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Martin-Broto J, Gutierrez A, Garcia-Del-Muro X, Lopez-Guerrero JA, Martinez-Trufero J, de Sande LM, Lainez N, Maurel J, De Juan A, Losa F, Andres R, Casado A, Tejido PG, Blanco R, Carles J, Bellmunt J, Gomez-España A, Ramos R, Martinez-Serra J, Llombart-Bosch A, Poveda A. Prognostic time dependence of deletions affecting codons 557 and/or 558 of KIT gene for relapse-free survival (RFS) in localized GIST: a Spanish Group for Sarcoma Research (GEIS) Study. Ann Oncol 2010; 21:1552-1557. [PMID: 20231303 DOI: 10.1093/annonc/mdq047] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND To assess whether deletions involving codons 557 and/or 558 (critical deletions) of exon 11 of KIT are relevant in the prognosis of relapse-free survival (RFS) in gastrointestinal stromal tumor (GIST) patients with a long follow-up. PATIENTS AND METHODS A univariate and multivariate analysis for RFS were carried out on 162 localized GIST patients over the entire follow-up period and over the intervals 0-4 years and >4 years. Factors assessed among others were Fletcher/National Institutes of Health and Miettinen-Lasota/Armed Forces Institute of Pathology (M-L/AFIP) risk categories, critical deletions and non-deletion-type mutation (NDTM) within exon 11 of KIT. RESULTS Multivariate analyses revealed that M-L/AFIP [relative risk (RR) 11.45, confidence interval (CI) 4.40-29.76, for the high-risk subgroup and RR 5.97, CI 2.09-17.06, for the intermediate subgroup] and critical deletions (RR 3.05, CI 1.59-5.85) were independent prognostic factors for RFS for the first 4 years and for the entire follow-up period. Beyond 4 years, the high-risk M-L/AFIP subgroup (RR 8.12, CI 1.48-44.4) and NDTM (RR 6.42, CI 1.17-35.12) were independent prognostic factors for RFS. The median follow-up was 84 months. CONCLUSION Critical deletions represent a time-dependent prognostic factor limited to the first 4 years after surgery, which could help identify a subset with higher and earlier risk for relapse in GIST patients.
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Affiliation(s)
- J Martin-Broto
- Departments of Oncology and Hematology, Medical and Translational Hemato-Oncology Group, Hospital Universitario Son Dureta, Palma de Mallorca.
| | - A Gutierrez
- Departments of Oncology and Hematology, Medical and Translational Hemato-Oncology Group, Hospital Universitario Son Dureta, Palma de Mallorca
| | | | - J A Lopez-Guerrero
- Laboratory of Molecular Biology, Fundación Instituto Valenciano de Oncología, Valencia
| | | | - L M de Sande
- Department of Oncology, Complejo Hospitalario de León, Leon
| | - N Lainez
- Department of Oncology, Hospital Virgen del Camino, Pamplona
| | - J Maurel
- Department of Oncology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica de Enfermedades Hepáticas y Digestivas, Barcelona
| | - A De Juan
- Oncology Department, Hospital de Valdecilla, Santander
| | - F Losa
- Department of Oncology, Hospital General, Hospitalet de Llobregat
| | - R Andres
- Department of Oncology, Hospital Clínico Lozano Blesa, Zaragoza
| | - A Casado
- Department of Oncology, Hospital Universitario San Carlos, Madrid
| | - P G Tejido
- Department of Oncology, Hospital San Pedro, Logroño
| | - R Blanco
- Department of Oncology, Hospital Mutua de Terrassa, Terrassa
| | - J Carles
- Department of Oncology, Hospital del Mar, Barcelona
| | - J Bellmunt
- Department of Oncology, Hospital Vall d'Hebron, Barcelona
| | | | - R Ramos
- Department of Pathology, Hospital Universitario Son Dureta, Palma de Mallorca
| | - J Martinez-Serra
- Laboratory of Molecular Biology, Hospital Universitario Son Dureta, Palma de Mallorca
| | | | - A Poveda
- Department of Oncology, Fundación Instituto Valenciano de Oncología, Valencia, Spain
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Alvarado-Cabrero I, Vázquez G, Sierra Santiesteban FI, Hernández-Hernández DM, Pompa AZ. Clinicopathologic study of 275 cases of gastrointestinal stromal tumors: the experience at 3 large medical centers in Mexico. Ann Diagn Pathol 2007; 11:39-45. [PMID: 17240306 DOI: 10.1016/j.anndiagpath.2006.03.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
It is important to distinguish gastrointestinal (GI) stromal tumors (GISTs) from other GI mesenchymal tumors (GIMTs) because of the availability of molecular-targeted therapy for GISTs. The aim of the study was to reclassify GIMTs and to determine the clinicopathologic features of GISTs in Mexico. Cases of GIMT identified from the database of 3 large diagnostic centers in Mexico between 1995 and 2004 were reclassified according to current criteria. Hematoxylin and eosin-stained sections and clinical histories were reviewed, and immunohistochemistry was performed using anti-CD117, CD34, smooth muscle actin, and S-100 protein. A total of 275 GISTs were identified. The tumors were located in the stomach (40%), small intestine (35%), colorectum (12%), abdominal cavity (11%), and esophagus (2%). There were equal numbers of men and women with a mean age at diagnosis of 61 years. The tumors ranged in size from 3.5 to 34 cm (mean, 9.1 cm); 95 tumors (34%) were larger than 10 cm. Colorectal and omental tumors were the largest. The cell types included pure spindle (68%), pure epithelioid (16%), and mixed epithelioid/spindle (14%). Whereas 17.8% of tumors were regarded as low risk, 43% of tumors were in the high-risk category. CD117 positivity was detected in most of the tumors (96%). In addition to CD117, 255 cases (92%) were positive for CD34, 82 cases (32%) were positive for smooth muscle actin, and 13 cases (4.7%) were positive for desmin. Gastrointestinal stromal tumors in Mexico have the same clinicopathologic and immunohistochemical features as those reported in other countries. It is not always easy to distinguish GISTs from other soft tissue lesions. The diagnosis can be difficult even for experienced pathologists.
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Affiliation(s)
- Isabel Alvarado-Cabrero
- Department of Pathology, Mexican Oncology Hospital, Federal District Mexico, IMSS 06700, Mexico.
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Candelaria M, de la Garza J, Duenas-Gonzalez A. A clinical and biological overview of gastrointestinal stromal tumors. Med Oncol 2005; 22:1-10. [PMID: 15750190 DOI: 10.1385/mo:22:1:001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2004] [Accepted: 07/13/2004] [Indexed: 01/06/2023]
Abstract
In the last few years a body of knowledge has been generated on the molecular basis of gastrointestinal stromal tumors (GIST). These mesenchymal tumors are characterized by the expression of KIT protein and because they have an activating mutation in a class III receptor tyrosine kinase gene (KIT or PDGFRA). Several KIT-activating mutations, which are largely responsible for the development of this tumor, promote cell survival, proliferation, and migration through different pathways such as MAPK p42/44, AKT, S6K, STAT1, and STAT3. Likewise, gene-activating mutations in the gene PDGFRalpha which codes for the receptor tyrosine kinase, Platelet-derived growth factor receptor alpha have been identified in GIST lacking KIT mutations. This means that KIT and PDGFRalpha mutations appear to be alternative and mutually exclusive oncogenic pathways for GIST development. These tumors may occur anywhere along the gastrointestinal tract (GI). The most frequently involved sites are stomach and small intestine. They are typically chemo- and radioresistant. The discovery of a specific inhibitor of this tyrosine kinase, imatinib mesylate, has radically changed the prognosis of patients with unresectable disease. Only 4 yr after the first patient was successfully treated with imatinib, multiple phase II and III trials have been published and, currently, imatinib mesylate is the only effective systemic treatment available of these tumors. Response rates are approximately 70-90% with acceptable toxicity. GIST are the first model of a solid tumor efficiently treated with a molecular-targeted agent. This review summarizes the clinical and biological aspects of this unique neoplasm.
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Affiliation(s)
- Myrna Candelaria
- Division of Clinical Research, National Cancer Institute, Mexico City.
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