Potential indicators predict progress after surgical resection of gastrointestinal stromal tumors

Abstract

In order to find out the potential indicators predicting prognosis of malignant gastrointestinal stromal tumors (GISTs) after surgical resection, we collected clinical records of 80 patients with malignant GISTs. Tumor location, size, mitotic index, necrosis were compared with the prognosis of malignant GISTs by Kaplan-Meier method and log-rank test. After a median follow-up of 844 days (52–2 145), we found that as National Institutes of Health suggested, tumors with intermediate risk had more favorable prognosis than that with high risk. Their 3-year survival rate were 65.3% and 41.3%, respectively (P<0.001). Moreover, tumor size and mitotic index were associated with free survival. The 3-year survival rate for patients with tumor size≤10 cm and>10 cm were 62.3% and 41.8%, respectively (P = 0.002), Tumors with mitotic index≤5/50 HPF had a higher 3-year survival rate than tumors with mitotic index>5/50 HPF (67.1% versus 40.7%, P = 0.005). The presence of necrosis was directly related to the malignant behavior. The 3-year survival rate for presence and absence necrosis were 50.8% and 64.8% (P = 0.008). From the present study, we can conclude that besides tumors size and mitotic index, tumor location and necrosis also influence on the long-term survival of patient with malignant GISTs after surgical resection.

Keywords

gastrointestinal stromal tumors / surgery / survival

References

[1] Zabka J. Gastrointestinal stromal tumors. Klin Onkol2011; 24(3): 187–194 (in Czech)

[2] Liu SL, Song ZF, Li W, Liu XW, Zhang C, Zheng QC. A clinicopathologic andimmunohistochemical study of gastrointestinal stromal tumors based on 122 cases. Chinese-German J Clin Oncol2010; 9(10): 597–600

[3] Hirota S, Isozaki K. Pathology of gastrointestinal stromal tumors. Pathol Int2006; 56(1): 1–9

[4] Hirota S, Isozaki K, Moriyama Y, Hashimoto K, Nishida T, Ishiguro S, Kawano K, Hanada M, Kurata A, Takeda M, Muhammad Tunio G, Matsuzawa Y, Kanakura Y, Shinomura Y, Kitamura Y. Gain-of-function mutations of c-kit in human gastrointestinal stromal tumors. Science1998; 279(5350): 577–580

[5] Heinrich MC, Corless CL, Duensing A, McGreevey L, Chen CJ, Joseph N, Singer S, Griffith DJ, Haley A, Town A, Demetri GD, Fletcher CD, Fletcher JA. PDGFRA activating mutations in gastrointestinal stromal tumors. Science2003; 299(5607): 708–710

[6] Mochizuki Y, Kodera Y, Ito S, Yamamura Y, Kanemitsu Y, Shimizu Y, Hirai T, Yasui K, Inada K, Kato T. Treatment and risk factors for recurrence after curative resection of gastrointestinal stromal tumors of the stomach. World J Surg2004; 28(9): 870–875

[7] Keun Park C, Lee EJ, Kim M, Lim HY, Choi DI, Noh JH, Sohn TS, Kim S, Kim MJ, Lee HK, Kim KM. Prognostic stratification of high-risk gastrointestinal stromal tumors in the era of targeted therapy. Ann Surg2008; 247(6): 1011–1018

[8] Nilsson B, Bümming P, Meis-Kindblom JM, Odén A, Dortok A, Gustavsson B, Sablinska K, Kindblom LG. Gastrointestinal stromal tumors: the incidence, prevalence, clinical course, and prognostication in pre-imatinib mesylate era. Cancer2005; 103(4): 821–829

[9] Bertolini V, Chiaravalli AM, Klersy C, Placidi C, Marchet S, Boni L, Capella C. Gastrointestinal stromal tumors—frequency, malignancy, and new prognostic factors: the experience of a single institution. Pathol Res Pract2008; 204(4): 219–233

[10] Miettinen M, El-Rifai W, Sobin LH, Lasota J. Evaluation of malignancy and prognosis of gastrointestinal stromal tumors: a review. Hum Pathol2002; 33(5): 478–483

[11] Tryggvason G, Kristmundsson Ρ, Örvar K, Jónasson JG, Magnússon MK, Gíslason HG. Clinical study on gastrointestinal stromal tumors (GIST) in Iceland, 1990-2003. Dig Dis Sci2007; 52(9): 2249–2253

[12] Gold JS, Dematteo RP. Combined surgical and molecular therapy: the gastrointestinal stromal tumor model. Ann Surg2006; 244(2): 176–184

[13] Kontogianni-Katsarou K, Lariou C, Tsompanaki E, Vourlakou C, Kairi-Vassilatou E, Mastoris C, Pantazi G, Kondi-Pafiti A. KIT-negative gastrointestinal stromal tumors with a long term follow-up: a new subgroup does exist. World J Gastroenterol2007; 13(7): 1098–1102

[14] Casali PG, Blay JY. Gastrointestinal stromal tumours: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol2010; 21(Suppl 5): v98–v102

[15] Yamamoto H, Kojima A, Miyasaka Y, Imamura M, Nakamura N, Yao T, Tsuneyoshi M, Oda Y. Prognostic impact of blood vessel invasion in gastrointestinal stromal tumor of the stomach. Hum Pathol2010; 41(10): 1422–1430

[16] Greenson JK. Gastrointestinal stromal tumors and other mesenchymal lesions of the gut. Mod Pathol2003; 16(4): 366–375

[17] Dirnhofer S, Leyvraz S. Current standards and progress in understanding and treatment of GIST. Swiss Med Wkly2009; 139(7-8): 90–102

[18] Hassan I, You YN, Shyyan R, Dozois EJ, Smyrk TC, Okuno SH, Schleck CD, Hodge DO, Donohue JH. Surgically managed gastrointestinal stromal tumors: a comparative and prognostic analysis. Ann Surg Oncol2008; 15(1): 52–59

[19] Haller F, Happel N, Schulten HJ, von Heydebreck A, Schwager S, Armbrust T, Langer C, Gunawan B, Doenecke D, Füzesi L. Site-dependent differential KIT and PDGFRA expression in gastric and intestinal gastrointestinal stromal tumors. Mod Pathol2007; 20(10): 1103–1111

[20] Miettinen M, Lasota J. Gastrointestinal stromal tumors (GISTs): definition, occurrence, pathology, differential diagnosis and molecular genetics. Pol J Pathol2003; 54(1): 3–24

[21] Hoeben A, Schöffski P, Debiec-Rychter M. Clinical implications of mutational analysis in gastrointestinal stromal tumours. Br J Cancer2008; 98(4): 684–688

[22] Calabuig-Fariñas S, López-Guerrero JA, Navarro S, Machado I, Poveda A, Pellín A, Llombart-Bosch A. Evaluation of prognostic factors and their capacity to predict biological behavior in gastrointestinal stromal tumors. Int J Surg Pathol2011; 19(4): 448–461

[23] Hueman MT, Schulick RD. Management of gastrointestinal stromal tumors. Surg Clin North Am2008; 88(3): 599–614, vii

[24] Parfitt JR, Streutker CJ, Riddell RH, Driman DK. Gastrointestinal stromal tumors: a contemporary review. Pathol Res Pract2006; 202(12): 837–847

[25] Strickland L, Letson GD, Muro-Cacho CA. Gastrointestinal stromal tumors. Cancer Control2001; 8(3): 252–261

[26] Sanchez Hidalgo JM, Rufian Peña S, Ciria Bru R, Naranjo Torres A, Muñoz Casares C, Ruiz Rabelo J, Briceño Delgado J. Gastrointestinal stromal tumors (GIST): a prospective evaluation of risk factors and prognostic scores. J Gastrointest Cancer2010; 41(1): 27–37

[27] Blackstein ME, Blay JY, Corless C, Driman DK, Riddell R, Soulières D, Swallow CJ, Verma S. Gastrointestinal stromal tumours: consensus statement on diagnosis and treatment. Can J Gastroenterol2006; 20(3): 157–163

[28] Stratopoulos C, Soonawalla Z, Piris J, Friend PJ. Hepatopancreatoduodenectomy for metastatic duodenal gastrointestinal stromal tumor. Hepatobiliary Pancreat Dis Int2006; 5(1): 147–150

[29] Liu SL, Zheng QC, Song ZF, Li W, Hu SB. Gastrointestinal stromal tumor of duodenum: a cause of upper gastrointestinal hemorrhage. Chinese-German J Clin Oncol2010; 9(4): 243–245

[30] van der Zwan SM, DeMatteo RP. Gastrointestinal stromal tumor: 5 years later. Cancer2005; 104(9): 1781–1788

[31] Rutkowski P, Nowecki ZI, Michej W, Debiec-Rychter M, Woźniak A, Limon J, Siedlecki J, Grzesiakowska U, Kakol M, Osuch C, Polkowski M, Głuszek S, Zurawski Z, Ruka W. Risk criteria and prognostic factors for predicting recurrences after resection of primary gastrointestinal stromal tumor. Ann Surg Oncol2007; 14(7): 2018–2027

RIGHTS & PERMISSIONS

2014 Higher Education Press and Springer-Verlag Berlin Heidelberg