatinib mesylate treatment for primary gastrointestinal stromal tumors classified according to the strict definition of tumor rupture? Medicine (Baltimore) 2019; 98:e14177. [PMID: 30653164 PMCID: PMC6370173 DOI: 10.1097/md.0000000000014177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
In gastrointestinal stromal tumors (GISTs), rupture is a high-risk feature; however, "tumor rupture" is inconsistently defined, and its prognostic value remains controversial.Six hundred ninety-one patients undergoing surgery for primary nonmetastatic GISTs from 2003 to 2015 at our institution were enrolled. The strict definitions of "tumor rupture" according to the Kinki GIST Study Group (KGSG) were used.The median follow-up time was 64 months. The 5-year recurrence-free survival (RFS) and overall survival (OS) rates in the entire group were 79.3% and 84.1%, respectively. According to the KGSG's definition, tumor rupture occurred only in 24 (3.5%) of 691 patients. For all 691 patients, multivariable analysis showed that tumor rupture, according to KGSG's definition, is one of the independently prognostic factors for both RFS and OS. Twenty-four patients with tumor rupture were further analyzed. Receiving IM for more than 3 years was significantly associated with improved RFS and OS in GISTs patients with tumor rupture.Tumor rupture according to KGSG's definition was an independent predictive factor associated with GIST patient prognosis. More importantly, for GISTs with tumor rupture according to the KGSG's strict definition, receiving IM treatment for ≥3 years should be considered.
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Affiliation(s)
- Jun Lu
- Department of Gastric Surgery, Fujian Medical University Union Hospital
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian, China
| | - Yun Dai
- Department of Gastric Surgery, Fujian Medical University Union Hospital
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian, China
| | - Hua-Long Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian, China
| | - Jia-Bin Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian, China
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian, China
| | - Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian, China
| | - Long-Long Cao
- Department of Gastric Surgery, Fujian Medical University Union Hospital
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian, China
| | - Mi Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian, China
| | - Ru-Hong Tu
- Department of Gastric Surgery, Fujian Medical University Union Hospital
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian, China
| | - Ze-Ning Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian, China
| | - Ju-Li Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian, China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian, China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian, China
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49
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Li Z, Zhang W, Li Y, Cao S, Liu S, Ning L, Jiao X, Liu Z, Xing X, Li Y, Zhou Y. TIPE2 acts as a biomarker for GIST risk category and suppresses the viability and invasiveness of GIST cells. Cell Biosci 2018; 8:62. [PMID: 30534358 PMCID: PMC6282356 DOI: 10.1186/s13578-018-0261-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 11/29/2018] [Indexed: 12/23/2022] Open
Abstract
Evaluating the risk category of gastrointestinal stromal tumors (GISTs) is crucial for predicting prognosis and choosing treatment strategies, and tumor metastasis usually represent poor prognosis. Tumor necrosis factor-alpha-induced protein 8-like 2 (TIPE2) is a novel described tumor suppressor. In the present study, TIPE2 expression was detected using a total of 96 human GIST specimens by immunohistochemistry. The effect of TIPE2 on proliferation and invasiveness of GIST cells and its related mechanisms were explored in vitro. It was found that TIPE2 expression was gradually decreased in accordance with GIST risk grades and negatively associated with tumor size, mitotic count and risk category. Moreover, TIPE2 was identified as a biomarker for evaluating the risk grade of GIST. TIPE2 markedly suppressed the viability, colony formation, migration and invasion of GIST cells. Furthermore, TIPE2 induced apoptosis and suppressed MMP-9 expression of GIST cells by targeting Rac1. In conclusion, these results indicate that TIPE2 plays a pivotal role in the progression of GIST. TIPE2 serves as a promising biomarker for evaluating GIST risk grade and a potential target for treatment of GIST.
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Affiliation(s)
- Zequn Li
- 1Department of General Surgery, Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, Shandong People's Republic of China
| | - Wei Zhang
- 2Department of Emergency Medicine, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yi Li
- 1Department of General Surgery, Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, Shandong People's Republic of China
| | - Shougen Cao
- 1Department of General Surgery, Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, Shandong People's Republic of China
| | - Shanglong Liu
- 1Department of General Surgery, Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, Shandong People's Republic of China
| | - Liang Ning
- 3Department of Emergency General Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xuelong Jiao
- 1Department of General Surgery, Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, Shandong People's Republic of China
| | - Zimin Liu
- 4Department of Oncology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaoming Xing
- 5Department of Pathology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yujun Li
- 5Department of Pathology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yanbing Zhou
- 1Department of General Surgery, Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, Shandong People's Republic of China
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50
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Hølmebakk T. ASO Author Reflections: The Significance of Tumor Rupture in Gastric Gastrointestinal Stromal Tumors. Ann Surg Oncol 2018; 25:928-929. [PMID: 30327974 DOI: 10.1245/s10434-018-6881-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Toto Hølmebakk
- Department of Abdominal and Pediatric Surgery, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway.
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