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Chen H, Lyu J, Gong Z, Han Y, Tao K, Zhou H. Development of a simultaneous quantification method of imatinib and sunitinib and their main metabolites and its application in patients with gastrointestinal stromal tumor. Biomed Chromatogr 2024; 38:e5804. [PMID: 38152034 DOI: 10.1002/bmc.5804] [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: 10/20/2023] [Revised: 11/13/2023] [Accepted: 11/15/2023] [Indexed: 12/29/2023]
Abstract
Correlations between plasma concentrations of imatinib and sunitinib with efficacy and toxicity have been established. It is crucial to develop a sensitive and precise method for determining the plasma concentrations of imatinib and sunitinib, along with their active metabolites, to facilitate therapeutic drug monitoring and individualized therapy. Plasma samples were separated on an Agilent ZORBAX SB-C18 chromatographic column using gradient elution. Quantification was performed using a mass spectrometer equipped with electrospray ionization in multiple reaction monitoring. The analysis time was 18 min per run, with all analytes and internal standards eluting within 8 min. The calibration range was 25-4000 ng/mL for imatinib, 5-800 ng/mL for N-desmethyl imatinib (CGP74588), and 2.5-400 ng/mL for sunitinib and N-desethyl sunitinib (SU12662). Intra- and inter-assay precision were both below 15%, and accuracy ranged between 90.0% and 101.9%. The method was successfully applied to determine blood samples from 120 patients with gastrointestinal stromal tumors who received imatinib (n = 115) and sunitinib (n = 5). It has been validated as linear, accurate, precise, and robust, making it suitable for therapeutic drug monitoring of imatinib and sunitinib in routine clinical practice.
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Affiliation(s)
- Hefen Chen
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jianbo Lyu
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhujun Gong
- Department of Pharmacy, Chongqing Medical University, Chongqing, China
| | - Yong Han
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kaixiong Tao
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hong Zhou
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Farhat F, Hussein M, Sbaity E, Alsharm A, Rasul K, Khairallah S, Assi T, Allahverdi N, Othman A, Kattan J. Gastrointestinal stromal tumor in North Africa and the middle east: updates in presentation and management from an 11-year retrospective cohort. Hosp Pract (1995) 2023; 51:275-287. [PMID: 38112178 DOI: 10.1080/21548331.2023.2277682] [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: 02/07/2023] [Accepted: 10/25/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVES This study described the epidemiological, clinical, and survival profiles of patients with gastrointestinal stromal tumor (GIST) in North Africa and the Middle East (AfME). METHODS This regional, multicenter, observational, retrospective study collected 11-year data on demographics, medical history, disease characteristics, current treatment approaches of GIST, the safety of the most common tyrosine kinase inhibitors (TKIs), second cancers, and survival status. RESULTS Data of 201 eligible patients were analyzed: mean age was 56.9 ± 12.6 years; 111 (55.2%) patients were men, 21 (10.4%) patients had previous personal malignancy. The most common clinical presentation of GIST was dysphagia [92 (45.8%) patients]. The stomach was the most common primary site in 120 (60.7%) patients, 171 (85.1%) patients had localized disease at diagnosis. 198 (98.5%) GIST cases were CD117/CD34-positive. Imatinib was used in the neoadjuvant (18/21 patients), adjuvant (85/89 patients), and first-line metastatic treatment (28/33 patients) settings. The most common non-hematological toxicity associated with TKIs was vomiting in 32/85 (37.6%) patients. Overall, 100 (49.8%) patients (95%CI: 42.8-56.7%) were alive and disease-free while 30 (14.9%) patients were alive with active disease. CONCLUSION Presentation of GIST in our AfME population is consistent with global reports, being more frequent in patients >50 years old and having the stomach as the most common primary site. Unlike what is usually reported, though, we did have more patients with lymphatic spread of the disease. Despite the global trend and advances in the treatment of GIST according to molecular profile, this is still far to happen in our population given the lack of access to molecular profiles and the high associated cost.
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Affiliation(s)
- Fadi Farhat
- Department of Onco-Hematology, Mount Lebanon Hospital University Medical Center, Balamand University, Beirut, Hazmieh, Lebanon
| | - Marwa Hussein
- Department of Medical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Eman Sbaity
- Department of General Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Abdullah Alsharm
- Oncology Department, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Kakil Rasul
- Department of Hematology-Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | | | - Tarek Assi
- Department of Onco-Hematology, Mount Lebanon Hospital University Medical Center, Balamand University, Beirut, Hazmieh, Lebanon
- Department of Hematology-Oncology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Niloofar Allahverdi
- Translational Cancer Research Facility and Clinical Trial Unit, Interim Translational Research Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ahmad Othman
- Department of Hematology-Oncology, Hammoud Hospital University Medical Center, Saida, Lebanon
| | - Joseph Kattan
- Department of Hematology-Oncology, Hôtel-Dieu de France University Hospital, Beirut, Lebanon
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Nomogram for Predicting Recurrence-Free Survival of Primary Localized Gastrointestinal Stromal Tumor. J Pers Med 2023; 13:jpm13030498. [PMID: 36983680 PMCID: PMC10052207 DOI: 10.3390/jpm13030498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/02/2023] [Accepted: 03/08/2023] [Indexed: 03/12/2023] Open
Abstract
Purpose: This study aimed to establish a new nomogram that predicts recurrence-free survival (RFS) after a complete surgical resection of primary localized gastrointestinal stromal tumors (GISTs); it also aimed to evaluate the discrimination, calibration, and clinical utility of the decision-making nomogram. Methods: The clinicopathological data of patients with primary localized GISTs at the First Affiliated Hospital of Chongqing Medical University from January 2000 to June 2022 were retrospectively analyzed. The clinicopathological data were randomly split into two sets (7:3 ratio) for training and validation. Suitable variables for the construction of a nomogram for the 1-, 3-, and 5-year RFS were selected using univariate and multivariate Cox regression analyses. Receiver operating characteristic (ROC) analysis and a concordance index (C-index) were used to quantify the discrimination of the nomogram and were compared with four commonly used prognostic scoring systems: Memorial Sloan Kettering Cancer Center prognostic nomogram, National Institutes of Health–Fletcher staging system, Chen’s prognostic nomogram, and Air Forces Institute of Pathology risk criteria–Miettinen staging system. The calibration and clinical utility for the decision-making nomogram were validated using calibration curves and decision curves, respectively. Results: In total, 641 patients were screened and analyzed in this retrospective, observational study. RFS was significantly related to tumor size, mitotic count, gender, DOG-1, and adjuvant therapy with imatinib according to the results of the multivariate and univariate Cox analyses. The nomogram was constructed using the above variables (all p < 0.05) for the 1-, 3-, and 5-year RFS. In the training set, the 1-, 3-, and 5-year ROC and C-index values of the nomogram were 0.868, 0.838, 0.816, and 0.830, respectively. For internal validation, we performed model fitting on the validation set, and the 1-, 3-, and 5-year ROC and C-indices were 0.977, 0.845, 0.869, and 0.849, respectively. Among the five GIST prognostic scoring systems, our nomogram had almost all the largest area under these decision curves and had a good calibration capability. Conclusions: The newly constructed nomogram based on tumor size, gender, mitotic count, DOG-1, and adjuvant treatment with imatinib exhibited an excellent performance and may serve as a prognostic scoring system to support therapeutic decision-making and individualized treatment for GISTs in China.
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Molecular Mechanisms of Gastrointestinal Stromal Tumors and Their Impact on Systemic Therapy Decision. Cancers (Basel) 2023; 15:cancers15051498. [PMID: 36900287 PMCID: PMC10001062 DOI: 10.3390/cancers15051498] [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: 02/02/2023] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 03/08/2023] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are soft tissue sarcomas that mostly derive from Cajal cell precursors. They are by far the most common soft tissue sarcomas. Clinically, they present as gastrointestinal malignancies, most often with bleeding, pain, or intestinal obstruction. They are identified using characteristic immunohistochemical staining for CD117 and DOG1. Improved understanding of the molecular biology of these tumors and identification of oncogenic drivers have altered the systemic treatment of primarily disseminated disease, which is becoming increasingly complex. Gain-of-function mutations in KIT or PDGFRA genes represent the driving mutations in more than 90% of all GISTs. These patients exhibit good responses to targeted therapy with tyrosine kinase inhibitors (TKIs). Gastrointestinal stromal tumors lacking the KIT/PDGFRA mutations, however, represent distinct clinico-pathological entities with diverse molecular mechanisms of oncogenesis. In these patients, therapy with TKIs is hardly ever as effective as for KIT/PDGFRA-mutated GISTs. This review provides an outline of current diagnostics aimed at identifying clinically relevant driver alterations and a comprehensive summary of current treatments with targeted therapies for patients with GISTs in both adjuvant and metastatic settings. The role of molecular testing and the selection of the optimal targeted therapy according to the identified oncogenic driver are reviewed and some future directions are proposed.
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Mutation Status and Immunohistochemical Correlation of EGFR Mutations in Gastrointestinal Stromal Tumors. Balkan J Med Genet 2021; 24:67-72. [PMID: 34447661 PMCID: PMC8366477 DOI: 10.2478/bjmg-2021-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Being one of the leading causes of cancer deaths worldwide and their resistance to conventional treatment methods, made gastrointestinal stromal tumors (GISTs) one of the hot topics in medical research areas in the past decade. To investigate molecular alterations underlying the tumor is of great importance to be able to develop new, targeted treatment options. In this study, GIST samples obtained from 40 Turkish patients were analyzed for actionable epidermal growth factor receptor (EGFR) mutations that are related to treatment regimes in non small cell lung cancer (NSCLC) to understand whether EGFR expression is altered in GISTs. Established alterations in EGFR can make the use of tyrosine kinase inhibitors possible, which are currently used in cancer therapy, especially in NSCLC. Our results indicated that EGFR mutations are rare in GISTs. Further research is needed to sequence whole coding regions of the gene to investigate new actionable mutations in EGFR in an increased sample size.
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Orunmuyi A, Ayandipo O, Ogun G, Ajagbe O, Adegoke O, Adepoju O, Rahman A, Ajuyah C, Shittu O. Gastrointestinal stromal tumor experience in a surgical oncological unit in sub-Saharan Africa: A retrospective analysis. JOURNAL OF CLINICAL SCIENCES 2021. [DOI: 10.4103/jcls.jcls_60_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Xu L, Ma Y, Wang S, Feng J, Liu L, Wang J, Liu G, Xiu D, Fu W, Zhan S, Sun T, Gao P. Incidence of gastrointestinal stromal tumor in Chinese urban population: A national population-based study. Cancer Med 2020; 10:737-744. [PMID: 33320439 PMCID: PMC7877389 DOI: 10.1002/cam4.3644] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 11/07/2020] [Accepted: 11/24/2020] [Indexed: 12/18/2022] Open
Abstract
Background Information on incidence of gastrointestinal stromal tumor (GIST), the most common type of mesenchymal tumor in gastrointestinal tract, was limited in China. This study aimed to estimate the incidence of GIST in urban population from mainland China in 2016. Methods Urban Employee Basic Medical Insurance (UEBMI) and Urban Residence Basic Medical Insurance (URBMI) in China were used. The denominator of incidence was the total person‐years of insured individuals in 2016 in the database, covering approximately 0.43 billion individuals. The numerator was the number of incident GIST cases in 2016. Results The crude incidence in 2016 was 0.40 per 100,000 person‐years (95% CI, 0.06–1.03). Male incidence was higher than female incidence (0.44 vs. 0.36, rate ratio: 1.22, p < 0.001). The mean age at diagnosis was 55.20 years (SD = 14.26) and the incidence among those aged 50 years or older was 2.63 times (0.84 vs. 0.32, p < 0.001) higher than those aged under 50. The highest incidence was observed in East China (2.29, 95% CI: 0.46–5.54). Conclusions The incidence of GIST in mainland China was lower than Europe, North America and Korea. The mean age at diagnosis of GIST in China was younger than that of Europe and Canada. This study provides useful information to further research, policy formulating and management of GIST.
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Affiliation(s)
- Lu Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Yanpeng Ma
- Department of General Surgery, Peking University Third Hospital, Beijing, China
| | - Shengfeng Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Jingnan Feng
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Lili Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Jinxi Wang
- Shanghai Songsheng Business Consulting Co. Ltd, Beijing, China
| | - Guozhen Liu
- Peking University Health Information Technology Co. Ltd, Beijing, China
| | - Dianrong Xiu
- Department of General Surgery, Peking University Third Hospital, Beijing, China
| | - Wei Fu
- Department of General Surgery, Peking University Third Hospital, Beijing, China
| | - Siyan Zhan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China.,Center for Intelligent Public Health, Institute for Artificial Intelligence, Peking University, Beijing, China
| | - Tao Sun
- Department of General Surgery, Peking University Third Hospital, Beijing, China
| | - Pei Gao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
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Cuccaro F, Burgio Lo Monaco MG, Rashid I, Bisceglia L, Caputo E, Melcarne A, Palma F, Tanzarella M, Cozzi E, Coviello V. Population-based incidence of gastrointestinal stromal tumors in Puglia. TUMORI JOURNAL 2020; 107:39-45. [PMID: 32539634 DOI: 10.1177/0300891620931944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION This study presents the incidence of gastrointestinal stromal tumors (GISTs) in an Italian region of over 4 million inhabitants monitored for 10 years and is the largest incidence study of this type of cancer conducted so far in Italy. METHODS In order to ensure the registration of all GISTs, including those with nonmalignant behavior, a cancer list was integrated with the cases found through an ad hoc data mining process that covered all the pathologic reports of Puglia. Case distributions by sex, age groups, site, and prognostic groups according to Miettinem and Lasota classification and crude and age-standardized incidence rates were produced. RESULTS In the 10-year period 2006 to 2015, 708 cases of GIST were recorded in Puglia. The average crude incidence rate was 1.7 per 100,000 person-years and the age-standardized incidence rate, using 2013 European standard population, was 1.8 per 100,000 person-years (95% confidence interval [CI], 1.6-1.9). Incidence was higher in men than in women: crude incidence rate was 2.0 per 100,000 person-years and age-standardized incidence rate 2.2 per 100,000 person-years (95% CI, 2.0-2.4) in men and 1.5 per 100,000 person-years and 1.4 per 100,000 person-years (95% CI, 1.2-1.6) in women. DISCUSSION Our incidence rates are comparable with those of other international studies and they are located in the medium to high end of the range. The comparisons are affected by a different capacity of the cancer registries to intercept and record GISTs with nonmalignant behavior. Distribution of cases for sex, age groups, sites, and prognostic risk groups are consistent with previous results.
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Affiliation(s)
- Francesco Cuccaro
- Cancer Registry of the Local Health Unit of Barletta-Andria-Trani, section of the Puglia Cancer Registry, Barletta, Italy
| | | | - Ivan Rashid
- Coordination Center of the Puglia Cancer Registry, Regional Strategic Agency for Health and Social of Puglia, Bari, Italy
| | - Lucia Bisceglia
- Coordination Center of the Puglia Cancer Registry, Regional Strategic Agency for Health and Social of Puglia, Bari, Italy
| | - Enrico Caputo
- Cancer Registry of the Local Health Unit of Bari, section of the Puglia Cancer Registry, Bari, Italy
| | - Anna Melcarne
- Cancer Registry of the Local Health Unit of Lecce, section of the Puglia Cancer Registry, Lecce, Italy
| | - Fernando Palma
- Cancer Registry of the Local Health Unit of Foggia, section of the Puglia Cancer Registry, Foggia, Italy
| | - Margherita Tanzarella
- Cancer Registry of the Local Health Unit of Taranto, section of the Puglia Cancer Registry, Taranto, Italy
| | - Emma Cozzi
- Cancer Registry of the Local Health Unit of Brindisi, section of the Puglia Cancer Registry, Brindisi, Italy
| | - Vincenzo Coviello
- Cancer Registry of the Local Health Unit of Barletta-Andria-Trani, section of the Puglia Cancer Registry, Barletta, Italy
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Li J, Shen L. The current status of and prospects in research regarding gastrointestinal stromal tumors in China. Cancer 2020; 126 Suppl 9:2048-2053. [PMID: 32293728 DOI: 10.1002/cncr.32684] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/21/2019] [Accepted: 11/24/2019] [Indexed: 12/11/2022]
Abstract
China still lacks statistical data regarding the incidence of gastrointestinal stromal tumors (GISTs). Data from 3 regions have demonstrated that the incidence of GISTs in China is similar to that in the United States. Furthermore, no significant differences between both nations with regard to epidemiological characteristics and genotyping of GISTs have been reported. Chinese physicians are demonstrating an increased interest in studies regarding GISTs. Currently, to the authors' knowledge, China publishes the most research articles regarding GIST annually worldwide. Despite the paucity of relevant research regarding the clinical practices for GISTs, a series of studies performed by Chinese physicians in the fields of recurrence risk classification, laparoscopic surgery, and adjuvant therapy have contributed to the diagnosis and treatment of GISTs. The lack of innovative drugs, slow approval of new drugs, and insufficient research funds have limited further advancements in GIST-related research in China. In recent years, increased investment in scientific research has allowed for these advancements to be made by creating conditions for Chinese physicians to conduct high-level clinical research. Chinese researchers hope to further shorten the gap between China and the rest of the world in the field of GIST research within a relatively short period. The purpose of the current review article was to present the most updated information regarding the diagnosis and treatment of GISTs in Chinese medical practice and to suggest prospective research in this field.
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Affiliation(s)
- Jian Li
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education of Beijing, Department of Gastrointestinal Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Lin Shen
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education of Beijing, Department of Gastrointestinal Oncology, Peking University Cancer Hospital and Institute, Beijing, China
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Zhang X, Ning L, Hu Y, Zhao S, Li Z, Li L, Dai Y, Jiang L, Wang A, Chu X, Li Y, Yang D, Lu C, Yao L, Cui G, Lin H, Chen G, Cui Q, Guo H, Zhang H, Lun Z, Xia L, Su Y, Han G, Hui X, Wei Z, Sun Z, Shen S, Zhou Y. Prognostic Factors for Primary Localized Gastrointestinal Stromal Tumors After Radical Resection: Shandong Gastrointestinal Surgery Study Group, Study 1201. Ann Surg Oncol 2020; 27:2812-2821. [PMID: 32040699 DOI: 10.1245/s10434-020-08244-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Most previous risk-prediction models for gastrointestinal stromal tumors (GISTs) were based on Western populations. In the current study, we collected data from 23 hospitals in Shandong Province, China, and used the data to examine prognostic factors in Chinese patients and establish a new recurrence-free survival (RFS) prediction model. METHODS Records were analyzed for 5285 GIST patients. Independent prognostic factors were identified using Cox models. Receiver operating characteristic curve analysis was used to compare a novel RFS prediction model with current risk-prediction models. RESULTS Overall, 4216 patients met the inclusion criteria and 3363 completed follow-up. One-, 3-, and 5-year RFS was 94.6% (95% confidence interval [CI] 93.8-95.4), 85.9% (95% CI 84.7-87.1), and 78.8% (95% CI 77.0-80.6), respectively. Sex, tumor location, size, mitotic count, and rupture were independent prognostic factors. A new prognostic index (PI) was developed: PI = 0.000 (if female) + 0.270 (if male) + 0.000 (if gastric GIST) + 0.350 (if non-gastric GIST) + 0.000 (if no tumor rupture) + 1.259 (if tumor rupture) + 0.000 (tumor mitotic count < 6 per 50 high-power fields [HPFs]) + 1.442 (tumor mitotic count between 6 and 10 per 50 HPFs) + 2.026 (tumor mitotic count > 10 per 50 HPFs) + 0.096 × tumor size (cm). Model-predicted 1-, 3-, and 5-year RFS was S(12, X) = 0.9926exp(PI), S(36, X) = 0.9739exp(PI) and S(60, X) = 0.9471exp(PI), respectively. CONCLUSIONS Sex, tumor location, size, mitotic count, and rupture were independently prognostic for GIST recurrence. Our RFS prediction model is effective for Chinese GIST patients.
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Affiliation(s)
- Xiaoqian Zhang
- Division of General Surgery, Peking University First Hospital, Peking University, Beijing, China.,Department of General Surgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Liang Ning
- Department of General Surgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yulong Hu
- Department of General Surgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Shanfeng Zhao
- Department of General Surgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Zequn Li
- Department of General Surgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Leping Li
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Yong Dai
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Lixin Jiang
- Department of Gastrointestinal Thyroid Surgery, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Ailiang Wang
- Department of Gastrointestinal Surgery, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Xianqun Chu
- Department of Gastroenterology Surgery, Jining No.1 People's Hospital, Jining, Shandong, China
| | - Yuming Li
- Department of Gastrointestinal Surgery, Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Daogui Yang
- Department of Gastrointestinal Surgery, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Chunlei Lu
- Department of Laparoscopic Surgery Center, Linyi People's Hospital, Linyi, Shandong, China
| | - Linguo Yao
- Department of Gastrointestinal Surgery, Shengli Oilfield Central Hospital, Yantai, Shandong, China
| | - Gang Cui
- Department of General Surgery, Taian City Central Hospital, Taian, Shandong, China
| | - Huizhong Lin
- Department of Gastric Surgery, Qingdao Municipal Hospital, Qingdao, Shandong, China
| | - Gang Chen
- Department of Gastrointestinal Surgery, Tengzhou Central People's Hospital, Tengzhou, Shandong, China
| | - Qing Cui
- Department of General Surgery, Zibo Central Hospital, Zibo, Shandong, China
| | - Hongliang Guo
- The Fourth Department of General Surgery, Shandong Cancer Hospital, Jinan, Shandong, China
| | - Huanhu Zhang
- Department of General Surgery, Weihai Municipal Hospital, Weihai, Shandong, China
| | - Zengjun Lun
- Department of General Surgery, Zaozhuang Municipal Hospital, Zaozhuang, Shandong, China
| | - Lijian Xia
- Department of Gastrointestinal Surgery, Shandong Province Qianfoshan Hospital, Jinan, Shandong, China
| | - Yingfeng Su
- Department of General Surgery, Dezhou People's Hospital, Dezhou, Shandong, China
| | - Guoxin Han
- Department of General Surgery, Affiliated Hospital of Taishan Medical University, Taian, Shandong, China
| | - Xizeng Hui
- Department of Surgery, People's Hospital of Rizhao, Rizhao, Shandong, China
| | - Zhixin Wei
- Department of General Surgery, Heze Municipal Hospital, Heze, Shandong, China
| | - Zuocheng Sun
- Department of Surgery, Weifang People's Hospital, Weifang, Shandong, China
| | - Shuai Shen
- Department of General Surgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yanbing Zhou
- Department of General Surgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
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Hung KD, Van QL, Hoang GN, Bich PNT. Imatinib Mesylate for Patients With Unresectable or Recurrent Gastrointestinal Stromal Tumors: 10-Year Experience From Vietnam. Cancer Control 2020; 26:1073274819863776. [PMID: 31319677 PMCID: PMC6643187 DOI: 10.1177/1073274819863776] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Only limited data are available concerning the long-term outcomes of imatinib
treatment among Vietnamese or Asian patients with unresectable or recurrent
gastrointestinal stromal tumors (GISTs). Our study, which was conducted in 188
patients, aimed to assess the efficacy of imatinib mesylate against unresectable
or recurrent GISTs. Imatinib had a high response rate and long survival. Some
predictors favorable for progression-free survival and overall survival are good
performance status and response with imatinib. Findings are discussed in
relation to clinical practice in low- and middle-income country.
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Affiliation(s)
- Kien Do Hung
- 1 Department of Medical Oncology, Vietnam National Cancer Hospital-K Hospital, Hanoi, Vietnam
| | - Quang Le Van
- 2 Department of Oncology, Hanoi Medical University, Hanoi, Vietnam
| | | | - Phuong Nguyen Thi Bich
- 1 Department of Medical Oncology, Vietnam National Cancer Hospital-K Hospital, Hanoi, Vietnam
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12
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Laparoscopic and Endoscopic Cooperative Dissection for Small Gastric Gastrointestinal Stromal Tumor without Causing Injury to the Mucosa. Gastroenterol Res Pract 2019; 2019:7376903. [PMID: 31915434 PMCID: PMC6930728 DOI: 10.1155/2019/7376903] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 11/22/2019] [Indexed: 01/01/2023] Open
Abstract
Objective To investigate the feasibility of laparoscopic and endoscopic cooperative dissection (LECD) for small gastric gastrointestinal stromal tumors (GISTs) without causing injury to the mucosa, compared with ESD surgery which is widely used now. Methods A total of 25 patients with small gastric GISTs who underwent LECD and 20 patients with small gastric GISTs who underwent ESD between October 2014 and June 2016 were included in this study. All patients underwent curative resection for pathologically diagnosed small gastric GISTs. Patients' clinical data were retrospectively analyzed. Results In LECD group, the operation was successfully performed in all patients. However, in the ESD group, three patients were transferred to laparoscopic surgery due to intraoperative massive bleeding or intraoperative perforation. No additional targeted chemotherapy drugs for interstitial tumors were prescribed in two groups. There was no difference in the complete tumor capsule rate (100% vs. 90%, p = 0.11), operation time (80.76 ± 13.86 ml vs. 84.05 ± 15.33 ml, p = 0.45), major intraoperative bleeding (0 vs. 5%, p = 0.26), postoperative bleeding (0 vs. 10%, p = 0.11), and postoperative infection (0 vs. 10%, p = 0.11) between the two groups. Compared to ESD (endoscopic submucosal dissection), LECS patients had shorter postoperative indwelling gastric tube (1.04 ± 0.98 d vs. 2.85 ± 0.24 d, p < 0.01), earlier postoperative eating (1.96 ± 0.98 d vs. 3.50 ± 1.15 d, p < 0.01), shorter average postoperative hospital stay (3.44 ± 1.00 d vs. 7.85 ± 1.18 d, p < 0.01), smaller perforation rate (0 vs. 25%, p < 0.05), and fewer surgical supplies. No recurrence or metastasis cases were found between the two groups during the follow-up period, and there were no cases of death due to gastric GISTs. Conclusion LECD is a novel surgery for small gastric gastrointestinal stromal tumors that leads to satisfactory short-term outcomes and meets the idea of minimally invasive surgery and rapid recovery; compared with ESD, LECD surgery has some advantages in clinical practice. However, further follow-up is needed to confirm.
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Association of Hepatic Nuclear Factor 4 Alpha Gene Polymorphisms With Free Imatinib Plasma Levels and Adverse Reactions in Chinese Gastrointestinal Stromal Tumor Patients. Ther Drug Monit 2019; 41:582-590. [DOI: 10.1097/ftd.0000000000000642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Xue W, Li Y, Wang S, Yu K, Yu J, Zhao Z, Jiang D, Zhang M, Liu T, Wang M. Rectal adenocarcinoma coexisting with incidentally found microscopic gastrointestinal stromal tumor: A case report. Medicine (Baltimore) 2019; 98:e16644. [PMID: 31374035 PMCID: PMC6708707 DOI: 10.1097/md.0000000000016644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
RATIONALE Adenocarcinoma coexists with adjacent microscopic gastrointestinal stromal tumor (micro-GIST) is rare, especially in the rectum, where the gastrointestinal stromal tumors (GISTs) have the lower incidence rate. It is easy to ignore the concurrent micro-GIST due to the untypical symptoms. PATIENT CONCERNS A 77-year-old male patient suffered from lower abdominal pain for 20 days and presented with per rectal bleeding for 10 days. He had the medical history of hypertension and diabetes for more than 25 years. DIAGNOSES Endoscopy revealed that the patient had rectum adenocarcinoma and multiple rectum polyps. Besides, the gastrointestinal stromal tumor was diagnosed by the pathologist. INTERVENTIONS The patient underwent surgery of laparoscopic rectum resection and prophylactic ileostomy and took 6 courses of Capecitabine tablets orally. OUTCOMES One year after surgery, the patient had no local relapse by the CT scan. However, not long after the CT examination, he died of cardiovascular disease. LESSONS Although micro-GIST may be noninvasive and asymptomatic, it may have the potential for transforming to malignancies. More attention should be paid to the patients diagnosed with gastrointestinal malignancy coexisting with micro-GIST.
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Affiliation(s)
| | | | - Shuang Wang
- Department of Dermatology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Ke Yu
- Department of the General Surgery
| | | | | | | | | | | | - Min Wang
- Department of the General Surgery
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Wu X, Li J, Zhou Y, Mao Y, Luo S, He X, Wang L, Shen Y, Zhang H, Yang L, Zhang J. Relative Factors Analysis of Imatinib Trough Concentration in Chinese Patients with Gastrointestinal Stromal Tumor. Chemotherapy 2019; 63:301-307. [PMID: 30836365 DOI: 10.1159/000493195] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 08/24/2018] [Indexed: 11/19/2022]
Abstract
AIMS Imatinib plasma trough levels (IM Cmin) have been reported to have a considerable clinical impact in patients with gastrointestinal stromal tumors (GISTs). We therefore have investigated the factors affecting IM plasma concentration in Chinese GIST patients. METHODS IM Cmin in 190 patients with GIST who were taking IM were measured. RESULTS In patients treated with IM 300 mg/day (n = 16), 400 mg/day (n = 168), and > 400 mg/day (500: n = 1, 600: n = 5), IM Cmin was 1,564.54 ± 596.15, 1,521.26 ± 610.33, and 2,540.31 ± 1,298.14 ng/mL, respectively. Of the 168 patients treated with IM 400 mg/day, IM Cmin was significantly lower in males (1,353.94 ± 492.89 ng/mL) than in females (1,680.79 ± 669.03 ng/mL, p < 0.01), and in patients with gastrectomy (1,439.60 ± 587.66 ng/mL) than those without gastrectomy (1,649.88 ± 620.12 ng/mL) (p = 0.033). High IM Cmin was correlated with low body weight (p = 0.004) and low body surface area (p < 0.001). CONCLUSION IM Cmin at steady state was significantly associated with body weight and body surface area. Monitoring of IM Cmin might be particularly important for the optimal treatment with IM of male patients and those who have undergone gastrectomy.
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Affiliation(s)
- Xingye Wu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Juan Li
- Department of Pharmacy, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yi Zhou
- Department of Pharmacy, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yun Mao
- Department of Imaging, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shiqiao Luo
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xuemei He
- Department of Ultrasound, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li Wang
- Department of Gastroenterology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yifan Shen
- The Center for Clinical Molecular Medical Detection of Chongqing, Chongqing, China
| | - Hua Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Longwei Yang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jun Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China,
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Ressing M, Wardelmann E, Hohenberger P, Jakob J, Kasper B, Emrich K, Eberle A, Blettner M, Zeissig SR. Strengthening health data on a rare and heterogeneous disease: sarcoma incidence and histological subtypes in Germany. BMC Public Health 2018; 18:235. [PMID: 29433465 PMCID: PMC5809940 DOI: 10.1186/s12889-018-5131-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 01/30/2018] [Indexed: 12/31/2022] Open
Abstract
Background The population-based incidence of sarcoma and its histological subtypes in Germany is unknown. Up-to-date information on a disease with an incidence comparable to other cancer entities is of high public health relevance. The aim of this study was to determine this incidence and to detect significant changes in incidence trends using data from German epidemiological cancer registries. Methods Pooled data from the German Centre for Cancer Registry Data with a primary diagnosis occurring in 2013 were used. To date, this is the latest data on cancer incidence available for Germany. All German cancer registries with sufficient completeness were included (10 out of 11), covering a population of 70.0 million people, representing 87% of the German population. All malignant sarcomas according to the RARECARE Project and the WHO classification 2002 were considered for analysis and, above all, gastrointestinal stromal tumours (GIST) of uncertain behaviour. Sensitivity analysis was performed excluding certain histologies. Results The analysis included 3404 cases in men and 3442 cases in women diagnosed in 2013. The age adjusted sarcoma incidence (European standard) was 7.4 (men) and 6.6 (women) per 100,000 inhabitants. About 70% of sarcomas were soft tissue sarcomas, about 22% GIST, and about 9% bone sarcomas. The most common histological subtypes besides GIST were fibrosarcomas (14%) and liposarcomas (12%) in men and complex mixed and stromal neoplasms (22%), non-uterine leiomysarcomas (10%) and fibrosarcomas (9%) in women. Considering the trend for the years of diagnosis 2004 to 2013, there was a significant increase in incidence for GIST while the incidence of soft tissue sarcomas (only men) as well as of bone sarcoma stayed constant over time. As to soft tissue sarcoma in women, the incidence stayed constant up to the year 2009 and significantly decreased afterwards. Conclusion This study is the first detailed analysis of a German-wide population-based sarcoma incidence showing results comparable to the incidence detected in the RARECARE Project. Electronic supplementary material The online version of this article (10.1186/s12889-018-5131-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Meike Ressing
- Cancer Registry of Rhineland-Palatinate, Große Bleiche 46, 55116, Mainz, Germany.,Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Johannes Gutenberg University Mainz, 55101, Mainz, Germany
| | - Eva Wardelmann
- University Hospital Muenster, Gerhard-Domagk-Institute of Pathology, Albert-Schweitzer-Campus 1, Gebäude D17, 48149, Münster, Germany
| | - Peter Hohenberger
- Division of Surgical Oncology & Thoracic Surgery, Medical Faculty Mannheim, University of Heidelberg Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Jens Jakob
- Division of Surgical Oncology & Thoracic Surgery, Medical Faculty Mannheim, University of Heidelberg Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Bernd Kasper
- University of Heidelberg, Mannheim University Medical Center, Interdisciplinary Tumor Center (ITM), Sarcoma Unit, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Katharina Emrich
- Cancer Registry of Rhineland-Palatinate, Große Bleiche 46, 55116, Mainz, Germany.,Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Johannes Gutenberg University Mainz, 55101, Mainz, Germany
| | - Andrea Eberle
- Cancer Registry Bremen, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359, Bremen, Germany
| | - Maria Blettner
- Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Johannes Gutenberg University Mainz, 55101, Mainz, Germany
| | - Sylke Ruth Zeissig
- Cancer Registry of Rhineland-Palatinate, Große Bleiche 46, 55116, Mainz, Germany. .,Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Johannes Gutenberg University Mainz, 55101, Mainz, Germany.
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Hatipoğlu E, Demiryas S. Gastrointestinal stromal tumors: 16 years' experience within a university hospital. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2018; 110:358-364. [PMID: 29421913 DOI: 10.17235/reed.2018.5199/2017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM the aim was to convey our 16-year experience regarding gastrointestinal stromal tumors within in a high volume university hospital. Factors that may impact on patient survival were evaluated. MATERIAL AND METHODS all patients diagnosed with gastrointestinal stromal tumors in our clinic over a 16-year period were retrospectively evaluated. All patients included in the study had their tumors surgically resected. Survival analyses were performed using the Kaplan-Meier method. Survival time comparisons between groups were performed using the log-rank test. The effect of continuous variables on survival times were evaluated via a Cox-regression analysis with a backward conditional method. RESULTS one hundred and thirty-five patients (76 males and 59 females) were included into the study and the mean age was 62.8 ± 13.3 years. Overall survival time was 121.3 ± 7.0 months and the 5-year survival rate was 66.6 ± 4.2%. Patients with colorectal tumors had significantly lower survival times than patients with tumors located in the stomach (p = 0.001) and small intestine (p = 0.033). Patients with moderate risk scores had a significantly longer survival compared to patients with high risk scores (p = 0.003) and patients with tumor recurrence had a significantly shorter survival (p < 0.001). There was no significant relationship between survival and factors such as gender and tumor size (p > 0.05). However, age, Ki-67 and the mitotic index were poor prognostic factors and C-kit was considered as a good prognostic factor. CONCLUSION some of the findings in this study are consistent with published data. However, our data significantly differs from previous studies such as the common finding of the effect of gender and tumor size on survival.
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Affiliation(s)
- Engin Hatipoğlu
- General Surgery, Istanbul University Cerrahpaşa Medical Faculty, Turkey
| | - Süleyman Demiryas
- General Surgery Department, Istanbul University, Cerrahpaşa Faculty of Medicine, Türkiye
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The incidence, mutational status, risk classification and referral pattern of gastro-intestinal stromal tumours in the Netherlands: a nationwide pathology registry (PALGA) study. Virchows Arch 2018; 472:221-229. [PMID: 29308530 PMCID: PMC5856869 DOI: 10.1007/s00428-017-2285-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 10/31/2017] [Accepted: 12/18/2017] [Indexed: 01/17/2023]
Abstract
Symptomatic gastrointestinal stromal tumours (GIST) are infrequent with an incidence of 12.7 per million inhabitants in the western population. We studied whether the incidence of GIST has further increased between 2003 and 2012 and assessed the frequency of mutations, risk groups, histological subtypes and immunohistochemistry results. From PALGA, the nationwide Dutch Pathology Registry, pathology excerpts from all patients with a GIST or GIST-like tumour between 2003 and 2012 were retrieved to calculate incidence rates. Full pathology reports were retrieved of resections in 2011 and 2012 to study the frequency of mutations, risk groups, histological subtypes and immunohistochemistry results. The incidence of GIST increased to 17.7 per million inhabitants in 2012 with a median age of 67 years. Mutational analysis was performed in 33.9% of patients with a resection between 2011 and 2012 (KIT mutation 67.5%, PDGFRA 16.3%, wild-type 11.4%). The percentage of high risk patients in the different risk classifications varied from 19.9% to 38.0% depending on the used classification. Only 35.9% of patients had diagnosis or revision of pathology diagnosis within three months in a designated GIST referral centre. No increase in proportion of central pathology reviews was found. Proportion of patients with mutational analysis increased over the years. The registered incidence of GIST, 17.7 per million inhabitants in 2012 in the Netherlands, is still rising. Despite incorporation in the ESMO GIST guidelines since 2008 for mutational testing and since 2010 for central review of pathology, both are performed in a minority of patients.
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Ramaswamy A, Jain D, Sahu A, Ghosh J, Prasad P, Deodhar K, Shetty N, Banavali S, Shrikhande S, Ostwal V. Neoadjuvant imatinib: longer the better, need to modify risk stratification for adjuvant imatinib. J Gastrointest Oncol 2016; 7:624-31. [PMID: 27563454 DOI: 10.21037/jgo.2016.03.13] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Multimodality treatment of gastrointestinal stromal tumor (GIST) with surgery and adjuvant imatinib mesylate (IM), along with an emerging role for neoadjuvant IM prior to evaluation for resectability has resulted in high survival rates. METHODS We conducted a retrospective analysis of prospectively collected data of patients who underwent surgery for GIST, prior to or followed by IM therapy. A total of 112 patients underwent surgery between January 2009 and March 2015 at our centre. This included 27 patients with upfront resectable disease, 76 patients with locally advanced GIST who received neoadjuvant IM followed by surgery and 9 patients with metastatic disease who had excellent response to IM and were taken for surgery. RESULTS The primary tumor in the non metastatic patients was in the stomach (53%), duodenum (16%), rectum (12%), jejunum (11%), ileum (7%), and others (2%). Median duration of neoadjuvant IM was 5 months with 4 patients showing disease progression during neoadjuvant IM. Ninety-three percent of all patients had R0 resections, while 7% had R+ resections. The estimated 3- and 5-year DFS in non-metastatic patients was 86.1% and 67% respectively with a 3- and 5-year median OS of 95.4% and 91.7% respectively. Five-year PFS and OS for the metastatic patients was 88.8% and 100% respectively. Lack of adjuvant IM was the only factor related to inferior PFS and OS. CONCLUSIONS Longer duration of neoadjuvant IM should be considered in locally advanced GIST prior to surgery and resection may be considered in responding metastatic patients.
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Affiliation(s)
- Anant Ramaswamy
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Deepak Jain
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Arvind Sahu
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Joydeep Ghosh
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Priya Prasad
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Kedar Deodhar
- Department of Pathology, Tata Memorial Hospital, Mumbai, India
| | - Nitin Shetty
- Department of Interventional Radiology, Tata Memorial Hospital, Mumbai, India
| | - Shripad Banavali
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | | | - Vikas Ostwal
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
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Hu J, Or BHN, Hu K, Wang ML. Comparison of the post-operative outcomes and survival of laparoscopic versus open resections for gastric gastrointestinal stromal tumors: A multi-center prospective cohort study. Int J Surg 2016; 33 Pt A:65-71. [PMID: 27475743 DOI: 10.1016/j.ijsu.2016.07.064] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 07/09/2016] [Accepted: 07/25/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES Laparoscopic resection (LR) is increasingly performed for gastrointestinal stromal tumor (GIST). The aim of this study is to investigate the short-term outcomes and therapeutic effects of LR compared to open resection (OR) of gastric GISTs. METHODS During 2009-2014, a prospective cohort of 200 patients with gastric GISTs indicated for resection underwent LR and OR procedures in three centers in Shanghai. Patient demographics, peri-operative complications, and clinical outcomes were compared between the two groups. RESULTS After exclusions, 176 patients who underwent gastric GIST resections were compared, of which 91 were laparoscopic, 85 were open. Compared to open surgery, laparoscopic resection of GIST has shorter operative time (102 vs. 172 min, p < 0.001), lower blood loss (100 vs 144 ml, p < 0.001), and shorter length of stay (9.1 vs. 15.3 d, p < 0.001). No statistical significant difference is observed for time to bowel function or semi-liquid diet, complications, recurrence rates, and mortality. CONCLUSION LR is a safe and efficacious treatment for gastric GISTs, providing the advantages of shorter operative time, reduced blood loss, and shorter length of stay, all without compromising post-operative outcomes and survival.
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Affiliation(s)
- Jin Hu
- Department of Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Brian Ho Nam Or
- Department of Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kai Hu
- Department of Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ming Liang Wang
- Department of Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Du J, Shen N, He HS, Fu XL, Wang JZ, Mao CZ. Synchronous gastrointestinal cancer and gastrointestinal stromal tumors: a single-institution experience. World J Surg Oncol 2016; 14:130. [PMID: 27129592 PMCID: PMC4850719 DOI: 10.1186/s12957-016-0882-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 04/21/2016] [Indexed: 12/18/2022] Open
Abstract
Background A study was conducted to investigate the clinicopathological features and survival outcomes of gastrointestinal stromal tumors (GISTs) that are synchronous with other gastrointestinal cancers. Methods Clinical and pathological data of 286 patients with primary GIST from a single institution from January 2009 to December 2014 were reviewed. Results The entire study population comprised 286 patients with GISTs. Of these patients, 167 (58.4 %) were males and 119 (41.6 %) were females. The median age was 58 years old (in the range 29–86 years). A total of 47 patients were diagnosed with GISTs synchronous with other digestive tract malignancies (synchronous group), whereas 239 patients were diagnosed with non-synchronous disease (non-synchronous group). The concomitant digestive tumors in 27, 12, 7, and 1 patients were diagnosed as gastric carcinoma, esophageal carcinoma, colorectal carcinoma, and pancreatic adenocarcinoma, respectively. Compared with the synchronous group, the non-synchronous group exhibited a higher percentage of increased mitotic count (P = 0.011). The difference in tumor diameter between the two groups was statistically significant (P < 0.001). Patients in the non-synchronous group exhibited larger tumor size than the patients in the synchronous group (5.9 ± 3.5 cm vs. 1.6 ± 0.4 cm, P < 0.001). The majority of GIST lesions in the synchronous group were located in the stomach (P = 0.020). Lower risk stratifications and worse ECOG performance statuses were observed in the synchronous group (P < 0.001) than in the non-synchronous group. The 5-year overall survival rate was significantly higher in patients with no synchronous digestive tract malignancies than in patients with synchronous disease (70.8 vs. 34.1 %, P < 0.001). Conclusions Patients with GIST synchronous with other gastrointestinal cancers show worse prognosis than those with non-synchronous tumors. Clinicians should pay more attention to this subgroup.
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Affiliation(s)
- Jian Du
- Department of General Surgery, Suining Municipal Hospital of Traditional Chinese Medicine, Suining, 629000, Sichuan, China
| | - Ning Shen
- Department of General Surgery, Suining Municipal Hospital of Traditional Chinese Medicine, Suining, 629000, Sichuan, China.
| | - Hai-Shan He
- Department of General Surgery, Suining Municipal Hospital of Traditional Chinese Medicine, Suining, 629000, Sichuan, China
| | - Xiao-Lan Fu
- Department of General Surgery, Suining Municipal Hospital of Traditional Chinese Medicine, Suining, 629000, Sichuan, China
| | - Jing-Zhong Wang
- Department of General Surgery, Suining Municipal Hospital of Traditional Chinese Medicine, Suining, 629000, Sichuan, China
| | - Chong-Zhou Mao
- Department of General Surgery, Suining Municipal Hospital of Traditional Chinese Medicine, Suining, 629000, Sichuan, China
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Wu CR, Huang LY, Guo J, Zhang B, Cui J, Sun CM, Jiang LX, Wang ZH, Ju AH. Clinical Control Study of Endoscopic Full-thickness Resection and Laparoscopic Surgery in the Treatment of Gastric Tumors Arising from the Muscularis Propria. Chin Med J (Engl) 2016; 128:1455-9. [PMID: 26021500 PMCID: PMC4733781 DOI: 10.4103/0366-6999.157651] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Gastric stromal tumors arising from the muscularis propria are located in deeper layers. Endoscopic resection may be contraindicated due to the possibility of perforation. These tumors are therefore usually removed by surgical or laparoscopic procedures. This study evaluated the curative effects, safety and feasibility of endoscopic full-thickness resection (EFR) of gastric stromal tumors originating from the muscularis propria. METHODS This study enrolled 92 patients with gastric stromal tumors >2.5 cm originating from the muscularis propria. Fifty patients underwent EFR, and 42 underwent laparoscopic intragastric surgery. Operation time, complete resection rate, length of hospital stay, incidence of complications, and recurrence rates were compared in these two groups. RESULTS EFR resulted in complete resection of all 50 gastric stromal tumors, with a mean procedure time of 85 ± 20 min, a mean hospitalization time of 7.0 ± 1.5 days and no complications. Laparoscopic intragastric surgery also resulted in a 100% complete resection rate, with a mean operation time of 88 ± 12 min and a mean hospitalization period of 7.5 ± 1.6 days. The two groups did not differ significantly in operation time, complete resection rates, hospital stay or incidence of complications (P > 0.05). No patient in either group experienced tumor recurrence. CONCLUSIONS EFR technique is effective and safe for the resection of gastric stromal tumors arising from the muscularis propria.
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Affiliation(s)
| | - Liu-Ye Huang
- Department of Gastroenterology, Yantai Yuhuangding Hospital Affiliated to Medical College of Qingdao University, Yantai, Shandong 264000, China
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Søreide K, Sandvik OM, Søreide JA, Giljaca V, Jureckova A, Bulusu VR. Global epidemiology of gastrointestinal stromal tumours (GIST): A systematic review of population-based cohort studies. Cancer Epidemiol 2015; 40:39-46. [PMID: 26618334 DOI: 10.1016/j.canep.2015.10.031] [Citation(s) in RCA: 429] [Impact Index Per Article: 47.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 10/29/2015] [Accepted: 10/30/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gastrointestinal stromal tumours (GISTs) are rare, yet the most common mesenchymal tumour within the digestive tract. Lack of diagnostic criteria and no specific code in the ICD system has prevented epidemiological evaluation except from overt malignant cases in the past. A global estimate of incidence and disease patterns has thus not been available. METHODS A systematic literature search of all available population-based studies on GIST published between January 2000 and December 2014 were reviewed. Descriptive epidemiological data are presented. RESULTS The search found 29 studies of more than 13,550 patients from 19 countries that reported sufficient data for regional or national population-based statistics. Age at diagnosis ranged from 10 to 100 years, with median age being mid 60s across most studies. Gender distribution was equal across studies. On average, 18% of patients had an incidental diagnosis (range from 5% to 40%). Anatomical location of primary tumour in 9747 GISTs demonstrated gastric location as the most frequent (55.6%) followed by small bowel (31.8%), colorectal (6.0%), other/various location (5.5%) and oesophagus (0.7%). Most studies reported incidence at 10-15 per million per year. Notably, lowest incidence was in China (Shanxi province) with 4.3 per million per year. Highest incidence rates were reported also from China (Hong Kong and Shanghai areas), and in Taiwan and Norway (Northern part), with up to 19-22 per million per year. CONCLUSIONS Epidemiology of GIST demonstrates some consistent features across geographical regions. Whether the reported extreme differences in incidence reflect real variation in population risk warrants further investigation.
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Affiliation(s)
- Kjetil Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.
| | - Oddvar M Sandvik
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - Jon Arne Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Vanja Giljaca
- Department of Internal medicine, Division of Gastroenterology, University Hospital Center Rijeka, Croatia
| | | | - V Ramesh Bulusu
- Oncology Centre, Cambridge University Hospitals, Cambridge, UK
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Shen C, Chen H, Yin Y, Chen J, Han L, Zhang B, Chen Z, Chen J. Endoscopic versus open resection for small gastric gastrointestinal stromal tumors: safety and outcomes. Medicine (Baltimore) 2015; 94:e376. [PMID: 25569663 PMCID: PMC4602836 DOI: 10.1097/md.0000000000000376] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Endoscopic resection has been performed to treat small gastric neoplasms. However, this technique for small gastric gastrointestinal stromal tumors (GISTs) remains controversial. This study aims to compare the safety and surgical outcomes of endoscopic versus open resection of small gastric GISTs.The medical records of 54 consecutive gastric GISTs patients with tumor size of ≤2 cm, who were surgically treated with endoscopic resection (endoscopic group) or open surgery (laparotomy group) in a single institution from March 2010 to June 2014, were retrospectively analyzed. The clinical and tumor characteristics, surgical safety, and tumor-related outcomes were evaluated.Of 54 patients, 32 and 22 patients underwent endoscopic resection and laparotomy, respectively. Patients who underwent endoscopic resection yielded a significantly shorter hospital stay compared with patients who underwent laparotomy (P < 0.001). Compared with patients in the endoscopic group, patients in the laparotomy group had more intraoperative blood loss (P < 0.001), had longer nasogastric tube retention (P < 0.001), and required longer operative time (P < 0.001). More laparotomy patients required postoperative analgesic drugs than those in the endoscopic group (n = 9 vs 4; P = 0.016). Gastric perforation occurred in 1 case during operation in the endoscopic group. Patients who underwent these 2 procedures did not differ with respect to tumor size (P = 0.168), perioperative transfusion (P = 1.000), reoperation (P = 1.000), early satiety (P = 0.560), and postoperative bleeding (P = 1.000). With a median follow-up time of 34.5 months, 1 high-risk patient in each group experienced tumor recurrence/metastasis postoperatively.The endoscopic procedure allows safe resection with good surgical outcomes for small gastric GISTs compared with laparotomy. Moreover, larger randomized controlled trials are warranted to confirm endoscopic application for small gastric GISTs.
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Affiliation(s)
- Chaoyong Shen
- From the Department of Gastrointestinal Surgery (CS, HC, YY, JC, BZ, ZC, JC); and Intensive Care Unit (LH), West China Hospital, Sichuan University, Chengdu, Sichuan, China
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