Comparison of Prognosis Between Microscopically Positive and Negative Surgical Margins for Primary Gastrointestinal Stromal Tumors: A Systematic Review and Meta-Analysis

Liu, Zhen; Zhang, Yichunzi; Yin, Han; Geng, Xiuzhu; Li, Sishang; Zhao, Jinrong; Zeng, Ziyang; Ye, Xin; Yu, Jianchun; Feng, Fan; Kang, Weiming

doi:10.3389/fonc.2022.679115

Cited by 6 publications

(3 citation statements)

References 36 publications

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“…A large retrospective study found no significant differences in RFS between R0 and R1 resections 5. Conversely, a recent meta-analysis showed a lower RFS for R1 resections even when combined with adjuvant imatinib 13. While R0 resections remain the ideal outcome, it may not always be possible due to the location of the tumour.…”

Section: Discussionmentioning

confidence: 98%

Anal canal gastrointestinal stromal tumour (GIST)

Brucchi

Lauricella²,

Bottero

et al. 2023

BMJ Case Rep

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SummaryGastrointestinal stromal tumours (GISTs) are malignant mesenchymal tumours that originate from the interstitial pacemaker cells of Cajal. They are particularly rare, comprising only 5% of all GISTs, and often present at an advanced stage. Treatment for these tumours is still a topic of debate due to their low incidence and insidious location. A woman in her mid-70s presented with rectal bleeding and anal discomfort. A 4.5×4 cm anal GIST was diagnosed. A local excision was performed and the patient was further treated with tyrosine kinase inhibitors. At a 6-month follow-up, the MRI showed that she was disease free. Anorectal GISTs are unusual and tend to be aggressive. Surgical resection is the first-line treatment for primary, localised GISTs. However, the appropriate surgical technique for these tumours is still a topic of debate. Further studies are needed to fully understand the oncologic behaviour of these rare neoplasms.

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Section: Discussionmentioning

confidence: 98%

Anal canal gastrointestinal stromal tumour (GIST)

Brucchi

Lauricella²,

Bottero

et al. 2023

BMJ Case Rep

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“…The pooled results showed that DFS was not significantly associated with neoadjuvant imatinib in rectal GIST. It is reported that positive margin is possibly associated with the recurrence of GIST but this negative impact disappeared in the era of imatinib due to the use of adjuvant imatinib ( Liu et al, 2022 ). This comparable DFS between neoadjuvant imatinib group and no-neoadjuvant therapy group in current meta-analysis might partly due to the balanced rate of R0 resection between the two groups and the proper use of adjuvant imatinib in both groups.…”

Section: Discussionmentioning

confidence: 99%

Comparison of prognosis between neoadjuvant imatinib and upfront surgery for GIST: A systematic review and meta-analysis

et al. 2022

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Background: Significant survival benefit of adjuvant imatinib therapy has been observed in gastrointestinal stromal tumor (GIST). However, the impact of neoadjuvant imatinib on prognosis of GIST remains unclear. This meta-analysis aimed to compare the prognostic impact between upfront surgery and neoadjuvant imatinib plus surgery on GIST.Methods: A comprehensive literature search was performed to identify eligible studies up to 30 Sep 2021, through PubMed, Embase, Web of Science, and Cochrane Library. Studies compared the impact of upfront surgery and neoadjuvant imatinib plus surgery on disease-free (DFS) or overall survival (OS) in patients with GIST were selected.Results: Seven eligible studies with 17,171 patients were included. The reduction rates of tumor size in rectal and mixed site GIST were 33% and 29.8%, respectively. Neoadjuvant imatinib was not significantly associated with DFS compared with no-neoadjuvant therapy in rectal GIST (HR: 0.71, 95% CI: 0.35–1.41). The OS of rectal GIST was significantly improved by neoadjuvant imatinib compared with no-neoadjuvant therapy (HR: 0.36, 95% CI: 0.17–0.75).Conclusion: Neoadjuvant imatinib therapy contributed to tumor shrinkage and R0 resection of rectal GIST. Neoadjuvant imatinib plus surgery significantly improved overall survival of rectal GIST in comparison with upfront surgery.

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“…A positive surgical margin (PSM) denotes the presence of residual cancer cells at the margin of resected specimens, and has been shown to increase the risk of local recurrence and decrease overall survival in several cancer types. [1][2][3][4] Numerous studies have further stratified recurrence risk levels based on margin status, with the recommendation of additional therapies if a PSM is present. [5][6][7][8] Accurate identification of PSMs during surgery is, therefore, crucial to guide secondary resection and avoid the need for reoperations or adjuvant treatment.…”

Section: Introductionmentioning

confidence: 99%

Accuracy of Ex-vivo Fluorescence Confocal Microscopy in Margin Assessment of Solid Tumors: A Systematic Review

Au,

Almeida-Magana,

Al-Hammouri

et al. 2023

J Histochem Cytochem.

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Fluorescence confocal microscopy (FCM) is a novel technology that enables rapid high-resolution digital imaging of non-formalin-fixed tissue specimens and offers real-time positive surgical margin identification. In this systematic review, we evaluated the accuracy metrics of ex vivo FCM for intraoperative margin assessment of different tumor types. A systematic search of MEDLINE via PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus was performed for relevant papers (PROSPERO ID: CRD42022372558). We included 14 studies evaluating four types of microscopes in six different tumor types, including breast, prostate, central nervous system, kidney, bladder, and conjunctival tumors. Using the Quality Assessment of Diagnostic Accuracy Studies tool, we identified a high risk of bias in patient selection (21%) and index test (36%) of the included studies. Overall, we found that FCM has good accuracy metrics in all tumor types, with high sensitivity and specificity (>80%) and almost perfect concordance (>90%) against final pathology results. Despite these promising findings, the quality of the available evidence and bias concerns highlight the need for adequately designed studies to further define the role of ex vivo FCM in replacing the frozen section as the tool of choice for intraoperative margin assessment:

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Comparison of Prognosis Between Microscopically Positive and Negative Surgical Margins for Primary Gastrointestinal Stromal Tumors: A Systematic Review and Meta-Analysis

Cited by 6 publications

References 36 publications

Anal canal gastrointestinal stromal tumour (GIST)

Anal canal gastrointestinal stromal tumour (GIST)

Comparison of prognosis between neoadjuvant imatinib and upfront surgery for GIST: A systematic review and meta-analysis

Accuracy of Ex-vivo Fluorescence Confocal Microscopy in Margin Assessment of Solid Tumors: A Systematic Review

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