1
|
Tanaka I, Shimamura Y, Inoue H, Azuma D, Ushikubo K, Yamamoto K, Okada H, Nishikawa Y, Tanabe M, Onimaru M. Endoscopic resection for gastric submucosal tumors: A single-center experience in Japan. DEN OPEN 2025; 5:e402. [PMID: 39011512 PMCID: PMC11249007 DOI: 10.1002/deo2.402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/22/2024] [Accepted: 06/21/2024] [Indexed: 07/17/2024]
Abstract
Objectives Endoscopic resection (ER) for gastric submucosal tumors (SMTs) has gained prominence in recent years, with studies emerging from various countries. However, there is a paucity of reports from Japan. We aimed to elucidate the efficacy and safety of ER for gastric SMT in Japan. Methods In this retrospective observational study, we investigated the outcomes of consecutive patients who underwent ER for gastric SMT from January 2017 to May 2023. The outcome variables assessed included the complete resection rate, procedure time, closure-related outcomes, and the incidence of adverse events. Results A total of 13 patients were included in the analysis. The median procedure time was 163 (55-283) min. Complete full-thickness resection was performed in seven cases, while in four cases, the serosa remained, and in two cases, the outer layer of the muscularis propria remained. In two cases where the SMT was located on the anterior side, conversion to laparoscopic surgery became necessary, resulting in a procedural success rate of 84.6% (11/13). Excluding these two cases, endoscopic closure of the defect was successfully accomplished in the remaining 11 cases. R0 resection was achieved in 12 out of 13 cases (92.3%). Although one patient had peritonitis, which was successfully treated conservatively, no other treatment-related adverse events were encountered. Conclusions Although ER for SMT on the anterior side may be challenging, our experience revealed that ER is a safe and efficacious approach for gastric SMT.
Collapse
Affiliation(s)
- Ippei Tanaka
- Digestive Diseases Center Showa University Koto Toyosu Hospital Tokyo Japan
| | - Yuto Shimamura
- Digestive Diseases Center Showa University Koto Toyosu Hospital Tokyo Japan
| | - Haruhiro Inoue
- Digestive Diseases Center Showa University Koto Toyosu Hospital Tokyo Japan
| | - Daisuke Azuma
- Digestive Diseases Center Showa University Koto Toyosu Hospital Tokyo Japan
| | - Kei Ushikubo
- Digestive Diseases Center Showa University Koto Toyosu Hospital Tokyo Japan
| | - Kazuki Yamamoto
- Digestive Diseases Center Showa University Koto Toyosu Hospital Tokyo Japan
| | - Hiroki Okada
- Digestive Diseases Center Showa University Koto Toyosu Hospital Tokyo Japan
| | - Yohei Nishikawa
- Digestive Diseases Center Showa University Koto Toyosu Hospital Tokyo Japan
| | - Mayo Tanabe
- Digestive Diseases Center Showa University Koto Toyosu Hospital Tokyo Japan
| | - Manabu Onimaru
- Digestive Diseases Center Showa University Koto Toyosu Hospital Tokyo Japan
| |
Collapse
|
2
|
Lin XM, Peng YM, Zeng HT, Yang JX, Xu ZL. Endoscopic “calabash” ligation and resection for small gastric mesenchymal tumors. World J Gastrointest Endosc 2024; 16:545-556. [DOI: 10.4253/wjge.v16.i10.545] [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: 06/25/2024] [Revised: 08/16/2024] [Accepted: 09/05/2024] [Indexed: 10/15/2024] Open
Abstract
BACKGROUND Gastric mesenchymal tumors (GMT) are identified as soft tissue neoplasms that arise from mesenchymal stem cells within the gastrointestinal tract. GMT primarily encompass gastric stromal tumors (GST), gastric leiomyomas, and gastric schwannomas. Although most GMT are benign, there are still potential malignant changes, especially GST. Thus, early surgical intervention is the primary treatment for GMT. We have designed a simple endoscopic “calabash” ligation and resection (ECLR) procedure to treat GMT. Its efficacy and safety need to be compared with those of traditional endoscopic techniques, such as endoscopic submucosal excavation (ESE).
AIM To assess the safety and effectiveness of ECLR in managing small GMT (sGMT) with a maximum diameter ≤ 20 mm by comparing to ESE.
METHODS This retrospective analysis involved patients who were hospitalized in our institution between November 2021 and March 2023, underwent endoscopic resection, and received a pathological diagnosis of GMT. Cases with a tumor diameter ≤ 20 mm were chosen and categorized into two cohorts: Study and control groups. The study group was composed of patients treated with ECLR, whereas the control group was composed of those treated with ESE. Data on general clinical characteristics (gender, age, tumor diameter, tumor growth direction, tumor pathological type, and risk grade), surgery-related information (complete tumor resection rate, operation duration, hospitalization duration, hospitalization cost, and surgical complications), and postoperative follow-up were collected for both groups. The aforementioned data were subsequently analyzed and compared.
RESULTS Five hundred and eighty-nine individuals were included, with 297 cases in the control group and 292 in the study group. After propensity score matching, the final analysis incorporated 260 subjects in each cohort. The findings indicated that the study group exhibited shorter operation duration and lowered medical expenses relative to the control group. Furthermore, the study group reported less postoperative abdominal pain and had a lower incidence of intraoperative perforation and postoperative electrocoagulation syndrome than the control group. There were no substantial variations observed in other parameters among the two cohorts.
CONCLUSION ECLR is a viable and effective approach for managing sGMT.
Collapse
Affiliation(s)
- Xi-Min Lin
- Department of Gastroenterology, The Second Clinical Medical College, Jinan University, Shenzhen 518000, Guangdong Province, China
| | - Yue-Ming Peng
- Department of Nursing, Shenzhen People’s Hospital, The Second Clinical Medical College, Jinan University, Shenzhen 518000, Guangdong Province, China
| | - Hao-Tian Zeng
- Department of Gastroenterology, The Second Clinical Medical College, Jinan University, Shenzhen 518000, Guangdong Province, China
| | - Jia-Xing Yang
- Department of Gastroenterology, The Second Clinical Medical College, Jinan University, Shenzhen 518000, Guangdong Province, China
| | - Zheng-Lei Xu
- Department of Gastroenterology, Shenzhen People’s Hospital, The Second Clinical Medical College, Jinan University, Shenzhen 518000, Guangdong Province, China
| |
Collapse
|
3
|
Zhuo M, Chen X, Guo J, Qian Q, Xue E, Chen Z. Deep Learning-Based Segmentation and Risk Stratification for Gastrointestinal Stromal Tumors in Transabdominal Ultrasound Imaging. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:1661-1672. [PMID: 38822195 DOI: 10.1002/jum.16489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/19/2024] [Accepted: 05/12/2024] [Indexed: 06/02/2024]
Abstract
PURPOSE To develop a deep neural network system for the automatic segmentation and risk stratification prediction of gastrointestinal stromal tumors (GISTs). METHODS A total of 980 ultrasound (US) images from 245 GIST patients were retrospectively collected. These images were randomly divided (6:2:2) into a training set, a validation set, and an internal test set. Additionally, 188 US images from 47 prospective GIST patients were collected to evaluate the segmentation and diagnostic performance of the model. Five deep learning-based segmentation networks, namely, UNet, FCN, DeepLabV3+, Swin Transformer, and SegNeXt, were employed, along with the ResNet 18 classification network, to select the most suitable network combination. The performance of the segmentation models was evaluated using metrics such as the intersection over union (IoU), Dice similarity coefficient (DSC), recall, and precision. The classification performance was assessed based on accuracy and the area under the receiver operating characteristic curve (AUROC). RESULTS Among the compared models, SegNeXt-ResNet18 exhibited the best segmentation and classification performance. On the internal test set, the proposed model achieved IoU, DSC, precision, and recall values of 82.1, 90.2, 91.7, and 88.8%, respectively. The accuracy and AUC for GIST risk prediction were 87.4 and 92.0%, respectively. On the external test set, the segmentation models exhibited IoU, DSC, precision, and recall values of 81.0, 89.5, 92.8, and 86.4%, respectively. The accuracy and AUC for GIST risk prediction were 86.7 and 92.5%, respectively. CONCLUSION This two-stage SegNeXt-ResNet18 model achieves automatic segmentation and risk stratification prediction for GISTs and demonstrates excellent segmentation and classification performance.
Collapse
Affiliation(s)
- Minling Zhuo
- Department of Ultrasound, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xing Chen
- Department of General Surgery, Fujian Medical University Provincial Clinical Medical College, Fujian Provincial Hospital, Fuzhou, China
| | - Jingjing Guo
- Department of Ultrasound, Fujian Medical University Union Hospital, Fuzhou, China
| | - Qingfu Qian
- Department of Ultrasound, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ensheng Xue
- Department of Ultrasound, Fujian Medical University Union Hospital, Fuzhou, China
| | - Zhikui Chen
- Department of Ultrasound, Fujian Medical University Union Hospital, Fuzhou, China
| |
Collapse
|
4
|
Kirkpatrick J, Wang Y, Tu'inukuafe J, Chao P, Robertson J, Koea J, Srinivasa S. Gastrointestinal stromal tumours: incidence, recurrence and mortality. A decade of patients from a New Zealand tertiary surgical centre. ANZ J Surg 2024; 94:1556-1562. [PMID: 39148403 DOI: 10.1111/ans.19195] [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: 11/24/2023] [Revised: 07/25/2024] [Accepted: 07/28/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal tumours of the gastrointestinal tract. The New Zealand (NZ) population incidence has not previously been documented nor has the potential effect of ethnicity been reviewed. We furthermore wanted to assess the difference between those undergoing a wedge resection versus a more extensive operation which we hypothesised would correlate with recurrence and mortality. METHODS All patients (n = 103) with a GIST diagnosed and treated at Te Whatu Ora Waitematā (Auckland, New Zealand) between 2012 and 2021 are presented. Patient demographics, method of GIST detection, management approach, index surgery, histological features, use of adjuvant and neoadjuvant imatinib, follow-up, recurrence and mortality rates were analysed. RESULTS This paper reports the largest NZ GIST cohort to date and estimates an incidence of 17 cases per million per year. Eighty-four patients underwent surgical resection, 58 received a wedge resection and 17 received a more extensive operation. Five-year disease-free survival rates were 100% in the low/very low risk, 90% in the intermediate and 59% in the high risk groups as determined by the modified NIH criteria. Our overall 5-year GIST-specific survival rate was 83%; it was 91% in those who underwent a wedge resection and 60% in the extensive operation group. There is evidence that Māori have higher rates of GIST recurrence compared to non-Māori and are more likely to require an extensive surgical resection.
Collapse
Affiliation(s)
| | - Yijiao Wang
- Department of Surgery, North Shore Hospital, Auckland, New Zealand
| | | | - Philip Chao
- Department of Surgery, North Shore Hospital, Auckland, New Zealand
| | - Jason Robertson
- Department of Surgery, North Shore Hospital, Auckland, New Zealand
| | - Jonathan Koea
- Department of Surgery, North Shore Hospital, Auckland, New Zealand
| | - Sanket Srinivasa
- Department of Surgery, North Shore Hospital, Auckland, New Zealand
| |
Collapse
|
5
|
Xie Y, Zhang S, Liu X, Luo Y, Zhou J. Whole-lesion iodine map histogram analysis in the risk classification of gastrointestinal stromal tumors: comparison with single-slice iodine concentration measurements. Abdom Radiol (NY) 2024; 49:2988-2995. [PMID: 38472310 DOI: 10.1007/s00261-024-04224-9] [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: 12/07/2023] [Revised: 01/20/2024] [Accepted: 01/23/2024] [Indexed: 03/14/2024]
Abstract
PURPOSE To evaluate and compare the diagnostic performances of whole-lesion iodine map (IM) histogram analysis and single-slice IM measurement in the risk classification of gastrointestinal stromal tumors (GISTs). METHODS Thirty-seven patients with GISTs, including 19 with low malignant underlying GISTs (LG-GISTs) and 18 with high malignant underlying GISTs (HG-GISTs), were evaluated with dual-energy computed tomography (DECT). Whole-lesion IM histogram parameters (mean; median; minimum; maximum; standard deviation; variance; 1st, 10th, 25th, 50th, 75th, 90th, and 99th percentile; kurtosis, skewness, and entropy) were computed for each lesion. In other sessions, iodine concentrations (ICs) were derived from the IM by placing regions of interest (ROIs) on the tumor slices and normalizing them to the iodine concentration in the aorta. Both quantitative analyses were performed on the venous phase images. The diagnostic accuracies of the two methods were assessed and compared. RESULTS The minimum, maximum, 1st, 10th, and 25th percentile of the whole-lesion IM histogram and the IC and normalized IC (NIC) of the single-slice IC measurement significantly differed between LG- and HG-GISTs (p < 0.001 - p = 0.042). The minimum value in the histogram analysis (AUC = 0.844) and the NIC in the single-slice measurement analysis (AUC = 0.886) showed the best diagnostic performances. The NIC of single-slice measurements had a diagnostic performance similar to that of the whole-lesion IM histogram analysis (p = 0.618). CONCLUSIONS Both whole-lesion IM histogram analysis and single-slice IC measurement can differentiate LG-GISTs and HG-GISTs with similar diagnostic performances.
Collapse
Affiliation(s)
- Yijing Xie
- Department of Radiology, The Second Hospital of Lanzhou University, Lanzhou, 730000, China
- The Second Clinical Medical School, Lanzhou University, Lanzhou, 730000, China
- Key Laboratory of Medical Imaging of Gansu Province, The Second Hospital of Lanzhou University, Lanzhou, 730000, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, 730000, China
| | - Shipeng Zhang
- Department of Radiology, Gansu Provincial Maternity and Child-Care Hospital, Lanzhou, 730000, China
| | - Xianwang Liu
- Department of Radiology, The Second Hospital of Lanzhou University, Lanzhou, 730000, China
- The Second Clinical Medical School, Lanzhou University, Lanzhou, 730000, China
- Key Laboratory of Medical Imaging of Gansu Province, The Second Hospital of Lanzhou University, Lanzhou, 730000, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, 730000, China
| | - Yongjun Luo
- Department of Nuclear Medicine, The Second Hospital of Lanzhou University, Lanzhou, 730000, China
- The Second Clinical Medical School, Lanzhou University, Lanzhou, 730000, China
- Key Laboratory of Medical Imaging of Gansu Province, The Second Hospital of Lanzhou University, Lanzhou, 730000, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, 730000, China
| | - Junlin Zhou
- Department of Radiology, The Second Hospital of Lanzhou University, Lanzhou, 730000, China.
- Key Laboratory of Medical Imaging of Gansu Province, The Second Hospital of Lanzhou University, Lanzhou, 730000, China.
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, 730000, China.
| |
Collapse
|
6
|
Ma Z, Zhao J, Li S, Gao F, Zhang C, Wu L, Lin Y. Imatinib-induced ulcerative colitis. J Oncol Pharm Pract 2024; 30:1111-1117. [PMID: 38772691 DOI: 10.1177/10781552241255290] [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] [Indexed: 05/23/2024]
Abstract
INTRODUCTION Imatinib, a tyrosine kinase inhibitor, is the first-line therapy for patients with KIT mutation in gastrointestinal stromal tumor (GIST). Nausea, vomiting, diarrhea, dyspepsia and abdominal pain are common gastrointestinal adverse reactions of imatinib, but imatinib-induced ulcerative colitis (UC) is rarely reported. CASE REPORT We presented a case of UC induced by imatinib in a 56-year-old male patient who experienced this adverse event after 5 years of imatinib 400 mg/d treatment following GIST resection. MANAGEMENT AND OUTCOME The patient's diarrhea and bloody stools showed significant improvement following the discontinuation of imatinib therapy and administration of antidiarrheal medications. Then, imatinib was restarted at a daily dosage of 400 mg. DISCUSSION UC is a rare adverse event associated with imatinib. Physicians should consider the possibility of UC induced by imatinib when patients present with diarrhea and bloody stool after receiving imatinib treatment. This case offered objective evidence of UC induced by imatinib.
Collapse
Affiliation(s)
- Zengqing Ma
- Department of Pharmacy, Nanjing Gaochun People's Hospital, Nanjing, China
| | - Jianguo Zhao
- Department of Pharmacy, Nanjing Gaochun People's Hospital, Nanjing, China
| | - Susu Li
- Department of Pharmacy, Nanjing Gaochun People's Hospital, Nanjing, China
| | - Fuping Gao
- Department of Pathology, Nanjing Gaochun People's Hospital, Nanjing, China
| | - Chuanyang Zhang
- Department of Medical Imaging, Nanjing Gaochun People's Hospital, Nanjing, China
| | - Lianping Wu
- Department of Pharmacy, Nanjing Gaochun People's Hospital, Nanjing, China
| | - Yu Lin
- Department of Respiratory, Nanjing Gaochun People's Hospital, Nanjing, China
| |
Collapse
|
7
|
Popoiu TA, Pîrvu CA, Popoiu CM, Iacob ER, Talpai T, Voinea A, Albu RS, Tãban S, Bãlãnoiu LM, Pantea S. Gastrointestinal Stromal Tumors (GISTs) in Pediatric Patients: A Case Report and Literature Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:1040. [PMID: 39334573 PMCID: PMC11429550 DOI: 10.3390/children11091040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Revised: 08/18/2024] [Accepted: 08/23/2024] [Indexed: 09/30/2024]
Abstract
Gastrointestinal stromal tumors (GISTs) are rare mesenchymal neoplasms that primarily affect adults, with pediatric cases constituting only 0.5-2.7% of the total. Pediatric GISTs present unique clinical, genetic, and pathological features that distinguish them from adult cases. This literature review aims to elucidate these differences, emphasizing diagnostic and therapeutic challenges. We discuss the resistance of pediatric GISTs to conventional chemotherapy and highlight the importance of surgical intervention, especially in emergency situations involving intra-abdominal bleeding. The review also explores the molecular characteristics of pediatric GISTs, including rare mutations such as quadruple-negative wild-type GIST with an FGF3 gene gain mutation. To illustrate these points, we conclude with a case from our clinic involving a 15-year-old female with multiple CD117-positive gastric GISTs and a quadruple-negative wild-type genetic profile who required urgent surgical intervention following a failed tumor embolization. This case underscores the critical need for early diagnosis and individualized therapeutic strategies combining oncologic and surgical care to improve outcomes in pediatric GIST patients.
Collapse
Affiliation(s)
- Tudor-Alexandru Popoiu
- Department of General Surgery, "Victor Babeş" University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department III of Functional Sciences, Discipline of Medical Informatics and Biostatistics, "Victor Babeş" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Cãtãlin-Alexandru Pîrvu
- Department of General Surgery, "Victor Babeş" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Cãlin-Marius Popoiu
- Department of Pediatric Surgery, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Emil Radu Iacob
- Department of Pediatric Surgery, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Tamas Talpai
- Department of General Surgery, "Victor Babeş" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Amalia Voinea
- Department of General Surgery, "Victor Babeş" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Rãzvan-Sorin Albu
- Department of General Surgery, "Victor Babeş" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Sorina Tãban
- Department of Pathology, "Victor Babeş" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Larisa-Mihaela Bãlãnoiu
- Department of General Surgery, "Victor Babeş" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Stelian Pantea
- Department of General Surgery, "Victor Babeş" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| |
Collapse
|
8
|
Gao J, Liu Z, Liu X, Shu X, Zhu Y, Chen Y, Zeng C. Follow-up analysis and research of very low-risk and low-risk gastrointestinal stromal tumors after endoscopic resection. Sci Rep 2024; 14:17872. [PMID: 39090269 PMCID: PMC11294471 DOI: 10.1038/s41598-024-68460-1] [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: 05/01/2024] [Accepted: 07/24/2024] [Indexed: 08/04/2024] Open
Abstract
Currently, due to limited long-term evidence, there remains some controversy surrounding the recommended postoperative monitoring strategy for primary low-risk gastrointestinal stromal tumors (GISTs). This study recruited a total of 532 patients diagnosed with very low-risk and low-risk GISTs who underwent endoscopic resection from 2015 to 2021, including 460 very low-risk patients and 72 low-risk patients. Descriptive statistical analysis was used to evaluate the clinical and pathological characteristics of GIST patients, and Kaplan-Meier methods were employed for survival analysis. The results showed that the 5-year recurrence-free survival rates for very low-risk and low-risk patients were 98.5% and 95.9%, respectively. The 5-year disease-specific survival rates for both groups were 100%. Additionally, the 5-year overall survival rates were 99.7% for very low-risk patients and 100% for low-risk patients (P = 0.69). Therefore, it is suggested that routine follow-up monitoring, including endoscopic surveillance and imaging, may not be necessary for very low-risk and low-risk GISTs after endoscopic resection.
Collapse
Affiliation(s)
- Jiaxin Gao
- Department of Gastroenterology, Jiangxi Provincial Key Laboratory of Digestive Diseases, Jiangxi Clinical Research Center for Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Zide Liu
- Department of Gastroenterology, Jiangxi Provincial Key Laboratory of Digestive Diseases, Jiangxi Clinical Research Center for Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Xingxing Liu
- Department of Gastroenterology, Jiangxi Provincial Key Laboratory of Digestive Diseases, Jiangxi Clinical Research Center for Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Xu Shu
- Department of Gastroenterology, Jiangxi Provincial Key Laboratory of Digestive Diseases, Jiangxi Clinical Research Center for Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Yin Zhu
- Department of Gastroenterology, Jiangxi Provincial Key Laboratory of Digestive Diseases, Jiangxi Clinical Research Center for Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Youxiang Chen
- Department of Gastroenterology, Jiangxi Provincial Key Laboratory of Digestive Diseases, Jiangxi Clinical Research Center for Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China.
| | - Chunyan Zeng
- Department of Gastroenterology, Jiangxi Provincial Key Laboratory of Digestive Diseases, Jiangxi Clinical Research Center for Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China.
| |
Collapse
|
9
|
Iwai T, Kida M, Okuwaki K, Watanabe M, Adachi K, Ishizaki J, Hanaoka T, Tamaki A, Tadehara M, Imaizumi H, Kusano C. Deep learning analysis for differential diagnosis and risk classification of gastrointestinal tumors. Scand J Gastroenterol 2024; 59:925-932. [PMID: 38950889 DOI: 10.1080/00365521.2024.2368241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 05/24/2024] [Accepted: 06/08/2024] [Indexed: 07/03/2024]
Abstract
OBJECTIVES Recently, artificial intelligence (AI) has been applied to clinical diagnosis. Although AI has already been developed for gastrointestinal (GI) tract endoscopy, few studies have applied AI to endoscopic ultrasound (EUS) images. In this study, we used a computer-assisted diagnosis (CAD) system with deep learning analysis of EUS images (EUS-CAD) and assessed its ability to differentiate GI stromal tumors (GISTs) from other mesenchymal tumors and their risk classification performance. MATERIALS AND METHODS A total of 101 pathologically confirmed cases of subepithelial lesions (SELs) arising from the muscularis propria layer, including 69 GISTs, 17 leiomyomas and 15 schwannomas, were examined. A total of 3283 EUS images were used for training and five-fold-cross-validation, and 827 images were independently tested for diagnosing GISTs. For the risk classification of 69 GISTs, including very-low-, low-, intermediate- and high-risk GISTs, 2,784 EUS images were used for training and three-fold-cross-validation. RESULTS For the differential diagnostic performance of GIST among all SELs, the accuracy, sensitivity, specificity and area under the receiver operating characteristic (ROC) curve were 80.4%, 82.9%, 75.3% and 0.865, respectively, whereas those for intermediate- and high-risk GISTs were 71.8%, 70.2%, 72.0% and 0.771, respectively. CONCLUSIONS The EUS-CAD system showed a good diagnostic yield in differentiating GISTs from other mesenchymal tumors and successfully demonstrated the GIST risk classification feasibility. This system can determine whether treatment is necessary based on EUS imaging alone without the need for additional invasive examinations.
Collapse
Affiliation(s)
- Tomohisa Iwai
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Mitsuhiro Kida
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kosuke Okuwaki
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Masafumi Watanabe
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kai Adachi
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Junro Ishizaki
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Taro Hanaoka
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Akihiro Tamaki
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Masayoshi Tadehara
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Hiroshi Imaizumi
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Chika Kusano
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
| |
Collapse
|
10
|
Bertsimas D, Margonis GA, Sujichantararat S, Koulouras A, Ma Y, Antonescu CR, Brennan MF, Martín-Broto J, Tang S, Rutkowski P, Kreis ME, Beyer K, Wang J, Bylina E, Sobczuk P, Gutierrez A, Jadeja B, Tap WD, Chi P, Singer S. Interpretable artificial intelligence to optimise use of imatinib after resection in patients with localised gastrointestinal stromal tumours: an observational cohort study. Lancet Oncol 2024; 25:1025-1037. [PMID: 38976997 DOI: 10.1016/s1470-2045(24)00259-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 04/29/2024] [Accepted: 05/01/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND Current guidelines recommend use of adjuvant imatinib therapy for many patients with gastrointestinal stromal tumours (GISTs); however, its optimal treatment duration is unknown and some patient groups do not benefit from the therapy. We aimed to apply state-of-the-art, interpretable artificial intelligence (ie, predictions or prescription logic that can be easily understood) methods on real-world data to establish which groups of patients with GISTs should receive adjuvant imatinib, its optimal treatment duration, and the benefits conferred by this therapy. METHODS In this observational cohort study, we considered for inclusion all patients who underwent resection of primary, non-metastatic GISTs at the Memorial Sloan Kettering Cancer Center (MSKCC; New York, NY, USA) between Oct 1, 1982, and Dec 31, 2017, and who were classified as intermediate or high risk according to the Armed Forces Institute of Pathology Miettinen criteria and had complete follow-up data with no missing entries. A counterfactual random forest model, which used predictors of recurrence (mitotic count, tumour size, and tumour site) and imatinib duration to infer the probability of recurrence at 7 years for a given patient under each duration of imatinib treatment, was trained in the MSKCC cohort. Optimal policy trees (OPTs), a state-of-the-art interpretable AI-based method, were used to read the counterfactual random forest model by training a decision tree with the counterfactual predictions. The OPT recommendations were externally validated in two cohorts of patients from Poland (the Polish Clinical GIST Registry), who underwent GIST resection between Dec 1, 1981, and Dec 31, 2011, and from Spain (the Spanish Group for Research in Sarcomas), who underwent resection between Oct 1, 1987, and Jan 30, 2011. FINDINGS Among 1007 patients who underwent GIST surgery in MSKCC, 117 were included in the internal cohort; for the external cohorts, the Polish cohort comprised 363 patients and the Spanish cohort comprised 239 patients. The OPT did not recommend imatinib for patients with GISTs of gastric origin measuring less than 15·9 cm with a mitotic count of less than 11·5 mitoses per 5 mm2 or for those with small GISTs (<5·4 cm) of any site with a count of less than 11·5 mitoses per 5 mm2. In this cohort, the OPT cutoffs had a sensitivity of 92·7% (95% CI 82·4-98·0) and a specificity of 33·9% (22·3-47·0). The application of these cutoffs in the two external cohorts would have spared 38 (29%) of 131 patients in the Spanish cohort and 44 (35%) of 126 patients in the Polish cohort from unnecessary treatment with imatinib. Meanwhile, the risk of undertreating patients in these cohorts was minimal (sensitivity 95·4% [95% CI 89·5-98·5] in the Spanish cohort and 92·4% [88·3-95·4] in the Polish cohort). The OPT tested 33 different durations of imatinib treatment (<5 years) and found that 5 years of treatment conferred the most benefit. INTERPRETATION If the identified patient subgroups were applied in clinical practice, as many as a third of the current cohort of candidates who do not benefit from adjuvant imatinib would be encouraged to not receive imatinib, subsequently avoiding unnecessary toxicity on patients and financial strain on health-care systems. Our finding that 5 years is the optimal duration of imatinib treatment could be the best source of evidence to inform clinical practice until 2028, when a randomised controlled trial with the same aims is expected to report its findings. FUNDING National Cancer Institute.
Collapse
Affiliation(s)
- Dimitris Bertsimas
- Operations Research Center, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Georgios Antonios Margonis
- Operations Research Center, Massachusetts Institute of Technology, Cambridge, MA, USA; Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Angelos Koulouras
- Operations Research Center, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Yu Ma
- Operations Research Center, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Cristina R Antonescu
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Murray F Brennan
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Javier Martín-Broto
- Medical Oncology Department, Fundación Jimenez Diaz University Hospital, Madrid, Spain; Medical Oncology Department, Hospital General de Villalba, Madrid, Spain; Instituto de Investigacion Sanitaria Fundacion Jimenez Diaz, Madrid, Spain
| | - Seehanah Tang
- Operations Research Center, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Piotr Rutkowski
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Martin E Kreis
- Department of General and Visceral Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Katharina Beyer
- Department of General and Visceral Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jane Wang
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Elzbieta Bylina
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Pawel Sobczuk
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Antonio Gutierrez
- Medical Oncology Department, Fundación Jimenez Diaz University Hospital, Madrid, Spain; Medical Oncology Department, Hospital General de Villalba, Madrid, Spain; Instituto de Investigacion Sanitaria Fundacion Jimenez Diaz, Madrid, Spain
| | - Bhumika Jadeja
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - William D Tap
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ping Chi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Samuel Singer
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| |
Collapse
|
11
|
Mariani A, Bajul M, Rebibo L, Broudin C, Lahlou W, Rahmi G, Zaanan A, Taieb J, Karoui M. Is laparoscopic approach as treatment of large gastric GIST acceptable? Langenbecks Arch Surg 2024; 409:231. [PMID: 39073458 DOI: 10.1007/s00423-024-03415-8] [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: 03/14/2024] [Accepted: 07/09/2024] [Indexed: 07/30/2024]
Abstract
AIM Laparoscopic surgery is widely used for small gastric gastrointestinal stromal tumors (GISTs) (≤ 5 cm) but remains a controversial approach for larger gastric GISTs (> 5 cm). This study aims to compare short- and long-term outcomes of laparoscopic resection in comparison with open resection for gastric GISTs measuring over 5 cm. METHOD All patients receiving surgery for gastric GIST > 5 cm between 2000 and 2021 in a single tertiary hospital were included. Data were collected from prospectively maintained records. Kaplan-Meier method and log rank test were used to compare survival outcomes. RESULTS Among 108 included patients, 59 patients had minimally invasive (MI) surgery (54.6%) whereas 49 patients had open surgery (46.4%). The rate of overall postoperative morbidity was 14.8% and the median length was significantly shorter in the MI group [4 (range 2-30) vs. 7 (range 4-33) days; P = 0.007]. The overall R0 resection rate was 98.2% and the rate of tumor rupture was 13%, not different between the two groups. Recurrence occurred in 24% of the whole population without any difference between groups (20.3% vs. 28.7%, p = 0.31). Minimally invasive surgery was not found as a negative prognostic disease-free survival factor. CONCLUSION Laparoscopic surgery could be a safe and feasible alternative to open surgery in large gastric GIST, bringing the benefits of minimally invasive surgery without compromising oncologic results.
Collapse
Affiliation(s)
- Antoine Mariani
- Department of Digestive Surgery, Université Paris Cité, Assistance Publique Hôpitaux de Paris, Georges Pompidou University Hospital, Paris, France.
- Department of Digestive and Oncologic Surgery, Université Paris Cité, Assistance Publique Hôpitaux de Paris, Georges Pompidou University Hospital, 20 rue Leblanc, Paris, France.
| | - Melinda Bajul
- Department of Digestive Surgery, Université Paris Cité, Assistance Publique Hôpitaux de Paris, Georges Pompidou University Hospital, Paris, France
| | - Lionel Rebibo
- Department of Digestive Surgery, Université Paris Cité, Assistance Publique Hôpitaux de Paris, Georges Pompidou University Hospital, Paris, France
| | - Chloé Broudin
- Department of pathology, Université Paris Cité, Assistance Publique Hôpitaux de Paris, Georges Pompidou University Hospital, Paris, France
| | - Widad Lahlou
- Department of Digestive Oncology, Université Paris Cité, Assistance Publique Hôpitaux de Paris, Georges Pompidou University Hospital, Paris, France
| | - Gabriel Rahmi
- Department of Gastroenterology, Université Paris Cité, Assistance Publique Hôpitaux de Paris, Georges Pompidou University Hospital, Paris, France
| | - Aziz Zaanan
- Department of Digestive Oncology, Université Paris Cité, Assistance Publique Hôpitaux de Paris, Georges Pompidou University Hospital, Paris, France
| | - Julien Taieb
- Department of Digestive Oncology, Université Paris Cité, Assistance Publique Hôpitaux de Paris, Georges Pompidou University Hospital, Paris, France
| | - Mehdi Karoui
- Department of Digestive Surgery, Université Paris Cité, Assistance Publique Hôpitaux de Paris, Georges Pompidou University Hospital, Paris, France
| |
Collapse
|
12
|
Song H, Xiao X, Han X, Sun Y, Zheng G, Miao Q, Zhang Y, Tan J, Liu G, He Q, Zhou J, Zheng Z, Jiang G. Development and interpretation of a multimodal predictive model for prognosis of gastrointestinal stromal tumor. NPJ Precis Oncol 2024; 8:157. [PMID: 39060449 PMCID: PMC11282065 DOI: 10.1038/s41698-024-00636-4] [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: 10/10/2023] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
Gastrointestinal stromal tumor (GIST) is the most common mesenchymal original tumor in gastrointestinal (GI) tract and is considered to have varying malignant potential. With the advancement of computer science, radiomics technology and deep learning had been applied in medical researches. It's vital to construct a more accurate and reliable multimodal predictive model for recurrence-free survival (RFS) aiding for clinical decision-making. A total of 254 patients underwent surgery and pathologically diagnosed with GIST in The First Hospital of China Medical University from 2019 to 2022 were included in the study. Preoperative contrast enhanced computerized tomography (CE-CT) and hematoxylin/eosin (H&E) stained whole slide images (WSI) were acquired for analysis. In the present study, we constructed a sum of 11 models while the multimodal model (average C-index of 0.917 on validation set in 10-fold cross validation) performed the best on external validation cohort with an average C-index of 0.864. The multimodal model also reached statistical significance when validated in the external validation cohort (n = 42) with a p-value of 0.0088 which pertained to the recurrence-free survival (RFS) comparison between the high and low groups using the optimal threshold on the predictive score. We also explored the biological significance of radiomics and pathomics features by visualization and quantitative analysis. In the present study, we constructed a multimodal model predicting RFS of GIST which was prior over unimodal models. We also proposed hypothesis on the correlation between morphology of tumor cell and prognosis.
Collapse
Affiliation(s)
- He Song
- Department of Gastrointestinal Surgery, The First Hospital of China Medical University, Shenyang, Liaoning, China.
| | - XianHao Xiao
- Department of Gastrointestinal Surgery, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xu Han
- Department of Pathology, The First Hospital and the College of Basic Medical Sciences of China Medical University, Shenyang, Liaoning, China
| | - YeFei Sun
- Department of Gastrointestinal Surgery, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - GuoLiang Zheng
- Department of Gastric Surgery, Cancer Hospital of China Medical University; Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital & Institute, Shenyang, Liaoning, China
| | - Qi Miao
- Department of Radiology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - YuLong Zhang
- Department of Gastrointestinal Surgery, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - JiaYing Tan
- Department of Gastrointestinal Surgery, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Gang Liu
- Department of Gastrointestinal Surgery, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - QianRu He
- The state Key laboratory of Neurology and Oncology Drug Development, Jiangsu Simcere Diagnostics Co.,Ltd, Nanjing, China
| | - JianPing Zhou
- Department of Gastrointestinal Surgery, The First Hospital of China Medical University, Shenyang, Liaoning, China.
| | - ZhiChao Zheng
- Department of Gastric Surgery, Cancer Hospital of China Medical University; Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital & Institute, Shenyang, Liaoning, China.
| | - GuiYang Jiang
- Department of Pathology, The College of Basic Medical Sciences and The First Hospital of China Medical University, Shenyang, Liaoning, China.
| |
Collapse
|
13
|
Liu L, Zhu Z, Zhou J, Ye Y, Xu L, Xu X. The influence of lymphadenectomy on the prognosis of small intestinal stromal tumors: a study based on the SEER database. Surg Endosc 2024; 38:3838-3848. [PMID: 38819464 DOI: 10.1007/s00464-024-10906-8] [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: 02/12/2024] [Accepted: 05/04/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Small intestinal stromal tumors (SISTs) typically require surgical treatment. However, the impact of lymphadenectomy (LA) on long-term prognosis in patients remains unclear. Therefore, we plan to analyze the effect of LA on the prognosis of patients with SISTs using the Surveillance, Epidemiology, and End Results (SEER) database. METHODS Data on SISTs patients between 2000 and 2019 were obtained from the SEER database. Multiple imputation (MI) was employed to handle missing data, while propensity score matching (PSM) was conducted to mitigate selection bias in the comparative assessments between the LA group and the No-LA group. Kaplan-Meier analyses and multivariate Cox proportional hazards models were utilized to evaluate both overall survival (OS) and cancer-specific survival (CSS). RESULTS A total of 2412 patients diagnosed with SISTs were included in the study, with 879 undergoing LA and 1533 not undergoing LA. There were no significant differences observed between the two cohorts concerning long-term OS (hazard ratio [HR] 0.97, 95% confidence interval [CI] 0.84-1.13, P = 0.720) and CSS (HR 1.05, 95% CI 0.86-1.29, P = 0.622). After PSM, 1596 patients (798 in the LA group and 789 in the No-LA group) were matched for comparison. There was also no difference in long-term OS and CSS between the two groups. Subgroup analysis revealed that in the age group > 60 years, the CSS in the No-LA group was superior to that in the LA group. Multivariate Cox regression analysis revealed that age, M stage, marital status, and mitotic rate are significant risk factors influencing OS and CSS. CONCLUSIONS Conducting LA in patients with SISTs does not enhance long-term prognosis. For patients aged over 60 years, it may be more advisable to refrain from performing LA.
Collapse
Affiliation(s)
- Luojie Liu
- Department of Gastroenterology, Changshu Hospital Affiliated to Soochow University, Suzhou, China
| | - Zhaoji Zhu
- Department of General Practice, Changshu Hospital Affiliated to Soochow University, Suzhou, China
| | - Jingjie Zhou
- Department of Gastroenterology, Changshu Hospital Affiliated to Soochow University, Suzhou, China
| | - Ye Ye
- Department of Gastroenterology, Changshu Hospital Affiliated to Soochow University, Suzhou, China
| | - Liansheng Xu
- Department of Gastroenterology, Changshu Hospital Affiliated to Soochow University, Suzhou, China.
| | - Xiaodan Xu
- Department of Gastroenterology, Changshu Hospital Affiliated to Soochow University, Suzhou, China.
| |
Collapse
|
14
|
Abu Lekham L, Hey E, Canario J, Rivas Y, Felice A, Mantegna T, Wang Y, Khasawneh MT. A Predefined Rule-Based Multi-Factor Risk Stratification Is Associated With Improved Outcomes at a Rural Primary Care Practice. FAMILY & COMMUNITY HEALTH 2024; 47:248-260. [PMID: 38728117 DOI: 10.1097/fch.0000000000000405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
This study built a predefined rule-based risk stratification paradigm using 19 factors in a primary care setting that works with rural communities. The factors include medical and nonmedical variables. The nonmedical variables represent 3 demographic attributes and one other factor represents transportation availability. Medical variables represent major clinical variables such as blood pressure and BMI. Many risk stratification models are found in the literature but few integrate medical and nonmedical variables, and to our knowledge, no such model is designed specifically for rural communities. The data used in this study contain the associated variables of all medical visits in 2021. Data from 2022 were used to evaluate the model. After our risk stratification model and several interventions were adopted in 2022, the percentage of patients with high or medium risk of deteriorating health outcomes dropped from 34.9% to 24.4%, which is a reduction of 30%. The medium-complex patient population size, which had been 29% of all patients, decreased by about 4% to 5.7%. According to the analysis, the total risk score showed a strong correlation with 3 risk factors: dual diagnoses, the number of seen providers, and PHQ9 (0.63, 0.54, and 0.45 correlation coefficients, respectively).
Collapse
Affiliation(s)
- Laith Abu Lekham
- Author Affiliations: Data Department/Quality Division (Mr Abu Lekham), Executive Department/Quality Division (Ms Hey), Executive Department/Medical Division (Dr Canario), Behavioral Health Department/Medical Divison (Ms Felice), Executive Department/Support Service Division (Ms Rivas), Care Management Department/Division (Mr Mantegna)
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Sutton TL, Billingsley KG, Johnson AJ, Corless CL, Blanke CD, Heinrich MC, Mayo SC. Adjuvant imatinib in high-risk resected gastrointestinal stromal tumors: Merely delaying the inevitable? J Surg Oncol 2024; 130:40-46. [PMID: 38924626 DOI: 10.1002/jso.27654] [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: 03/16/2024] [Accepted: 04/01/2024] [Indexed: 06/28/2024]
Abstract
INTRODUCTION Patients with high-risk resected gastrointestinal stromal tumors (GIST) receiving adjuvant imatinib have improved recurrence-free survival (RFS), however whether a complete cytocidal effect exists is unknown. We investigated this using a normalized recurrence timeline measured from end of oncologic treatment (EOOT), defined as the later of resection or end of adjuvant therapy. METHODS We reviewed patients with resected high-risk GIST at our cancer center from 2003 to 2018. RFS (measured from resection and EOOT), overall survival (OS), and time to imatinib resistance (TTIR) were analyzed using Kaplan-Meier analysis and multivariable Cox proportional hazards modeling. The performance of the Memorial Sloan Kettering (MSK) GIST nomogram was assessed. RESULTS We identified 86 patients with high-risk GIST with a median 106 months of postsurgical follow-up. One-third (n = 29; 34%) did not receive adjuvant imatinib, while 57 (66%) did for a median of 3 years. The MSK nomogram-predicted 5-year RFS for patients receiving adjuvant imatinib was similar to those who did not (29% vs. 31%, p = 0.64). When RFS was measured from EOOT, the MSK-predicted RFS was independently associated with EOOT RFS (hazard ratio 0.22, p = 0.02), while adjuvant imatinib receipt and duration were not. Neither receipt nor duration of adjuvant imatinib were associated with TTIR or OS (all p > 0.05). CONCLUSIONS Treatment with adjuvant imatinib delays, but does not clearly impact ultimate recurrence, TTIR, or OS, suggesting many patients with high-risk GIST may receive adjuvant imatinib unnecessarily. Additional studies are needed to establish the benefit of adjuvant therapy versus initiating therapy at first radiographic recurrence.
Collapse
Affiliation(s)
- Thomas L Sutton
- OHSU Department of Surgery, Division of Surgical Oncology, Knight Cancer Institute, Portland, Oregon, USA
| | | | - Alicia J Johnson
- OHSU Department of Surgery, Division of Surgical Oncology, Knight Cancer Institute, Portland, Oregon, USA
| | | | - Charles D Blanke
- OHSU Department of Medicine, Division of Hematology and Oncology, Knight Cancer Institute, Portland, Oregon, USA
| | - Michael C Heinrich
- OHSU Department of Medicine, Division of Hematology and Oncology, Knight Cancer Institute, Portland, Oregon, USA
| | - Skye C Mayo
- OHSU Department of Surgery, Division of Surgical Oncology, Knight Cancer Institute, Portland, Oregon, USA
| |
Collapse
|
16
|
Joensuu H, Reichardt A, Eriksson M, Hohenberger P, Boye K, Cameron S, Lindner LH, Jost PJ, Bauer S, Schütte J, Lindskog S, Kallio R, Jaakkola PM, Goplen D, Wardelmann E, Reichardt P. Survival of patients with ruptured gastrointestinal stromal tumour treated with adjuvant imatinib in a randomised trial. Br J Cancer 2024; 131:299-304. [PMID: 38862742 PMCID: PMC11263706 DOI: 10.1038/s41416-024-02738-z] [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: 02/21/2024] [Revised: 05/18/2024] [Accepted: 05/28/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Patients with ruptured gastrointestinal stromal tumour (GIST) have poor prognosis. Little information is available about how adjuvant imatinib influences survival. METHODS We explored recurrence-free survival (RFS) and overall survival (OS) of patients with ruptured GIST who participated in a randomised trial (SSG XVIII/AIO), where 400 patients with high-risk GIST were allocated to adjuvant imatinib for either 1 year or 3 years after surgery. Of the 358 patients with confirmed localised GIST, 73 (20%) had rupture reported. The ruptures were classified retrospectively using the Oslo criteria. RESULTS Most ruptures were major, four reported ruptures were reclassified unruptured. The 69 patients with rupture had inferior RFS and OS compared with 289 patients with unruptured GIST (10-year RFS 21% vs. 55%, OS 59% vs. 78%, respectively). Three-year adjuvant imatinib did not significantly improve RFS or OS of the patients with rupture compared with 1-year treatment, but in the largest mutational subset with KIT exon 11 deletion/indel mutation OS was higher in the 3-year group than in the 1-year group (10-year OS 94% vs. 54%). CONCLUSIONS About one-fifth of ruptured GISTs treated with adjuvant imatinib did not recur during the first decade of follow-up. Relatively high OS rates were achieved despite rupture. CLINICAL TRIAL REGISTRATION NCT00116935.
Collapse
Affiliation(s)
- Heikki Joensuu
- Department of Oncology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
| | - Annette Reichardt
- Helios Klinikum Berlin-Buch, and Berlin Medical School, Berlin, Germany
| | - Mikael Eriksson
- Department of Oncology, Skåne University Hospital and Lund University, Lund, Sweden
| | - Peter Hohenberger
- Division of Surgical Oncology & Thoracic Surgery, Mannheim University Medical Center, Mannheim, Germany
| | - Kjetil Boye
- Department of Oncology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Silke Cameron
- Department of Gastroenterology and Gastrointestinal Oncology, University Medicine Göttingen, Göttingen, Germany
| | - Lars H Lindner
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Philipp J Jost
- Medical Department III, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Division of Clinical Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Sebastian Bauer
- Department of Medical Oncology and Sarcoma Center, West German Cancer Center, University Duisburg-Essen, Medical School, Essen, Germany
- DKTK partner site Essen, German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Jochen Schütte
- Schwerpunktpraxis Oncology/ Hematology, Düsseldorf, Germany
- Universitätsklinikum Essen Innere Klinik Essen, Essen, Germany
| | - Stefan Lindskog
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, Halland Hospital, Varberg, Sweden
| | - Raija Kallio
- Department of Oncology and Radiotherapy, Oulu University Hospital, Oulu, Finland
| | - Panu M Jaakkola
- Department of Oncology, Turku University Hospital and University of Turku, Turku, Finland
| | | | - Eva Wardelmann
- Gerhard-Domagk-Institute of Pathology, University of Münster, Münster, Germany
| | - Peter Reichardt
- Helios Klinikum Berlin-Buch, and Berlin Medical School, Berlin, Germany
| |
Collapse
|
17
|
Yang J, Guo P, Zhang Z, Lu C, Qiao Z. The impact of gender on survival outcomes in patients with small intestinal stromal tumors: a comprehensive analysis using the SEER database. Surg Endosc 2024; 38:3905-3916. [PMID: 38831215 DOI: 10.1007/s00464-024-10942-4] [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: 12/31/2023] [Accepted: 05/19/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Small intestinal stromal tumors (SISTs) are a rare type of mesenchymal tumor. Gender is known to influence the incidence and prognosis of various tumors, but its role on the survival of SISTs at the population level remains unclear. Therefore, we aim to explore the relationship between gender and the prognosis of SISTs using the Surveillance, Epidemiology, and End Results (SEER) database. METHODS Data on SISTs patients from 2000 to 2019 were derived from the SEER database. Multiple imputation was used to address missing data. Kaplan-Meier analyses and Cox proportional hazard models were applied to evaluate the impact of demographic and clinical characteristics on overall survival (OS) and cancer-specific survival (CSS). RESULTS A total of 3513 patients with SISTs were analyzed, including 1921 males and 1592 females. Kaplan-Meier analysis coupled with log-rank testing demonstrated a significantly higher mortality rate among male patients compared to females (P < 0.001). Notably, female patients exhibited superior OS (hazard ratio [HR] 0.808, 95% confidence interval [CI] 0.724-0.902, P < 0.001) and CSS (HR 0.801, 95% CI 0.692-0.927, P = 0.003) compared to male patients. While the mean 1-year CSS rates were comparable between genders (95.3% for males vs. 96.0% for females, P = 0.332), male patients consistently showed lower mean survival rates at 3-, 5-, and 10-year intervals. Surgical intervention significantly boosted 5-year OS and CSS rates in both male and female patients (P < 0.001). Multivariate Cox regression analysis identified age, sex, grade, TNM stage, surgery, and mitotic rate as independent risk factors for OS and CSS in patients with SISTs. CONCLUSIONS Our findings suggest that male patients with SISTs have a higher risk of mortality compared to female patients, indicating that gender may serve as a predictive indicator for survival in this patient population.
Collapse
Affiliation(s)
- Jun Yang
- Department of Gastroenterology, Suzhou Ninth People's Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, China
| | - Ping Guo
- Department of Internal Medicine, Dianshan Lake People's Hospital, Suzhou, China
| | - Zhi Zhang
- Department of General Surgery, Suzhou Ninth People's Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, China
| | - Chengjie Lu
- Department of Traditional Chinese Medicine, Suzhou Ninth People's Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, China
| | - Zhenguo Qiao
- Department of Gastroenterology, Suzhou Ninth People's Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, China.
| |
Collapse
|
18
|
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.
Collapse
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
| |
Collapse
|
19
|
Li T, Li J, Hu Z, Lu M. An ultrasound based method for predicting the malignant potential of primary gastrointestinal stromal tumors preoperatively. Abdom Radiol (NY) 2024:10.1007/s00261-024-04341-5. [PMID: 38849537 DOI: 10.1007/s00261-024-04341-5] [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: 03/01/2024] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 06/09/2024]
Abstract
OBJECTIVE Gastrointestinal stromal tumors (GISTs) are difficult to identify the risk level accurately without surgical pathological confirmation. The purpose of our study was to propose a noninvasive prediction method for predicting the malignant potential of GISTs preoperatively by using contrast-enhanced ultrasound (CEUS) with gastric distention. METHODS We reviewed 47 GISTs who underwent CEUS from April 2017 to August 2023 retrospectively, all the lesions were certificated by pathology after surgery. The age of the patient, size of the lesion, shape, necrosis, calcification in the lesion, perfusion parameters including arrival time (AT), peak intensity (PI), time to peak (TTP), and area under the curve (AUC) of the lesion and surrounding normal tissue were analyzed. Logistic regression analyses were performed. Of the 47 GISTs, 26 were high-risk and 21 low-risk tumors respectively. RESULTS Compared with low-risk GISTs, high-risk GIST had faster AT (7.7s vs. 11.5s, p < 0.05), higher PI (15.2dB vs. 12.5dB, p < 0.05), and larger size (4.4 cm vs. 2.2 cm, p < 0.001). In multivariate logistic regression, AT, PI, and size were significant features. The corresponding regression equation In (p/(1-p)=-5.9 + 4.5 size + 4.6 PI + 4.0 AT). CONCLUSION The size, AT, and PI of the GISTs on CEUS can be used as parameters for a noninvasive risk level prediction model of GISTs. This model may help identify the different risk levels of GISTs before surgery.
Collapse
Affiliation(s)
- Tingting Li
- Department of Ultrasound, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Juan Li
- Department of Ultrasound, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - ZiYue Hu
- Department of Ultrasound, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Man Lu
- Department of Ultrasound, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China.
| |
Collapse
|
20
|
Lian J, Ji Y, Chen T, Wang G, Wang M, Li S, Cao J, Shen L, Lu W, Xu M. Endoscopic resection for esophageal gastrointestinal stromal tumors: a multi-center feasibility study. Therap Adv Gastroenterol 2024; 17:17562848241255304. [PMID: 38846174 PMCID: PMC11155357 DOI: 10.1177/17562848241255304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 04/26/2024] [Indexed: 06/09/2024] Open
Abstract
Background Esophageal gastrointestinal stromal tumors (E-GISTs) are highly uncommon and have not been thoroughly examined. Objectives The objective of this multi-center study was to assess the viability of endoscopic resection (ER) in the treatment of E-GISTs and to explore its clinical implications. Design This was a multi-center retrospective study. Consecutive patients referred to the four participating centers. Methods E-GISTs among the consecutive subepithelial tumors (SETs) treated by ER methods were enrolled from April 2019 to August 2022. Clinicopathological, endoscopic, and follow-up data were collected and analyzed. Results A total of 23 patients with E-GISTs were included for analysis, accounting for 1.9% of all the esophageal SETs (1243 patients). The average size of the tumor lesions was 2.3 cm (range 1.0-4.0 cm). We observed that tumors larger than 2.0 cm were more likely to grow deeper, with a statistically significant difference (p < 0.001). End bloc resection was achieved in all 23 patients. The mean operation time was 53.6 min (range 25-111 min). One patient experienced significant intraoperative bleeding, which was promptly managed endoscopically without necessitating surgery. The average hospital stay was 4.5 days (range 3-8 days). The overall median follow-up period was 31 months (range 13-47 months). No tumor recurrence, residual tumor, distal metastasis, or death was observed during the follow-up period. Conclusion Based on our limited data, our study indicates that ER may be a feasible and effective option for treating esophageal GISTs measuring 4 cm or less. We suggest submucosal tunnel endoscopic resection as the preferred approach, as all E-GISTs in our study were situated in the muscularis propria layer. Additionally, tumors larger than 2 cm were more prone to deeper growth or extraluminal extension.
Collapse
Affiliation(s)
- Jingjing Lian
- Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Yingjie Ji
- Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Tao Chen
- Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Guoxiang Wang
- Department of Gastroenterology, Taizhou Municipal Hospital, Taizhou, Zhejiang, China
| | - Mizhu Wang
- Department of Gastroenterology, The Second Affiliated Hospital of BaoTou Medical College, Baotou, Inner Mongolia Autonomous Region, China
| | - Shengxi Li
- Department of Gastroenterology, People’s Hospital of Liaoning Province, Shenyang, Liaoning, China
| | - Jia Cao
- Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Li Shen
- Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Wei Lu
- Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Meidong Xu
- Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Tongji University, 150 Jimo Road, Shanghai 200120, China
| |
Collapse
|
21
|
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.
Collapse
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
| | | |
Collapse
|
22
|
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.
Collapse
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
| |
Collapse
|
23
|
Zhang JW, Guo CQ, Zhu SS, Dai N, Liu P, Zhang FB, Zhou HN, Wang JF, Zhou SS, Cao XG. Endoscopic resection of extra-luminal gastric gastrointestinal stromal tumors using a snare assisted external traction technique (with video). Dig Liver Dis 2024:S1590-8658(24)00736-9. [PMID: 38744556 DOI: 10.1016/j.dld.2024.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 04/10/2024] [Accepted: 04/28/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVE The primary purpose of the study was to explore the clinical efficacy of the novel snare assisted endoscopic resection of extraluminal growing gastric gastrointestinal stromal tumors (gastric GISTs) using external traction, and the secondary purpose was to compare the novel snare assisted endoscopic resection of extraluminal GISTs with the standard laparoscopic procedure. METHODS We retrospectively analyzed the patients who underwent novel external traction assisted endoscopic resection or laparoscopic resection for their extraluminal gastric GIST ≤5 cm in diameter. RESULTS A total of 111 patients (27 in the endoscopic group and 84 in the laparoscopic group) were included in this study. There was no significant difference in tumor diameter and complication rate between the two groups. The overall procedure time was slightly higher in the endoscopic group compared to the laparoscopic group (P = 0.034). However, postoperative hospitalization time (P < 0.001) and postoperative fasting time (P = 0.005) were shorter in the endoscopic group compared to the laparoscopic group. CONCLUSION Snare external traction-assisted endoscopic resection of extraluminal growing gastric GISTs is safe and effective, and it provides a new adjunctive method for endoscopic resection of GIST.
Collapse
Affiliation(s)
- Jing-Wen Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Chang-Qing Guo
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Shan-Shan Zhu
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Nan Dai
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Ping Liu
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Fang-Bin Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Hai-Ning Zhou
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Jian-Feng Wang
- Department of Gastroenterology, Nanyang Central Hospital, Nanyang, 473000, Henan, China
| | - Si-Su Zhou
- Department of Gastroenterology, Nanshi Hospital of Nanyang, Nanyang, 473000, Henan, China
| | - Xin-Guang Cao
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China.
| |
Collapse
|
24
|
Maeda C, Yamaoka Y, Shiomi A, Kagawa H, Hino H, Manabe S, Kai C, Nanishi K. Short-term and long-term outcomes after robotic radical surgery for rectal gastrointestinal stromal tumor. BMC Surg 2024; 24:141. [PMID: 38720315 PMCID: PMC11080177 DOI: 10.1186/s12893-024-02434-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 05/03/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND The optimal approach for ensuring both complete resection and preservation of anal function in rectal gastrointestinal stromal tumor (GIST) remains unknown. The aim of this study was to clarify short-term and long-term outcomes after robotic radical surgery for rectal GIST. METHODS A total of 13 patients who underwent robotic radical surgery for rectal GIST between December 2011 and April 2022 were included. All robotic procedures were performed using a systematic approach. A supplemental video of robotic radical surgery for rectal GIST is attached. The short-term outcome was the incidence of postoperative complications during the first 30 days after surgery. Surgical outcomes were retrieved from a prospective database. Long-term outcomes, including overall survival and recurrence-free survival, were determined in all patients. RESULTS Median distance from the tumor to the anal verge was 4.0 cm. Surgical margins were negative in all patients. Two patients underwent neoadjuvant imatinib therapy. All patients underwent sphincter-preserving surgery. None underwent conversion to open or laparoscopic surgery. The incidence of postoperative Clavien-Dindo grade II and grade ≥ III complications was 7.7% and 0%, respectively. The median postoperative hospital stay was 7 days. Twelve patients (92.3%) underwent stoma closure within 5 months of the initial surgery. Median follow-up time was 76 months. The 5-year overall survival and recurrence-free survival rates were both 100%. None of the patients had recurrence. CONCLUSION Short-term and long-term outcomes after radical robotic surgery for rectal GIST were favorable. Robotic surgery might be a useful surgical approach for rectal GIST.
Collapse
Affiliation(s)
- Chikara Maeda
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan
| | - Yusuke Yamaoka
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan.
| | - Akio Shiomi
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan
| | - Hiroyasu Kagawa
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan
| | - Hitoshi Hino
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan
| | - Shoichi Manabe
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan
| | - Chen Kai
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan
| | - Kenji Nanishi
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan
| |
Collapse
|
25
|
Ruan J, He Y, Li Q, Jiang Z, Liu S, Ai J, Mao K, Dong X, Zhang D, Yang G, Gao D, Li Z. A nomogram for predicting liver metastasis in patients with gastric gastrointestinal stromal tumor. J Gastrointest Surg 2024; 28:710-718. [PMID: 38462423 DOI: 10.1016/j.gassur.2024.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/07/2024] [Accepted: 02/17/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Liver metastasis (LIM) is an important factor in the diagnosis, treatment, follow-up, and prognosis of patients with gastric gastrointestinal stromal tumor (GIST). There is no simple tool to assess the risk of LIM in patients with gastric GIST. Our aim was to develop and validate a nomogram to identify patients with gastric GIST at high risk of LIM. METHODS Patient data diagnosed as having gastric GIST between 2010 and 2019 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database and randomly divided into training cohort and internal validation cohort in a 7:3 ratio. For external validation, retrospective data collection was performed on patients diagnosed as having gastric GIST at Yunnan Cancer Center (YNCC) between January 2015 and May 2023. Univariate and multivariate logistic regression analyses were used to identify independent risk factors associated with LIM in patients with gastric GIST. An individualized LIM nomogram specific for gastric GIST was formulated based on the multivariate logistic model; its discriminative performance, calibration, and clinical utility were evaluated. RESULTS In the SEER database, a cohort of 2341 patients with gastric GIST was analyzed, of which 173 cases (7.39%) were found to have LIM; 239 patients with gastric GIST from the YNCC database were included, of which 25 (10.46%) had LIM. Multivariate analysis showed tumor size, tumor site, and sex were independent risk factors for LIM (P < .05). The nomogram based on the basic clinical characteristics of tumor size, tumor site, sex, and age demonstrated significant discrimination, with an area under the curve of 0.753 (95% CI, 0.692-0.814) and 0.836 (95% CI, 0.743-0.930) in the internal and external validation cohort, respectively. The Hosmer-Lemeshow test showed that the nomogram was well calibrated, whereas the decision curve analysis and the clinical impact plot demonstrated its clinical utility. CONCLUSION Tumor size, tumor subsite, and sex were significantly correlated with the risk of LIM in gastric GIST. The nomogram for patients with GIST can effectively predict the individualized risk of LIM and contribute to the planning and decision making related to metastasis management in clinical practice.
Collapse
Affiliation(s)
- Jinqiu Ruan
- Department of Radiology, the Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Yinfu He
- Department of Radiology, the Third People's Hospital of Honghe Hani and Yi Autonomous Prefecture, Gejiu, China
| | - Qingwan Li
- Department of Radiology, the Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Zhaojuan Jiang
- Department of Radiology, the Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Shaoyou Liu
- Department of Oncology Surgery, the Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Jing Ai
- Department of Radiology, the Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Keyu Mao
- Department of Radiology, the Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Xingxiang Dong
- Department of Radiology, the Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Dafu Zhang
- Department of Radiology, the Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Guangjun Yang
- Department of Radiology, the Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Depei Gao
- Department of Radiology, the Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China.
| | - Zhenhui Li
- Department of Radiology, the Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China.
| |
Collapse
|
26
|
Zhang JW, Guo CQ, Zhu SS, Nabi G, Dai N, Wan XY, Liu P, Zhang FB, Fu Y, Cao XG. Comparative Analysis of Enbloc or Piecemeal Removal After Enbloc Resection of Gastrointestinal Stromal Tumors. Dig Dis Sci 2024; 69:1755-1761. [PMID: 38483780 DOI: 10.1007/s10620-024-08340-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/24/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVE To investigate the safety and prognosis of enbloc or piecemeal removal after enbloc resection of a gastric GIST by comparing the clinical data of endoscopic en block resection and piecemeal removal (EP) and en block resection and complete removal (EC) of gastric GISTs. METHODS A total of 111 (43 endoscopic piecemeal, and 68 complete removal) patients with gastric GIST's ≥ 2 cm in diameter who underwent endoscopic therapy from January 2016 to June 2020 at the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed. In all cases, it was ensured that the tumor was intact during the resection, however, it was divided into EP group and EC group based on whether the tumor was completely removed or was cut into pieces which were then removed. The patients' recurrence-free survival rate and recurrence-free survival (RFS) were recorded. RESULTS There was no statistically significant difference in RFS rates between the two groups (P = 0.197). The EP group had relatively high patient age, tumor diameter, risk classification, and operation time. However, there was no statistically significant difference in the number of nuclear fission images, postoperative hospitalization time, postoperative fasting time, complication rate and complication grading between the two groups (P > 0.05). CONCLUSION Endoscopic piecemeal removal after en block resection of gastric GIST is safe and effective and achieves similar clinical outcomes as complete removal after en block resection.
Collapse
Affiliation(s)
- Jing-Wen Zhang
- Department of Digestive Disease, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Chang-Qing Guo
- Department of Digestive Disease, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Shan-Shan Zhu
- Department of Digestive Disease, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Ghulam Nabi
- Institute of Nature Conservation, Polish Academy of Sciences, 31120, Krakow, Poland
| | - Nan Dai
- Department of Digestive Disease, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Xiao-Yu Wan
- Department of Digestive Disease, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Ping Liu
- Department of Digestive Disease, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Fang-Bin Zhang
- Department of Digestive Disease, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Yang Fu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Xin-Gung Cao
- Department of Digestive Disease, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China.
| |
Collapse
|
27
|
Kim Y, Ahn JY, Jung HY, Kang S, Song HJ, Choi KD, Kim DH, Lee JH, Na HK, Park YS. Endoscopic resection of gastric gastrointestinal stromal tumor using clip-and-cut endoscopic full-thickness resection: a single-center, retrospective cohort in Korea. Clin Endosc 2024; 57:350-363. [PMID: 38356170 PMCID: PMC11133991 DOI: 10.5946/ce.2023.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 11/16/2023] [Accepted: 11/19/2023] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND/AIMS To overcome the technical limitations of classic endoscopic resection for gastric gastrointestinal stromal tumors (GISTs), various methods have been developed. In this study, we examined the role and feasibility of clip-and-cut procedures (clip-and-cut endoscopic full-thickness resection [cc-EFTR]) for gastric GISTs. METHODS Medical records of 83 patients diagnosed with GISTs after endoscopic resection between 2005 and 2021 were retrospectively reviewed. Moreover, clinical characteristics and outcomes were analyzed. RESULTS Endoscopic submucosal dissection (ESD) and cc-EFTR were performed in 51 and 32 patients, respectively. The GISTs were detected in the upper third of the stomach for ESD (52.9%) and cc-EFTR (90.6%). Within the cc-EFTR group, a majority of GISTs were located in the deep muscularis propria or serosal layer, accounting for 96.9%, as opposed to those in the ESD group (45.1%). The R0 resection rates were 51.0% and 84.4% in the ESD and cc-EFTR groups, respectively. Seven (8.4%) patients required surgical treatment (six patients underwent ESD and one underwent cc-EFTR,) due to residual tumor (n=5) and post-procedure adverse events (n=2). Patients undergoing R0 or R1 resection did not experience recurrence during a median 14-month follow-up period, except for one patient in the ESD group. CONCLUSIONS cc-EFTR displayed a high R0 resection rate; therefore, it is a safe and effective therapeutic option for small gastric GISTs.
Collapse
Affiliation(s)
- Yuri Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Yong Ahn
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hwoon-Yong Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seokin Kang
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Ho June Song
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee Don Choi
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Do Hoon Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Hoon Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Kyong Na
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Soo Park
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
28
|
Barat M, Pellat A, Terris B, Dohan A, Coriat R, Fishman EK, Rowe SP, Chu L, Soyer P. Cinematic Rendering of Gastrointestinal Stromal Tumours: A Review of Current Possibilities and Future Developments. Can Assoc Radiol J 2024; 75:359-368. [PMID: 37982314 DOI: 10.1177/08465371231211278] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023] Open
Abstract
Gastrointestinal stromal tumours (GISTs) are defined as CD117-positive primary, spindled or epithelioid, mesenchymal tumours of the gastrointestinal tract, omentum, or mesentery. While computed tomography (CT) is the recommended imaging modality for GISTs, overlap in imaging features between GISTs and other gastrointestinal tumours often make radiological diagnosis and subsequent selection of the optimal therapeutic approach challenging. Cinematic rendering is a novel CT post-processing technique that generates highly photorealistic anatomic images based on a unique lighting model. The global lighting model produces high degrees of surface detail and shadowing effects that generate depth in the final three-dimensional display. Early studies have shown that cinematic rendering produces high-quality images with enhanced detail by comparison with other three-dimensional visualization techniques. Cinematic rendering shows promise in improving the visualization of enhancement patterns and internal architecture of abdominal lesions, local tumour extension, and global disease burden, which may be helpful for lesion characterization and pretreatment planning. This article discusses and illustrates the application of cinematic rendering in the evaluation of GISTs and the unique benefit of using cinematic rendering in the workup of GIST with a specific emphasis on tumour characterization and preoperative planning.
Collapse
Affiliation(s)
- Maxime Barat
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hopitaux de Paris, Paris, France
- Université Paris Cité, Faculté de Médecine, Paris, France
| | - Anna Pellat
- Université Paris Cité, Faculté de Médecine, Paris, France
- Department of Gastroenterology and Digestive Oncology, Hôpital Cochin, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Benoit Terris
- Université Paris Cité, Faculté de Médecine, Paris, France
- Department of Pathology, Hôpital Cochin, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Anthony Dohan
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hopitaux de Paris, Paris, France
- Université Paris Cité, Faculté de Médecine, Paris, France
| | - Romain Coriat
- Université Paris Cité, Faculté de Médecine, Paris, France
- Department of Gastroenterology and Digestive Oncology, Hôpital Cochin, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Elliot K Fishman
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Steven P Rowe
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Linda Chu
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Philippe Soyer
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hopitaux de Paris, Paris, France
- Université Paris Cité, Faculté de Médecine, Paris, France
| |
Collapse
|
29
|
Wu L, Liu M, Lin X, Wang C, Yang Y, Fang H, Huang H, Lin R, Lu F. Feasibility and efficacy of minimally invasive limited resection for primary duodenal gastrointestinal stromal tumors: a retrospective cohort study. BMC Surg 2024; 24:126. [PMID: 38678296 PMCID: PMC11055357 DOI: 10.1186/s12893-024-02417-z] [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: 02/21/2024] [Accepted: 04/17/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND The primary duodenal gastrointestinal stromal tumor (GIST) is a rare type of gastrointestinal tract tumor. Limited resection (LR) has been increasingly performed for duodenal GIST. However, only a few studies reported minimally invasive limited resection (MI-LR) for primary duodenal GIST. METHODS The clinical data of 33 patients with primary duodenal GIST from December 2014 to February 2024 were retrospectively analyzed including 23 who received MI-LR and 10 who received laparoscopic or robotic pancreaticoduodenectomy (LPD/RPD). RESULTS A total of 33 patients with primary duodenal GIST were enrolled and retrospectively reviewed. Patients received MI-LR exhibited less OT (280 vs. 388.5min, P=0.004), EBL (100 vs. 450ml, P<0.001), and lower morbidity of postoperative complications (52.2% vs. 100%, P=0.013) than LPD/RPD. Patients received LPD/RPD burdened more aggressive tumors with larger size (P=0.047), higher classification (P<0.001), and more mitotic count/50 HPF(P=0.005) compared with patients received MI-LR. The oncological outcomes were similar in MI-LR group and LPD/RPD group. All the patients underwent MI-LR with no conversion, including 12 cases of LLR and 11 cases of RLR. All of the clinicopathological data of the patients were similar in both groups. The median OT was 280(210-480) min and 257(180-450) min, and the median EBL was 100(20-1000) mL and 100(20-200) mL in the LLR and the RLR group separately. The postoperative complications mainly included DGE (LLR 4 cases, 33.4% and RLR 4 cases, 36.4%), intestinal fistula (LLR 2 cases, 16.7%, and RLR 0 case), gastrointestinal hemorrhage (LLR 0 case and RLR 1 case, 9.1%), and intra-abdominal infection (LLR 3 cases, 25.0% and RLR 1 case, 9.1%). The median postoperative length of hospitalization was 19.5(7-46) days in the LLR group and 19(9-38) days in the RLR group. No anastomotic stenosis, local recurrence or distant metastasis was observed during the follow-up period in the two groups. CONCLUSIONS Minimally invasive limited resection is an optional treatment for primary duodenal GIST with satisfactory short-term and long-term oncological outcomes.
Collapse
Affiliation(s)
- Longhang Wu
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Miao Liu
- Fujian Clinical Research Center for Digestive System Tumors and Upper Gastrointestinal Diseases, Fuzhou, Fujian, China
- Department of Gastrointestinal Endoscopy Nursing, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Xianchao Lin
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Congfei Wang
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Yuanyuan Yang
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Haizong Fang
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Heguang Huang
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Ronggui Lin
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.
| | - Fengchun Lu
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.
| |
Collapse
|
30
|
Yin XN, Wang ZH, Zou L, Yang CW, Shen CY, Liu BK, Yin Y, Liu XJ, Zhang B. Computed tomography radiogenomics: A potential tool for prediction of molecular subtypes in gastric stromal tumor. World J Gastrointest Oncol 2024; 16:1296-1308. [PMID: 38660646 PMCID: PMC11037038 DOI: 10.4251/wjgo.v16.i4.1296] [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: 10/08/2023] [Revised: 01/23/2024] [Accepted: 02/25/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Preoperative knowledge of mutational status of gastrointestinal stromal tumors (GISTs) is essential to guide the individualized precision therapy. AIM To develop a combined model that integrates clinical and contrast-enhanced computed tomography (CE-CT) features to predict gastric GISTs with specific genetic mutations, namely KIT exon 11 mutations or KIT exon 11 codons 557-558 deletions. METHODS A total of 231 GIST patients with definitive genetic phenotypes were divided into a training dataset and a validation dataset in a 7:3 ratio. The models were constructed using selected clinical features, conventional CT features, and radiomics features extracted from abdominal CE-CT images. Three models were developed: ModelCT sign, modelCT sign + rad, and model CTsign + rad + clinic. The diagnostic performance of these models was evaluated using receiver operating characteristic (ROC) curve analysis and the Delong test. RESULTS The ROC analyses revealed that in the training cohort, the area under the curve (AUC) values for modelCT sign, modelCT sign + rad, and modelCT sign + rad + clinic for predicting KIT exon 11 mutation were 0.743, 0.818, and 0.915, respectively. In the validation cohort, the AUC values for the same models were 0.670, 0.781, and 0.811, respectively. For predicting KIT exon 11 codons 557-558 deletions, the AUC values in the training cohort were 0.667, 0.842, and 0.720 for modelCT sign, modelCT sign + rad, and modelCT sign + rad + clinic, respectively. In the validation cohort, the AUC values for the same models were 0.610, 0.782, and 0.795, respectively. Based on the decision curve analysis, it was determined that the modelCT sign + rad + clinic had clinical significance and utility. CONCLUSION Our findings demonstrate that the combined modelCT sign + rad + clinic effectively distinguishes GISTs with KIT exon 11 mutation and KIT exon 11 codons 557-558 deletions. This combined model has the potential to be valuable in assessing the genotype of GISTs.
Collapse
Affiliation(s)
- Xiao-Nan Yin
- Gastric Cancer Research Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Zi-Hao Wang
- Gastric Cancer Research Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Li Zou
- Department of Paediatric Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Cai-Wei Yang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Chao-Yong Shen
- Gastric Cancer Research Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Bai-Ke Liu
- Gastric Cancer Research Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yuan Yin
- Gastric Cancer Research Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Xi-Jiao Liu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Bo Zhang
- Department of Gastrointestinal Surgery, Sichuan University West China Hospital, Chengdu 610041, Sichuan Province, China
| |
Collapse
|
31
|
Xie Z, Suo S, Zhang W, Zhang Q, Dai Y, Song Y, Li X, Zhou Y. Prediction of high Ki-67 proliferation index of gastrointestinal stromal tumors based on CT at non-contrast-enhanced and different contrast-enhanced phases. Eur Radiol 2024; 34:2223-2232. [PMID: 37773213 PMCID: PMC10957607 DOI: 10.1007/s00330-023-10249-3] [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: 05/27/2023] [Revised: 07/12/2023] [Accepted: 07/23/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVES To evaluate and analyze radiomics models based on non-contrast-enhanced computed tomography (CT) and different phases of contrast-enhanced CT in predicting Ki-67 proliferation index (PI) among patients with pathologically confirmed gastrointestinal stromal tumors (GISTs). METHODS A total of 383 patients with pathologically proven GIST were divided into a training set (n = 218, vendor 1) and 2 validation sets (n = 96, vendor 2; n = 69, vendors 3-5). Radiomics features extracted from the most recent non-contrast-enhanced and three contrast-enhanced CT scan prior to pathological examination. Random forest models were trained for each phase to predict tumors with high Ki-67 proliferation index (Ki-67>10%) and were evaluated using the area under the receiver operating characteristic curve (AUC) and other metrics on the validation sets. RESULTS Out of 107 radiomics features extracted from each phase of CT images, four were selected for analysis. The model trained using the non-contrast-enhanced phase achieved an AUC of 0.792 in the training set and 0.822 and 0.711 in the two validation sets, similar to models trained on different contrast-enhanced phases (p > 0.05). Several relevant features, including NGTDM Busyness and tumor size, remained predictive in non-contrast-enhanced and different contrast-enhanced images. CONCLUSION The results of this study indicate that a radiomics model based on non-contrast-enhanced CT matches that of models based on different phases of contrast-enhanced CT in predicting the Ki-67 PI of GIST. GIST may exhibit similar radiological patterns irrespective of the use of contrast agent, and such radiomics features may help quantify these patterns to predict Ki-67 PI of GISTs. CLINICAL RELEVANCE STATEMENT GIST may exhibit similar radiomics patterns irrespective of contrast agent; thus, radiomics models based on non-contrast-enhanced CT could be an alternative for risk stratification in GIST patients with contraindication to contrast agent. KEY POINTS • Performance of radiomics models in predicting Ki-67 proliferation based on different CT phases is evaluated. • Non-contrast-enhanced CT-based radiomics models performed similarly to contrast-enhanced CT in risk stratification in GIST patients. • NGTDM Busyness remains stable to contrast agents in GISTs in radiomics models.
Collapse
Affiliation(s)
- Zhenhui Xie
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shiteng Suo
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wang Zhang
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qingwei Zhang
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China
| | - Yongming Dai
- School of Biomedical Engineering, ShanghaiTech University, Shanghai, China
| | - Yang Song
- MR Scientific Marketing, Siemens Healthineers Ltd., Shanghai, China
| | - Xiaobo Li
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China.
| | - Yan Zhou
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| |
Collapse
|
32
|
Liu Z, Gao J, Zeng C, Chen Y. Development and validation of a preoperative risk nomogram prediction model for gastric gastrointestinal stromal tumors. Surg Endosc 2024; 38:1933-1943. [PMID: 38334780 DOI: 10.1007/s00464-024-10674-5] [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: 08/07/2023] [Accepted: 12/30/2023] [Indexed: 02/10/2024]
Abstract
BACKGROUND AND STUDY AIMS Gastrointestinal stromal tumors (GIST) carry a potential risk of malignancy, and the treatment of GIST varies for different risk levels. However, there is no systematic preoperative assessment protocol to predict the malignant potential of GIST. The aim of this study was to develop a reliable and clinically applicable preoperative nomogram prediction model to predict the malignant potential of gastric GIST. PATIENTS AND METHODS Patients with a pathological diagnosis of gastric GIST from January 2015 to December 2021 were screened retrospectively. Univariate and multivariate logistic analyses were used to identify independent risk factors for gastric GIST with high malignancy potential. Based on these independent risk factors, a nomogram model predicting the malignant potential of gastric GIST was developed and the model was validated in the validation group. RESULTS A total of 494 gastric GIST patients were included in this study and allocated to a development group (n = 345) and a validation group (n = 149). In the development group, multivariate logistic regression analysis revealed that tumor size, tumor ulceration, CT growth pattern and monocyte-to- lymphocyte ratio (MLR) were independent risk factors for gastric GIST with high malignancy potential. The AUC of the model were 0.932 (95% CI 0.890-0.974) and 0.922 (95% CI 0.868-0.977) in the development and validation groups, respectively. The best cutoff value for the development group was 0.184, and the sensitivity and specificity at this value were 0.895 and 0.875, respectively. The calibration curves indicated good agreement between predicted and actual observed outcomes, while the DCA indicated that the nomogram model had clinical application. CONCLUSIONS Tumor size, tumor ulceration, CT growth pattern and MLR are independent risk factors for high malignancy potential gastric GIST, and a nomogram model developed based on these factors has a high ability to predict the malignant potential of gastric GIST.
Collapse
Affiliation(s)
- Zide Liu
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi, China
| | - Jiaxin Gao
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi, China
| | - Chunyan Zeng
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi, China.
- Jiangxi Clinical Research Center for Gastroenterology, Nanchang, Jiangxi, China.
| | - Youxiang Chen
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi, China.
- Jiangxi Clinical Research Center for Gastroenterology, Nanchang, Jiangxi, China.
| |
Collapse
|
33
|
Zeng J, Li K, Cao F, Zheng Y. The development of a prediction model based on deep learning for prognosis prediction of gastrointestinal stromal tumor: a SEER-based study. Sci Rep 2024; 14:6609. [PMID: 38504089 PMCID: PMC10951333 DOI: 10.1038/s41598-024-56701-2] [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: 10/12/2023] [Accepted: 03/09/2024] [Indexed: 03/21/2024] Open
Abstract
Accurately predicting the prognosis of Gastrointestinal stromal tumor (GIST) patients is an important task. The goal of this study was to create and assess models for GIST patients' survival patients using the Surveillance, Epidemiology, and End Results Program (SEER) database based on the three different deep learning models. Four thousand five hundred thirty-eight patients were enrolled in this study and divided into training and test cohorts with a 7:3 ratio; the training cohort was used to develop three different models, including Cox regression, RSF, and DeepSurv model. Test cohort was used to evaluate model performance using c-index, Brier scores, calibration, and the area under the curve (AUC). The net benefits at risk score stratification of GIST patients based on the optimal model was compared with the traditional AJCC staging system using decision curve analysis (DCA). The clinical usefulness of risk score stratification compared to AJCC tumor staging was further assessed using the Net Reclassification Index (NRI) and Integrated Discrimination Improvement (IDI). The DeepSurv model predicted cancer-specific survival (CSS) in GIST patients showed a higher c-index (0.825), lower Brier scores (0.142), and greater AUC of receiver operating characteristic (ROC) analysis (1-year ROC:0.898; 3-year:0.853, and 5-year ROC: 0.856). The calibration plots demonstrated good agreement between the DeepSurv model's forecast and actual results. The NRI values ( training cohort: 0.425 for 1-year, 0.329 for 3-year and 0.264 for 5-year CSS prediction; test cohort:0.552 for 1-year,0.309 for 3-year and 0.255 for 5-year CSS prediction) and IDI (training cohort: 0.130 for 1-year,0.141 for 5-year and 0.155 for 10-year CSS prediction; test cohort: 0.154 for 1-year,0.159 for 3-year and 0.159 for 5-year CSS prediction) indicated that the risk score stratification performed significantly better than the AJCC staging alone (P < 0.001). DCA demonstrated the risk score stratification as more clinically beneficial and discriminatory than AJCC staging. Finally, an interactive native web-based prediction tool was constructed for the survival prediction of GIST patients. This study established a high-performance prediction model for projecting GIST patients based on deep learning, which has advantages in predicting each person's prognosis and risk stratification.
Collapse
Affiliation(s)
- Junjie Zeng
- Department of Gastrointestinal Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, China
| | - Kai Li
- Department of Gastrointestinal Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, China
| | - Fengyu Cao
- Department of Gastrointestinal Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, China
| | - Yongbin Zheng
- Department of Gastrointestinal Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, China.
| |
Collapse
|
34
|
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.
Collapse
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
| |
Collapse
|
35
|
Zidan M, Hassan E, Refaie M. A Successful Central Gastrectomy and Gastro-Gastric Anastomosis for a Large Gastric GIST. J Gastrointest Cancer 2024; 55:202-206. [PMID: 38008873 DOI: 10.1007/s12029-023-00992-7] [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] [Accepted: 11/19/2023] [Indexed: 11/28/2023]
Abstract
PURPOSE Partial gastrectomy is always the preferred technique for GIST resection. Central gastrectomy is a practical technique that can be employed in many situations during the resection of both subepithelial stromal tumors and gastric tumors. CASE PRESENTATION A 53-year-old Egyptian female patient with a 15 × 19 cm large fungating gastric GIST managed by central gastrectomy. Central gastrectomy and gastro-gastric anastomosis were performed with negative resection margins, and the patient received post-operative imatinib, achieving disease control throughout an 8-month post-operative follow-up. CONCLUSION Central gastrectomy is an effective method of partial gastrectomy that can be considered in GIST resection; however, more studies are needed to evaluate the efficiency of central gastrectomy in terms of long-term follow-up and terms of R0 respectability in gastric cancer.
Collapse
Affiliation(s)
- Mohamed Zidan
- Department of Surgery, Alexandria University Hospital, Alexandria, 21568, Egypt.
- Alexandria Endoscopy Association, Alexandria, Egypt.
| | - Eslam Hassan
- Department of Surgery, Borg El Arab General Hospital, Alexandria, Egypt
| | - Mostafa Refaie
- Department of Surgery, Alexandria University Hospital, Alexandria, 21568, Egypt
- Faculty of Medicine, Alexandria University, Alexandria, 21568, Egypt
| |
Collapse
|
36
|
Barat M, Pellat A, Hoeffel C, Dohan A, Coriat R, Fishman EK, Nougaret S, Chu L, Soyer P. CT and MRI of abdominal cancers: current trends and perspectives in the era of radiomics and artificial intelligence. Jpn J Radiol 2024; 42:246-260. [PMID: 37926780 DOI: 10.1007/s11604-023-01504-0] [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: 09/13/2023] [Accepted: 10/12/2023] [Indexed: 11/07/2023]
Abstract
Abdominal cancers continue to pose daily challenges to clinicians, radiologists and researchers. These challenges are faced at each stage of abdominal cancer management, including early detection, accurate characterization, precise assessment of tumor spread, preoperative planning when surgery is anticipated, prediction of tumor aggressiveness, response to therapy, and detection of recurrence. Technical advances in medical imaging, often in combination with imaging biomarkers, show great promise in addressing such challenges. Information extracted from imaging datasets owing to the application of radiomics can be used to further improve the diagnostic capabilities of imaging. However, the analysis of the huge amount of data provided by these advances is a difficult task in daily practice. Artificial intelligence has the potential to help radiologists in all these challenges. Notably, the applications of AI in the field of abdominal cancers are expanding and now include diverse approaches for cancer detection, diagnosis and classification, genomics and detection of genetic alterations, analysis of tumor microenvironment, identification of predictive biomarkers and follow-up. However, AI currently has some limitations that need further refinement for implementation in the clinical setting. This review article sums up recent advances in imaging of abdominal cancers in the field of image/data acquisition, tumor detection, tumor characterization, prognosis, and treatment response evaluation.
Collapse
Affiliation(s)
- Maxime Barat
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hopitaux de Paris, 75014, Paris, France
- Faculté de Médecine, Université Paris Cité, 75006, Paris, France
| | - Anna Pellat
- Faculté de Médecine, Université Paris Cité, 75006, Paris, France
- Department of Gastroenterology and Digestive Oncology, Hôpital Cochin, Assistance Publique-Hopitaux de Paris, 75014, Paris, France
| | - Christine Hoeffel
- Department of Radiology, Hopital Robert Debré, CHU Reims, Université Champagne-Ardennes, 51092, Reims, France
| | - Anthony Dohan
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hopitaux de Paris, 75014, Paris, France
- Faculté de Médecine, Université Paris Cité, 75006, Paris, France
| | - Romain Coriat
- Faculté de Médecine, Université Paris Cité, 75006, Paris, France
- Department of Gastroenterology and Digestive Oncology, Hôpital Cochin, Assistance Publique-Hopitaux de Paris, 75014, Paris, France
| | - Elliot K Fishman
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Stéphanie Nougaret
- Department of Radiology, Montpellier Cancer Institute, 34000, Montpellier, France
- PINKCC Lab, IRCM, U1194, 34000, Montpellier, France
| | - Linda Chu
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Philippe Soyer
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hopitaux de Paris, 75014, Paris, France.
- Faculté de Médecine, Université Paris Cité, 75006, Paris, France.
| |
Collapse
|
37
|
Khan M, Urban C, Vanwyk A, Everin O, Mitchell N, Chung M, Assifi MM, Wright GP. Utility and costs of surveillance imaging for low- and very low-risk gastrointestinal stromal tumors. Surgery 2024; 175:752-755. [PMID: 38097482 DOI: 10.1016/j.surg.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 09/27/2023] [Accepted: 10/24/2023] [Indexed: 02/04/2024]
Abstract
BACKGROUND There is limited evidence on the optimal surveillance approach in patients with low- and very low-risk gastrointestinal stromal tumors, resulting in inconsistent and arbitrary approaches to surveillance in this population. In this study, we reviewed our institutional approach to surveillance in patients with low- and very low-risk gastrointestinal stromal tumors and the costs associated with detecting recurrence. METHODS We retrospectively reviewed consecutive adult patients treated for low- and very low-risk gastrointestinal stromal tumors at our institution from 2010 to 2019. Data collected included patient and tumor characteristics, surgical management, and postoperative follow-up. Surveillance-related expenses were calculated using estimates of average costs obtained from our institution. A cost analysis was performed to evaluate estimated yearly costs based on the surveillance strategy used. RESULTS There were 60 patients included. The mean age at diagnosis was 63.9 (±12.5) years. The primary tumor was typically in the stomach (73%; n = 44). Computed tomography scan of the abdomen and pelvis with intravenous contrast was the most common surveillance modality (total = 226 scans). No recurrences were identified. Median follow-up duration was 49.0 (interquartile range = 19.5-61.5) months. The mean number of surveillance images per patient was 4 (±2.6). Surveillance imaging was obtained more frequently than just annually in 83% (n = 50) of patients, with an estimated yearly cost of $2,840.77 (interquartile range = $2,273.62-$3,895.92) and no detection of recurrence. CONCLUSION In this study population, patients with low- and very low-risk gastrointestinal stromal tumors underwent frequent imaging studies for surveillance with little yield and at substantial cost. Further multi-institutional studies on practice patterns and outcomes of surveillance are warranted to better inform standardized surveillance recommendations.
Collapse
Affiliation(s)
- Mariam Khan
- General Surgery Residency, Corewell Health - Grand Rapids/Michigan State University, Grand Rapids, MI.
| | - Caitlin Urban
- College of Human Medicine, Michigan State University, Grand Rapids, MI
| | - Austin Vanwyk
- College of Human Medicine, Michigan State University, Grand Rapids, MI
| | - Olivia Everin
- College of Human Medicine, Michigan State University, Grand Rapids, MI
| | - Nicole Mitchell
- Office of Research and Education, Corewell Health - Grand Rapids/Michigan State University, Grand Rapids, MI
| | - Mathew Chung
- Division of Surgical Oncology, Corewell Health - Grand Rapids/Michigan State University, Grand Rapids, MI
| | - M Mura Assifi
- Division of Surgical Oncology, Corewell Health - Grand Rapids/Michigan State University, Grand Rapids, MI
| | - G Paul Wright
- Division of Surgical Oncology, Corewell Health - Grand Rapids/Michigan State University, Grand Rapids, MI
| |
Collapse
|
38
|
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.
Collapse
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
| | | |
Collapse
|
39
|
He Z, Du C, Cheng B, Feng J, Wang N, Ma Y, Li L, Zhang B, Wang H, Tang P, Chai N, Linghu E. Endoscopic resection for the treatment of gastric gastrointestinal stromal tumors: a retrospective study from a large tertiary hospital in China. Surg Endosc 2024; 38:1398-1405. [PMID: 38148402 DOI: 10.1007/s00464-023-10619-4] [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: 10/15/2023] [Accepted: 11/28/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND AND AIMS With the continuous development of endoscopic technology, endoscopic resection (ER) has gradually become an optional method for the treatment of gastric gastrointestinal stromal tumors (GISTs). However, studies with a large sample or a long follow-up are lacking. Therefore, this research aims to evaluate the efficacy and safety of ER for gastric GISTs in the real-world setting with more than 300 enrolled patients and a follow-up period longer than 45 months. METHODS From January 2013 to February 2023, 409 patients with a pathological diagnosis of GISTs after ER were retrospectively enrolled in this study. After excluding 86 patients with non-gastric GISTs, we assessed 323 patients with gastric GISTs. The main outcome measures were en bloc resection, complete resection, residual disease, recurrence, and complications. RESULTS There were 194 (60.06%) females and 129 (39.94%) males, and the median age of the included patients was 58 years (51, 63). The median tumor size was 15.0 (10.0, 20.0) mm. According to the modified NIH criteria, 246 (75.85%) patients were classified as very low risk, 62 (19.20%) were classified as low risk, 12 (3.72%) were classified as moderate risk, and 3 (0.93%) were classified as high risk. A total of 287 (88.85%) patients achieved en bloc resection, and 287 (88.85%) also achieved complete resection. Only one patient showed residual and no recurrent lesions were noted during the follow-up. Regarding complications, three patients had complications, with a complication rate of 0.93%, and no severe complications requiring surgical intervention occurred. CONCLUSION ER is an appropriate alternative method for the treatment of gastric GISTs, with an en bloc resection rate of 88.85% and a complication rate of 0.93%. No recurrence was noted during follow-up, even for GISTs with piecemeal resection.
Collapse
Affiliation(s)
- Zhengting He
- Senior Department of Gastroenterology, The First Medical Center of PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Chen Du
- Senior Department of Gastroenterology, The First Medical Center of PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Bingqian Cheng
- Senior Department of Gastroenterology, The First Medical Center of PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Jiancong Feng
- Senior Department of Gastroenterology, The First Medical Center of PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Nanjun Wang
- Senior Department of Gastroenterology, The First Medical Center of PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Yan Ma
- Senior Department of Gastroenterology, The First Medical Center of PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Longsong Li
- Senior Department of Gastroenterology, The First Medical Center of PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Bo Zhang
- Senior Department of Gastroenterology, The First Medical Center of PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Hongbin Wang
- Senior Department of Gastroenterology, The First Medical Center of PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Ping Tang
- Senior Department of Gastroenterology, The First Medical Center of PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Ningli Chai
- Senior Department of Gastroenterology, The First Medical Center of PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China.
| | - Enqiang Linghu
- Senior Department of Gastroenterology, The First Medical Center of PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China.
| |
Collapse
|
40
|
Sun M, Tong Y, Yuan W, Wang Y, Pu Y, Huang W, Lv B, Xu C, Jiang W, Luo R, Fang R, Tang S, Ren L, Wang J, Feng J, Sun C, Shen K, He F, Hou Y, Ding C. Proteomic Characterization Identifies Clinically Relevant Subgroups of Gastrointestinal Stromal Tumors. Gastroenterology 2024; 166:450-465.e33. [PMID: 37995868 DOI: 10.1053/j.gastro.2023.11.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 11/06/2023] [Accepted: 11/14/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND & AIMS Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal tract, and it has high metastatic and recurrence rates. We aimed to characterize the proteomic features of GIST to understand biological processes and treatment vulnerabilities. METHODS Quantitative proteomics and phosphoproteomics analyses were performed on 193 patients with GIST to reveal the biological characteristics of GIST. Data-driven hypotheses were tested by performing functional experiments using both GIST cell lines and xenograft mouse models. RESULTS Proteomic analysis revealed differences in the molecular features of GISTs from different locations or with different histological grades. MAPK7 was identified and functionally proved to be associated with tumor cell proliferation in GIST. Integrative analysis revealed that increased SQSTM1 expression inhibited the patient response to imatinib mesylate. Proteomics subtyping identified 4 clusters of tumors with different clinical and molecular attributes. Functional experiments confirmed the role of SRSF3 in promoting tumor cell proliferation and leading to poor prognosis. CONCLUSIONS Our study provides a valuable data resource and highlights potential therapeutic approaches for GIST.
Collapse
Affiliation(s)
- Mingjun Sun
- Institutes of Biomedical Sciences, State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Human Phenome Institute, Department of Pathology, Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yexin Tong
- Institutes of Biomedical Sciences, State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Human Phenome Institute, Department of Pathology, Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei Yuan
- Institutes of Biomedical Sciences, State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Human Phenome Institute, Department of Pathology, Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yunzhi Wang
- Institutes of Biomedical Sciences, State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Human Phenome Institute, Department of Pathology, Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yan Pu
- Institutes of Biomedical Sciences, State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Human Phenome Institute, Department of Pathology, Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wen Huang
- Institutes of Biomedical Sciences, State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Human Phenome Institute, Department of Pathology, Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Boqiong Lv
- Department of Hepatobiliary Surgery, Anhui Provincial Clinical Research Center for Hepatobiliary Diseases, Anhui Province Key Laboratory of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China; Chinese Academy of Sciences (CAS) Key Laboratory of Innate Immunity and Chronic Disease, School of Basic Medical Sciences, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China; Institute of Immunology, University of Science and Technology of China, Hefei, China
| | - Chen Xu
- Institutes of Biomedical Sciences, State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Human Phenome Institute, Department of Pathology, Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei Jiang
- State Key Laboratory of Cell Biology, Shanghai Institute of Biochemistry and Cell Biology, Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai, China
| | - Rongkui Luo
- Institutes of Biomedical Sciences, State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Human Phenome Institute, Department of Pathology, Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Rundong Fang
- Institutes of Biomedical Sciences, State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Human Phenome Institute, Department of Pathology, Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shaoshuai Tang
- Institutes of Biomedical Sciences, State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Human Phenome Institute, Department of Pathology, Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lei Ren
- Institutes of Biomedical Sciences, State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Human Phenome Institute, Department of Pathology, Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiachen Wang
- Institutes of Biomedical Sciences, State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Human Phenome Institute, Department of Pathology, Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jinwen Feng
- Institutes of Biomedical Sciences, State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Human Phenome Institute, Department of Pathology, Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Cheng Sun
- Department of Hepatobiliary Surgery, Anhui Provincial Clinical Research Center for Hepatobiliary Diseases, Anhui Province Key Laboratory of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China; Chinese Academy of Sciences (CAS) Key Laboratory of Innate Immunity and Chronic Disease, School of Basic Medical Sciences, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China; Institute of Immunology, University of Science and Technology of China, Hefei, China
| | - Kuntang Shen
- Institutes of Biomedical Sciences, State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Human Phenome Institute, Department of Pathology, Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Fuchu He
- Institutes of Biomedical Sciences, State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Human Phenome Institute, Department of Pathology, Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; State Key Laboratory of Proteomics, Beijing Proteome Research Center, National Center for Protein Sciences, Beijing, China; Research Unit of Proteomics Driven Cancer Precision Medicine. Chinese Academy of Medical Sciences, Beijing, China.
| | - Yingyong Hou
- Institutes of Biomedical Sciences, State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Human Phenome Institute, Department of Pathology, Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Chen Ding
- Institutes of Biomedical Sciences, State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Human Phenome Institute, Department of Pathology, Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
| |
Collapse
|
41
|
Cao L, Lin C, Liu Y, Sui C, Li Z, Chen L, Guan W, Tao L, Tao T, Wang M, Wang F. Clinical characteristics and prognostic analysis of postoperative recurrence or metastasis of low-risk gastrointestinal stromal tumors. World J Surg Oncol 2024; 22:65. [PMID: 38395931 PMCID: PMC10885449 DOI: 10.1186/s12957-024-03339-z] [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: 12/11/2023] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the digestive tract. This study aimed to investigate the clinical characteristics and prognosis of postoperative recurrence or metastasis in patients with low-risk stromal tumors, in order to take individualized postoperative management and treatment for patients with low-risk GISTs with relatively high recurrence. METHODS We retrospectively analyzed the clinicopathological and follow-up data of patients with GISTs who underwent surgical resection in Nanjing Drum Tower Hospital from March 2010 to December 2021. A total of 282 patients with low-risk GISTs were included, none of whom were treated with imatinib. Univariate and multivariate Cox analysis and survival curves were used to explore the relationship between clinical features and recurrence or metastasis in patients with low-risk GISTs. RESULTS Of the 282 patients with low-risk GISTs who met inclusion criteria, 14 (4.96%) had recurrence or metastasis. There was a correlation between tumor size, primary site, resection type, Ki67 index, neutrophil lymphocyte ratio (NLR) and CD34 expression and postoperative recurrence or metastasis of GISTs (P < 0.05). Subsequently, multifactorial analysis showed that tumor primary site, tumor size, and Ki67 index were independent risk factors affecting postoperative recurrent or metastasis in patients with low-risk GISTs (P < 0.05). Ultimately, According to Kaplan-Meier analysis, non-gastric primary tumors, larger tumors, and high Ki67 index were significantly associated with poor progression-free survival ( PFS ). CONCLUSIONS Tumor location, tumor size and Ki-67 were independent risk factors for postoperative recurrence and metastasis in patients with low-risk GISTs. Based on the 2008 modified NIH recurrence risk grading system, combined with the above three factors, it can be used to evaluate the prognosis of patients with low-risk GISTs and provide personalized postoperative review and follow-up management recommendations.
Collapse
Affiliation(s)
- Lianlian Cao
- Division of Gastric Surgery, Department of General Surgery, Nanjing Drum Tower Hospital, Drum Tower Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Chen Lin
- Division of Gastric Surgery, Department of General Surgery, Nanjing Drum Tower Hospital, Drum Tower Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yu Liu
- Division of Gastric Surgery, Department of General Surgery, Nanjing Drum Tower Hospital, Drum Tower Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Chao Sui
- Division of Gastric Surgery, Department of General Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Zhaoping Li
- Division of Gastric Surgery, Department of General Surgery, Nanjing Drum Tower Hospital, Drum Tower Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Li Chen
- Division of Gastric Surgery, Department of General Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Wenxian Guan
- Division of Gastric Surgery, Department of General Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Liang Tao
- Division of Gastric Surgery, Department of General Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Tingting Tao
- Division of Gastric Surgery, Department of General Surgery, Nanjing Drum Tower Hospital, Drum Tower Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China.
- Department of General Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
| | - Meng Wang
- Division of Gastric Surgery, Department of General Surgery, Nanjing Drum Tower Hospital, Drum Tower Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China.
- Division of Gastric Surgery, Department of General Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
| | - Feng Wang
- Division of Gastric Surgery, Department of General Surgery, Nanjing Drum Tower Hospital, Drum Tower Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China.
- Division of Gastric Surgery, Department of General Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
| |
Collapse
|
42
|
Yoshinami Y, Nishimura E, Hosokai T, Yamamoto S, Matsuda S, Nomura M, Kawakubo H, Kato K, Kitagawa Y. Rare malignant neoplasm of the esophagus: current status and future perspectives. Jpn J Clin Oncol 2024; 54:111-120. [PMID: 37861097 PMCID: PMC10849183 DOI: 10.1093/jjco/hyad144] [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: 06/14/2023] [Accepted: 09/29/2023] [Indexed: 10/21/2023] Open
Abstract
Esophageal cancer is common worldwide, including in Japan, and its major histological subtype is squamous cell carcinoma. However, there are some rare esophageal cancers, including neuroendocrine neoplasm, gastrointestinal stromal tumor, carcinosarcoma and malignant melanoma. The biological and clinical features of these cancers differ from those of esophageal squamous cell carcinoma. Therefore, different treatment strategies are needed for these cancers but are based on limited evidence. Neuroendocrine neoplasm is mainly divided into neuroendocrine tumor and neuroendocrine carcinoma by differentiation and the Ki-67 proliferation index or mitotic index. Epidemiologically, the majority of esophageal neuroendocrine neoplasms are neuroendocrine carcinoma. The treatment of neuroendocrine carcinoma is similar to that of small cell lung cancer, which has similar morphological and biological features. Gastrointestinal stromal tumor is known to be associated with alterations in the c-KIT and platelet-derived growth factor receptor genes and, if resectable, is treated in accordance with the modified Fletcher classification. Carcinosarcoma is generally resistant to both chemotherapy and radiotherapy and requires multimodal treatments such as surgery plus chemotherapy to achieve cure. Primary malignant melanoma is resistant to cytotoxic chemotherapy, but immune checkpoint inhibitors have recently demonstrated efficacy for malignant melanoma of the esophagus. This review focuses on the current status and future perspectives for rare cancer of the esophagus.
Collapse
Affiliation(s)
- Yuri Yoshinami
- Department of Head and Neck, Esophageal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Erica Nishimura
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Taisuke Hosokai
- Department of Clinical Oncology, Kyoto University Hospital, Kyoto, Japan
| | - Shun Yamamoto
- Department of Head and Neck, Esophageal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Satoru Matsuda
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Motoo Nomura
- Department of Clinical Oncology, Kyoto University Hospital, Kyoto, Japan
| | - Hirofumi Kawakubo
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Ken Kato
- Department of Head and Neck, Esophageal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
43
|
Barat M, Pellat A, Dohan A, Hoeffel C, Coriat R, Soyer P. CT and MRI of Gastrointestinal Stromal Tumors: New Trends and Perspectives. Can Assoc Radiol J 2024; 75:107-117. [PMID: 37386745 DOI: 10.1177/08465371231180510] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are defined as mesenchymal tumors of the gastrointestinal tract that express positivity for CD117, which is a c-KIT proto-oncogene antigen. Expression of the c-KIT protein, a tyrosine kinase growth factor receptor, allows the distinction between GISTs and other mesenchymal tumors such as leiomyoma, leiomyosarcoma, schwannoma and neurofibroma. GISTs can develop anywhere in the gastrointestinal tract, as well as in the mesentery and omentum. Over the years, the management of GISTs has improved due to a better knowledge of their behaviors and risk or recurrence, the identification of specific mutations and the use of targeted therapies. This has resulted in a better prognosis for patients with GISTs. In parallel, imaging of GISTs has been revolutionized by tremendous progress in the field of detection, characterization, survival prediction and monitoring during therapy. Recently, a particular attention has been given to radiomics for the characterization of GISTs using analysis of quantitative imaging features. In addition, radiomics has currently many applications that are developed in conjunction with artificial intelligence with the aim of better characterizing GISTs and providing a more precise assessment of tumor burden. This article sums up recent advances in computed tomography and magnetic resonance imaging of GISTs in the field of image/data acquisition, tumor detection, tumor characterization, treatment response evaluation, and preoperative planning.
Collapse
Affiliation(s)
- Maxime Barat
- Department of Radiology, Hopital Cochin, Paris, France
- Université Paris Cité, Faculté de Médecine, Paris, France
| | - Anna Pellat
- Université Paris Cité, Faculté de Médecine, Paris, France
- Department of Gastroenterology and Digestive Oncology, Hôpital Cochin, Paris, France
| | - Anthony Dohan
- Department of Radiology, Hopital Cochin, Paris, France
- Université Paris Cité, Faculté de Médecine, Paris, France
| | - Christine Hoeffel
- Reims Medical School, Department of Radiology, Hopital Robert Debré, CHU Reims, Université Champagne-Ardennes, Reims, France
| | - Romain Coriat
- Université Paris Cité, Faculté de Médecine, Paris, France
- Department of Gastroenterology and Digestive Oncology, Hôpital Cochin, Paris, France
| | - Philippe Soyer
- Department of Radiology, Hopital Cochin, Paris, France
- Université Paris Cité, Faculté de Médecine, Paris, France
| |
Collapse
|
44
|
Sasa K, Son R, Oguchi A, Ashizawa K, Hasegawa N, Kubota D, Suehara Y, Takagi T, Okubo T, Akaike K, Sugimoto K, Takahashi M, Sakamoto K, Hashimoto T, Mine S, Fukunaga T, Ishijima M, Hayashi T, Yao T, Murakawa Y, Saito T. NTRK2 expression in gastrointestinal stromal tumors with a special emphasis on the clinicopathological and prognostic impacts. Sci Rep 2024; 14:768. [PMID: 38191907 PMCID: PMC10774370 DOI: 10.1038/s41598-024-51211-7] [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: 06/26/2023] [Accepted: 01/02/2024] [Indexed: 01/10/2024] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are typically characterized by activating mutations of the KIT proto-oncogene receptor tyrosine kinase (KIT) or platelet-derived growth factor receptor alpha (PDGFRA). Recently, the neurotrophic tyrosine receptor kinase (NTRK) fusion was reported in a small subset of wild-type GIST. We examined trk IHC and NTRK gene expressions in GIST. Pan-trk immunohistochemistry (IHC) was positive in 25 (all 16 duodenal and 9 out of 16 small intestinal GISTs) of 139 cases, and all pan-trk positive cases showed diffuse and strong expression of c-kit. Interestingly, all of these cases showed only trkB but not trkA/trkC expression. Cap analysis of gene expression (CAGE) analysis identified increased number of genes whose promoters were activated in pan-trk/trkB positive GISTs. Imbalanced expression of NTRK2, which suggests the presence of NTRK2 fusion, was not observed in any of trkB positive GISTs, despite higher mRNA expression. TrkB expression was found in duodenal GISTs and more than half of small intestinal GISTs, and this subset of cases showed poor prognosis. However, there was not clear difference in clinical outcomes according to the trkB expression status in small intestinal GISTs. These findings may provide a possible hypothesis for trkB overexpression contributing to the tumorigenesis and aggressive clinical outcome in GISTs of duodenal origin.
Collapse
Affiliation(s)
- Keita Sasa
- Department of Human Pathology, Juntendo University School of Medicine, Tokyo, Japan
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University School of Medicine, Tokyo, Japan
| | - Raku Son
- RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Akiko Oguchi
- RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Karin Ashizawa
- Department of Human Pathology, Juntendo University School of Medicine, Tokyo, Japan
| | - Nobuhiko Hasegawa
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University School of Medicine, Tokyo, Japan
| | - Daisuke Kubota
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University School of Medicine, Tokyo, Japan
| | - Yoshiyuki Suehara
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University School of Medicine, Tokyo, Japan
| | - Tatsuya Takagi
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University School of Medicine, Tokyo, Japan
| | - Taketo Okubo
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University School of Medicine, Tokyo, Japan
| | - Keisuke Akaike
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University School of Medicine, Tokyo, Japan
- Department of Orthopaedic Surgery, Yamanashi Central Hospital, Yamanashi, Japan
| | - Kiichi Sugimoto
- Department of Coloproctological Surgery, Graduate School of Medicine, Juntendo University, Tokyo, 113-8421, Japan
| | - Makoto Takahashi
- Department of Coloproctological Surgery, Graduate School of Medicine, Juntendo University, Tokyo, 113-8421, Japan
| | - Kazuhiro Sakamoto
- Department of Coloproctological Surgery, Graduate School of Medicine, Juntendo University, Tokyo, 113-8421, Japan
| | - Takashi Hashimoto
- Department of Upper Gastroenterological Surgery, Juntendo University Hospital, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Shinji Mine
- Department of Upper Gastroenterological Surgery, Juntendo University Hospital, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Tetsu Fukunaga
- Department of Upper Gastroenterological Surgery, Juntendo University Hospital, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Muneaki Ishijima
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University School of Medicine, Tokyo, Japan
- Intractable Disease Research Center, Graduate School of Medicine, Juntendo University, Tokyo, 113-8421, Japan
| | - Takuo Hayashi
- Department of Human Pathology, Juntendo University School of Medicine, Tokyo, Japan
| | - Takashi Yao
- Department of Human Pathology, Juntendo University School of Medicine, Tokyo, Japan
| | - Yasuhiro Murakawa
- RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
- Institute for the Advanced Study of Human Biology (ASHBi), Kyoto University, Kyoto, Japan
- IFOM ETS - the AIRC Institute of Molecular Oncology, Milan, Italy
| | - Tsuyoshi Saito
- Department of Human Pathology, Juntendo University School of Medicine, Tokyo, Japan.
- Intractable Disease Research Center, Graduate School of Medicine, Juntendo University, Tokyo, 113-8421, Japan.
| |
Collapse
|
45
|
Trembath HE, Yeh JJ, Lopez NE. Gastrointestinal Malignancy: Genetic Implications to Clinical Applications. Cancer Treat Res 2024; 192:305-418. [PMID: 39212927 DOI: 10.1007/978-3-031-61238-1_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Advances in molecular genetics have revolutionized our understanding of the pathogenesis, progression, and therapeutic options for treating gastrointestinal (GI) cancers. This chapter provides a comprehensive overview of the molecular landscape of GI cancers, focusing on key genetic alterations implicated in tumorigenesis across various anatomical sites including GIST, colon and rectum, and pancreas. Emphasis is placed on critical oncogenic pathways, such as mutations in tumor suppressor genes, oncogenes, chromosomal instability, microsatellite instability, and epigenetic modifications. The role of molecular biomarkers in predicting prognosis, guiding treatment decisions, and monitoring therapeutic response is discussed, highlighting the integration of genomic profiling into clinical practice. Finally, we address the evolving landscape of precision oncology in GI cancers, considering targeted therapies and immunotherapies.
Collapse
Affiliation(s)
- Hannah E Trembath
- Division of Colon and Rectal Surgery, Department of Surgery, University of California San Diego, 4303 La Jolla Village Drive Suite 2110, San Diego, CA, 92122, USA
- Division of Surgical Oncology, Department of Surgery, University of North Carolina, 170 Manning Drive, CB#7213, 1150 Physician's Office Building, Chapel Hill, NC, 27599-7213, USA
| | - Jen Jen Yeh
- Division of Colon and Rectal Surgery, Department of Surgery, University of California San Diego, 4303 La Jolla Village Drive Suite 2110, San Diego, CA, 92122, USA
- Division of Surgical Oncology, Department of Surgery, University of North Carolina, 170 Manning Drive, CB#7213, 1150 Physician's Office Building, Chapel Hill, NC, 27599-7213, USA
| | - Nicole E Lopez
- Division of Colon and Rectal Surgery, Department of Surgery, University of California San Diego, 4303 La Jolla Village Drive Suite 2110, San Diego, CA, 92122, USA.
- Division of Surgical Oncology, Department of Surgery, University of North Carolina, 170 Manning Drive, CB#7213, 1150 Physician's Office Building, Chapel Hill, NC, 27599-7213, USA.
| |
Collapse
|
46
|
Schroder PM, Biesterveld BE, Al-Adra DP. Premalignant Lesions in the Kidney Transplant Candidate. Semin Nephrol 2024; 44:151495. [PMID: 38490902 DOI: 10.1016/j.semnephrol.2024.151495] [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] [Indexed: 03/17/2024]
Abstract
End-stage kidney disease patients who are referred for transplant undergo an extensive evaluation process to ensure their health prior to transplant due in part to the shortage of available organs. Although management and surveillance guidelines exist for malignancies identified in the transplant and waitlist populations, less is written about the management of premalignant lesions in this population. This review covers the less common premalignant lesions (intraductal papillary mucinous neoplasm, gastrointestinal stromal tumor, thymoma, and pancreatic neuroendocrine tumor) that can be found in the transplant candidate population. High-level evidence for the management of these rarer premalignant lesions in the transplant population is lacking, and this review extrapolates evidence from the general population and should not be a substitute for a multidisciplinary discussion with medical and surgical oncologists.
Collapse
Affiliation(s)
- Paul M Schroder
- Department of Surgery, Division of Transplantation, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Ben E Biesterveld
- Department of Surgery, Division of Transplantation, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - David P Al-Adra
- Department of Surgery, Division of Transplantation, University of Wisconsin School of Medicine and Public Health, Madison, WI.
| |
Collapse
|
47
|
Shou C, Chen Z, Li Z, Yang W, Zhang Q, Bai H, Yu J. Gastric gastrointestinal stromal tumors: therapeutic strategies and long-term prognosis. Scand J Gastroenterol 2024; 59:239-245. [PMID: 37865826 DOI: 10.1080/00365521.2023.2270758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/09/2023] [Indexed: 10/23/2023]
Abstract
OBJECTIVES This study aimed to evaluate the clinical and prognostic characteristics of primary gastric gastrointestinal stromal tumors (GIST). METHODS Patients who underwent resection for primary gastric GIST between January 2002 and December 2017 were included. Recurrence-free survival (RFS) was calculated by Kaplan-Meier analysis, and Cox proportional hazards model was used to identify independent prognostic factors. RESULTS Altogether, 653 patients were enrolled. The median patient age was 59 years (range 15-86 years). Open, laparoscopic, and endoscopic resections were performed in 394 (60.3%), 105 (16.1%), and 154 (23.6%) patients, respectively. According to the modified NIH consensus classification, 132 (20.2%), 245 (37.5%), 166 (25.4%), and 88 (13.5%) patients were categorized into very low-, low-, intermediate-, and high-risk, respectively. A total of 136 (20.8%) patients received adjuvant imatinib treatment. The median follow-up time was 78 months (range 4-219 months), and the estimated 5-year RFS rate was 93.0%. In all patients, tumor size and rupture, mitotic counts, and adjuvant imatinib treatment were independent prognostic factors. The prognosis of gastric GIST treated with endoscopic resection was not significantly different from that of laparoscopic or open resection after adjusting for covariates using propensity score matching (log-rank p = .558). Adjuvant imatinib treatment (HR = 0.151, 95%CI 0.055-0.417, p < .001) was a favorable prognostic factor for high-risk patients, but was not associated with prognosis in intermediate-risk patients. CONCLUSION Patients with small gastric GISTs who successfully underwent endoscopic resection may have a favorable prognosis. Adjuvant imatinib treatment improve the prognosis of high-risk gastric GISTs, however, its use in intermediate-risk patients remains controversial.
Collapse
Affiliation(s)
- Chunhui Shou
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhou Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhijian Li
- Cancer Institute and Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Weili Yang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qing Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hao Bai
- Department of Epidemiology and Biostatistics, School of Public Health, Zhejiang University, Hangzhou, China
| | - Jiren Yu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
48
|
Zhuo M, Tang Y, Guo J, Qian Q, Xue E, Chen Z. Predicting the risk stratification of gastrointestinal stromal tumors using machine learning-based ultrasound radiomics. J Med Ultrason (2001) 2024; 51:71-82. [PMID: 37798591 DOI: 10.1007/s10396-023-01373-0] [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: 07/15/2023] [Accepted: 08/21/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE This study aimed to use conventional ultrasound features, ultrasound radiomics, and machine learning algorithms to establish a predictive model to assess the risk of post-surgical recurrence of gastrointestinal stromal tumors (GISTs). METHODS This retrospective analysis included 230 patients with pathologically diagnosed GISTs. Radiomic features were extracted from manually annotated images. Radiomic features plus conventional ultrasound features were selected using the SelectKbest analysis of variance and stratified tenfold cross-validation recursive elimination methods. Finally, five different machine learning algorithms (logistic regression [LR], support vector machine [SVM], random forest [RF], extreme gradient boosting [XGBoost], and multilayer perceptron [MLP]) were established to predict risk stratification of GISTs. The predictive performance of the established model was mainly evaluated based on the area under the receiver operating characteristic (ROC) curve (AUC) and accuracy, whereas the predictive performance of the optimal machine learning algorithm and a radiologist's subjective assessment were compared using McNemar's test. RESULTS Seven radiomics features and one conventional ultrasound feature were selected to construct the machine learning models for GIST risk classification. The mentioned five machine learning models were able to predict the malignant potential of GISTs. LR and SVM outperformed other classifiers on the test set, with LR achieving an accuracy of 0.852 (AUC, 0.881; sensitivity, 0.871; specificity, 0.826) and SVM achieving an accuracy of 0.852 (AUC, 0.879; sensitivity, 0.839; specificity, 0.870), and proved significantly better than the radiologist (accuracy, 0.691; sensitivity, 0.645; specificity, 0.813). CONCLUSION Machine learning-based ultrasound radiomics features are able to noninvasively predict the biological risk of GISTs.
Collapse
Affiliation(s)
- Minling Zhuo
- Department of Ultrasound, Fujian Medical University Affiliated Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian, China
| | - Yi Tang
- Department of Ultrasound, Fujian Medical University Affiliated Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian, China
| | - Jingjing Guo
- Department of Ultrasound, Fujian Medical University Affiliated Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian, China
| | - Qingfu Qian
- Department of Ultrasound, Fujian Medical University Affiliated Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian, China
| | - Ensheng Xue
- Department of Ultrasound, Fujian Medical University Affiliated Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian, China
| | - Zhikui Chen
- Department of Ultrasound, Fujian Medical University Affiliated Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian, China.
| |
Collapse
|
49
|
Chen LJ, Han YD, Zhang M. CT features of calcified micro-gastric gastrointestinal stromal tumors: a case series. BMC Med Imaging 2023; 23:192. [PMID: 37986048 PMCID: PMC10662392 DOI: 10.1186/s12880-023-01146-8] [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: 09/28/2022] [Accepted: 10/30/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Due to the lack of corresponding clinical symptoms, small calcified gastric gastrointestinal stromal tumors (GISTs) are often overlooked in clinical practice. Therefore, there is an unmet need to define the imaging features of calcified micro-gastric GISTs to facilitate diagnosis. This study retrospectively analyzed the computed tomography (CT) features of pathologically confirmed calcified micro-gastric GISTs. METHODS The medical records (gastroscopy, pre-treatment gastric CT imaging [pre- and post-contrast scans], pathology) of patients with calcified gastric GISTs < 1 cm in diameter confirmed pathologically after endoscopic submucosal dissection, endoscopic submucosal excavation, or endoscopic full-thickness resection were retrospectively reviewed. RESULTS Seven patients had 8 calcified gastric GISTs < 1 cm in diameter. Six patients hadsingle lesions, and 1patients had multiple lesions. Six patients had lesions in the gastric fundus, 1 patient had a lesion in the body of the stomach. Lesions had a mean diameter of 5.2 mm (range, 1.3 mm ~ 7 mm). Unenhanced CT scans showed spots and high-density nodular calcifications in 3 submucosal lesions, 2 lesions in the muscularis propria, and 3 subserosal lesions that protruded outside the stomach. Among the 8 lesions, only two had solid soft tissue components surrounding the calcification, with one of these two showing post contrast enhancement of the solid soft tissue component. CONCLUSIONS Novel CT features of gastric GISTs included: commonly found in the gastric antrum, small size (< 1 cm in diameter), calcification, few solid soft tissue components, and no abnormal enhancement in most cases.
Collapse
Affiliation(s)
- Li-Jun Chen
- The Department for Radiology, Gao Xin Hospital Xi'an, Xi'an, Shannxi, 710075, China
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiao Tong University, No.277, West Yanta Road, Xi'an, Shaanxi, 710061, P.R. China
| | - Yue-Dong Han
- The Department for Radiology, Gao Xin Hospital Xi'an, Xi'an, Shannxi, 710075, China
| | - Ming Zhang
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiao Tong University, No.277, West Yanta Road, Xi'an, Shaanxi, 710061, P.R. China.
| |
Collapse
|
50
|
Berndsen M, Renberg S, Hølmebakk T, Hancke E, Puls F, Karlsson F, Stoldt S, Bjerkehagen B, Haglund de Flon F, Muth A, Papakonstantinou A, Boye K, Lindskog S. Long-term outcome after surgical resection of non-high-risk gastrointestinal stromal tumours without adjuvant therapy. Br J Surg 2023; 110:1857-1862. [PMID: 37758514 PMCID: PMC10638541 DOI: 10.1093/bjs/znad309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 08/04/2023] [Accepted: 09/08/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Gastrointestinal stromal tumour (GIST) is the most common intra-abdominal sarcoma. Risk classification systems, commonly the modified National Institutes of Health consensus criteria, identify tumour properties relating to patient outcomes. However, owing to limited long-term evidence, most guidelines recommend up to 10-year follow-up for all risk groups except very low-risk GIST. METHODS This retrospective multicentre study included patients who had complete resection of primary, non-metastatic GIST from three Scandinavian sarcoma centres: Gothenburg (2004-2020), Stockholm (2000-2019), and Oslo (2000-2017). Medical records were reviewed for clinical details regarding diagnosis, treatment, and follow-up, and recurrence-free and disease-specific survival evaluated. RESULTS The total cohort consisted of 1213 patients with GIST. High-risk patients and those treated with tyrosine kinase inhibitors were excluded. The remaining 649 patients were included in the present analysis: 118 with very low-, 381 with low-, and 150 with intermediate-risk GISTs. Five-year recurrence-free survival rates were 100, 98.5, and 100 per cent for the intermediate-, low-, and very low-risk groups respectively (P = 0.246). Disease-specific survival rates 10 years after surgery were 100, 98.4, and 100 per cent for the intermediate-, low-, and very low-risk groups respectively (P = 0.262). CONCLUSION Patients with completely resected non-high-risk GISTs have an excellent long-term outcome, irrespective of risk group. Follow-up programmes to detect disease recurrences in these patients are probably not indicated.
Collapse
Affiliation(s)
- Marta Berndsen
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Section of Endocrine and Sarcoma Surgery, Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sara Renberg
- Department of Head, Neck, Lung and Skin Tumours, Karolinska University Hospital, Stockholm, Sweden
| | - Toto Hølmebakk
- Department of Abdominal and Paediatric Surgery, Oslo University Hospital, Norwegian Radium Hospital, Oslo, Norway
| | - Emma Hancke
- Section of Endocrine and Sarcoma Surgery, Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Florian Puls
- Department of Clinical Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Fredrik Karlsson
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Department of Breast Cancer, Endocrine Tumours and Sarcoma, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Stephan Stoldt
- Department of Abdominal and Paediatric Surgery, Oslo University Hospital, Norwegian Radium Hospital, Oslo, Norway
| | - Bodil Bjerkehagen
- Department of Pathology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Felix Haglund de Flon
- Department of Oncology–Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Pathology and Cancer diagnostics, Karolinska University Hospital, Stockholm, Sweden
| | - Andreas Muth
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Section of Endocrine and Sarcoma Surgery, Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Andri Papakonstantinou
- Department of Breast Cancer, Endocrine Tumours and Sarcoma, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology–Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Kjetil Boye
- Department of Oncology, Oslo University Hospital, Norwegian Radium Hospital, Oslo, Norway
| | - Stefan Lindskog
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Section of Endocrine and Sarcoma Surgery, Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Surgery, Halland Hospital, Varberg, Sweden
| |
Collapse
|