Association Between Gastrointestinal Stromal Tumors and Other Malignancies: It Is Only a Matter of Time ? A Case Series and an Overview of Systematic Reviews

Abstract

Purpose Little is known about the sporadic coincidence of gastrointestinal stromal tumors (GISTs) with second primary tumors (SPTs). The aim of this study is to clarify if there is a clinicopathologic correlation responsible for the synchronous or metachronous occurrence of SPTs in GIST patients. Methods We carried out a single-center, retrospective analysis on patients with GISTs surgically treated at our institution from January 2019 to June 2019. Two groups of patients were identified: isolated GIST (group A) and GIST associated with SPT (group B). A meta-review was conducted with the aim to examine the published systematic reviews that included studies assessing the SPT risk in GIST patients. Results Thirty-nine patients were surgically treated for GIST during the study period, with seven (17.9%) of them having other SPTs. SPTs were most frequent in the colon. Group A patients had a lower mean age at initial diagnosis (56.8 ± 15.2 vs. 73.4 ± 16.6, P = 0.012). No statistically significant difference was found between the two groups in terms of tumor location, mitotic index, Ki-67 expression, risk classification, and imatinib therapy. The overview showed that the cumulative prevalence rate of SPTs ranged from 9.3 to 18.0%. SPTs were more frequent in the gastrointestinal tract (37.9-95.0%), followed by the genitourinary tract. Conclusion GIST patients under our care experienced a 17.9% overall risk of developing SPTs with different histology. When comparing patients with isolated GIST and patients with GIST and SPT, age was the only variable significantly related to the development of other neoplasms. However, the potential non-random association and causal relationship between GISTs and SPTs remain to be investigated.

Ki67 for evaluating the prognosis of gastrointestinal stromal tumors: A systematic review and meta‑analysis

“…1). A total of 20 studies that fulfilled the inclusion criteria were finally included in the analysis (15,(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40). The NOS was used to verify the quality of the evidence.…”

Second Primary Tumors in Patients with Gastrointestinal Stromal Tumors: A Single-Center Experience

“…The distribution and frequency of secondary tumors associated with GISTs may differ. Although they vary in different series in the literature, gastrointestinal and genitourinary cancers are the most common together with GISTs [ 1 , 11 , 12 , 14 , 18 , 20 , 23 ]. In our study, gastrointestinal system cancers (60%), followed by breast cancers (15%), were found to be the most common SPMTs accompanying GISTs.…”

“…In terms of the rates of mitosis, some studies found no mitosis, if found, the rate was mostly ≤5/50 HPF [ 9 , 15 , 18 , 23 , 27 ], although one study found a rate of >5/50 HPF [ 25 ]. In most studies, GISTs associated with secondary tumors had a low risk score [ 9 , 11 , 15 , 20 , 21 , 23 , 24 , 28 ]. Our results of low risk, stomach localization, small tumor diameter, and low mitosis rates are in line with other findings reported in the literature.…”

“…Although varying rates have been reported in literature, the association of GISTs with secondary tumors was reported to be 20% in a meta-analysis performed in 2019 [ 11 , 12 ]. Most studies have shown that GISTs are most commonly associated with gastrointestinal and genitourinary system tumors [ 11 , 12 , 14 , 18 , 20 ]. Further, gastrointestinal tumors frequently include stomach and colorectal cancers [ 10 , 11 , 12 , 14 , 15 , 18 ].…”