Surgical Therapy for Gastrointestinal Stromal Tumours of the Upper Gastrointestinal Tract (original) (raw)
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An audit of surgical management of gastrointestinal stromal tumours (GIST)
European Journal of Surgical Oncology (EJSO), 2006
Aim: To analyze GIST outcome after primary resection and to determine if a new grading system could adequately predict there prognosis. Methods: A retrospective review (1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002) identified 80 patients who underwent primary surgical resection for, c-KIT positive, GIST. Follow-up was complete for all patients (median follow-up 42, range 1-132, months). GIST were classified as low or high grade according to the following parameters: size, mitotic rate, mitotic index (MiB1), presence of necrosis, invasion of adjacent structure and presence of metastasis. Results: GIST originated from the stomach (46), small bowel (30), colon and rectum two and mesentery two. At surgery, 94% of cases presented with localized disease and 6% blood born metastasis with or without lymph node invasion. Resections were complete (R0) in 72 cases. R0 resection correlated with prognosis (p!0.01). Sixty GIST were classified as low grade (median follow-up 60 months) and 20 as high grade (median follow-up 27 months). Five-year actuarial survival of patients with low or high grade GIST were of 95 and 21%, respectively, (p!0.001). Conclusion: Prognosis of GIST after surgical treatment is influenced by completeness of primary resection and tumour malignant potential. Low grade GIST have an excellent prognosis after surgery alone, while high grade GIST have a high rate of recurrence after primary resection. Adjuvant treatment should be advocated for patient with either high grade GIST or after incomplete primary resection. The presented grading system can reliably predict GIST outcome after primary surgical treatment.
World journal of surgical oncology, 2006
Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal neoplasm of the gastrointestinal (GI) tract which has only been recently described based on their specific immunohistochemistry and the presence of particular KIT-related mutations which potentially make them targets for tyrosine kinase inhibition. Sixty-one patients (29 M; 32 F, median age 60 years; range: 23-86 years) between June 1994 and March 2005, were analyzed from two allied institutions. Patient, tumour, and treatment variables were analyzed to identify factors affecting survival. Of the 61 patients, 55 (90%) underwent complete surgical resection of macroscopic disease. The 5-year overall survival (OS) rate in the 61 patients was 88% and the 5-year disease-free survival (DFS) in the 55 cases completely resected was 75%. Univariate analysis revealed that R0 resection was strongly associated with a better OSrate (p < 0.0001). Likewise, univariate analysis also showed high mitotic count of > 10 mito...
Annals of Surgical Oncology, 2007
Background The introduction of adjuvant imatinib in gastrointestinal stromal tumors (GISTs) raised debate over the accuracy of National Institutes of Health risk criteria and the significance of other prognostic factors in GIST. Methods Tumor aggressiveness and other clinicopathological factors influencing disease-free survival (DFS) were assessed in 335 patients with primary resectable CD117-immunopositive GISTs (median follow-up, 31 months after primary tumor resection) from a prospectively collected tumor registry. Results Overall median DFS was 37 months, and estimated 5-year DFS was 37.8 %. In univariate analysis, high or intermediate risk group (P < .000001), mitotic index >5/50 high-power field (P < .00001), primary tumor size >5 cm (P < .00001), nongastric primary location (P = .0001), male sex (P = .01), R1 resection/tumor rupture (P = .0003), and epithelioid cell or mixed cell pathological subtype (P = .05) negatively affected DFS. In multivariate analysis, statistically significant factors negatively influencing DFS for model 1 were mitotic index >5/50 high-power field (P = .004), primary tumor size >5 cm (P = .001), male sex (P = .003), R1 resection/tumor rupture (P = .04), and nongastric primary tumor location (P = .02), and for model 2 were high/intermediate risk primary tumor (P < .0001 and P = .008, respectively), male sex (P = .007), resection R1/tumor rupture (P = .01), and nongastric primary tumor location (P = .02). Five-year DFS for high, intermediate, and low/very low risk group was 20%, 54%, and 96%, respectively. Conclusions The risk criteria for assessing the natural course of primary GISTs were validated, but additional independent prognostic factors—primary tumor location and sex—were also identified.
Surgical Margin Status and Prognosis of Gastrointestinal Stromal Tumor
World Journal of Surgery, 2008
Background Surgery is the best treatment for primary GIST and may be curative, but resection extension/completeness impact on the prognosis remains controversial. The authors aim was to evaluate the clinicopathological (CP) parameters and surgical margins status influence on GIST patients’ outcome. Materials and methods The study evaluated 113 consecutive patients with sporadic GIST; the influence of CP parameters on recurrence-free survival (RFS) and disease-specific survival (DSS) was determined by univariate analysis (UA) and multivariate analysis (MA). Results Of 104 cases, macroscopically complete resection was achieved in 96: R0 surgical margin status in 78 and R1 in 18. Recurrence rates (12.5%) were significantly lower in R0 (9.0%) than in R1 (27.8%). Tumor >10 cm, mitotic count >5/50 high power field (HPF), and high-risk GIST predicted poor RFS and DSS (UA). Disease-specific survival was significantly shorter after macroscopic incomplete (R2) resection, for mixed cellular morphology, and in tumors with necrosis (UA). High-risk GIST (p = 0.016) and R2 resection (p = 0.013) predicted poor DSS of patients (MA). Conclusions High risk and positive macroscopic surgical margin status are parameters associated with poor disease-specific survival in GIST patients.
Conditional Disease-Free Survival After Surgical Resection of Gastrointestinal Stromal Tumors
JAMA Surgery, 2015
IMPORTANCE Gastrointestinal stromal tumors (GISTs) are the most commonly diagnosed mesenchymal tumors of the gastrointestinal tract. The risk of recurrence following surgical resection of GISTs is typically reported from the date of surgery. However, disease-free survival (DFS) over time is dynamic and changes based on disease-free time already accumulated following surgery. OBJECTIVES To assess the comparative performance of established GIST recurrence risk prognostic scoring systems and to characterize conditional DFS following surgical resection of GISTs. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study of 502 patients who underwent surgery for a primary, nonmetastatic GIST between January 1, 1998, and December 31, 2012, at 7 major academic cancer centers in the United States and Canada. MAIN OUTCOMES AND MEASURES Disease-free survival of the patients was classified according to 5 prognostic scoring systems, including the National Institutes of Health criteria, modified National Institutes of Health criteria, Memorial Sloan Kettering Cancer Center GIST nomogram, and American Joint Committee on Cancer gastric and nongastric categories. The concordance index (also known as the C statistic or the area under the receiver operating curve) of established GIST recurrence risk prognostic scoring systems. Conditional DFS estimates were calculated. RESULTS Overall 1-year, 3-year, and 5-year DFS following resection of GISTs was 95%, 83%, and 74%, respectively. All the prognostic scoring systems had fair prognostic ability. For all tumor sites, the American Joint Committee on Cancer gastric category demonstrated the best discrimination (C = 0.79). Using conditional DFS, the probability of remaining disease free for an additional 3 years given that a patient was disease free at 1 year, 3 years, and 5 years was 82%, 89%, and 92%, respectively. Patients with the highest initial recurrence risk demonstrated the greatest increase in conditional survival as time elapsed. CONCLUSIONS AND RELEVANCE Conditional DFS improves over time following resection of GISTs. This is valuable information about long-term prognosis to communicate to patients who are disease free after a period following surgery.
Outcome of surgical resection for localized gastrointestinal stromal tumors
International Surgery Journal, 2017
Background: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. The clinical outcome and the factors which are potentially related to tumor recurrence and survival after surgical intervention for GISTs has not been adequately addressed in the Southern part of Egypt. Methods: Medical records of adult patients who underwent surgical resection of localized GISTs (February 2007-December 2013) in Sohag University Hospital were reviewed. Data on the clinical presentation, treatment strategies, tumor characteristics including the risk for aggressive behavior and survival rate were analyzed. Results: Fifteen patients with 7 gastric (47%), 5 small bowel (33%), 2 duodenal (13%) and 1 colonic (7%) GISTs and median age of 56 (range: 32-73) years were eligible. Nine patients (60%) were males. Non-specific abdominal pain was the most common presenting symptoms (40%). Emergency presentation occurred only in two patients (13%). Complete resection was achieved in thirteen patients (87%). There was no major operative morbidity or mortality. The risk for aggressive behaviour was low in 7 (47%), intermediate in 5 (33%) and high in 3 (20%) patients. Two patients died 7 and 10 months after surgery, one with histopathological criteria of high risk for aggressive tumor behaviour and the other with incomplete tumor resection. During a median follow up of 21 (range: 8-48) months, overall and recurrence-free survival were 87% and 67%, respectively. Conclusions: Adequate resection of GISTs is associated with high rate of survival. Increased risk for aggressive tumor behaviour and incomplete resection are associated with tumor recurrence and decreased survival.
2009
GISTs are the most common mesenchimal tumors and represent approximately 1% of all of the gastrointestinal tract cancers. The treatment for localized GISTs is the surgical excision with macroscopically negative margins. However, recurrence is a relatively common event even after a complete resection. Almost 30% of recurrences are locally and distant metastases represent the 50% of total recurrences. Materials and methods: From July 2002 to March 2009 a total of nineteen patients (12 males, 7 females), median age 65 years (49-79),underwent curative resection (R0). Tumor site: stomach 12; small intestine 5; colon rectum 2. Surgical treatments: segmental resection of small intestine (5); gastric wedge resection (9), subtotal gastrectomy (2); gastric resection extended to distal splenopancreasectomy (1); right colectomy (1); anterior resection (1). Results: Gastric GISTs were high grade in 4 patients, intermediate in 1 patient and low-risk in 7 patients. Small intestine GISTs were high ...