Predictors of Recurrence After Resection of Small Gastric Gastrointestinal Stromal Tumors of 5 cm or Less

Kim, Mi Young; Park, Young Su; Choi, Kee Don; Lee, Jeong Hoon; Choi, Kyeong‐Hee; Kim, Do Hoon; Song, Ho June; Lee, Gin Hyug; Jung, Hwoon Yong; Kim, Jin Ho; Yun, Sung Cheol; Kim, Kab Choong; Yook, Jeong Hwan; Oh, Seok‐Young; Kim, Byung Sik; Ryu, Min Hee; Kang, Yoon Koo

doi:10.1097/mcg.0b013e31821f8bf6

Cited by 18 publications

(5 citation statements)

References 33 publications

(31 reference statements)

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“…In the present study, although the small GISTs were ≤2 cm in size, the mitotic index of 6 small non-gastric GISTs was >5 mitoses per 50 HPF and the mitotic index of 2 out of 7 small GISTs (≤1 cm) was >5 per 50 HPF, which indicated the malignant potential and implied the necessity of surgical resection of small GISTs. No significant difference was identified between the mitotic index in the ≤1 cm diameter and 1–2 cm diameter groups, indicating that mitosis occurs in the early stage of disease, which is consistent with the findings of numerous studies in the literature ( 24 , 25 ). Gene detection was not performed in the present study, but a previous study by Corless et al ( 26 ) performed c-kit gene mutation testing on 13 small GISTs that were identified during autopsy or found incidentally, among which exon 11 (84.7%) was found to possess mutations of the c-kit gene.…”

Section: Discussionsupporting

confidence: 90%

Clinicopathological features and prognosis of small gastrointestinal stromal tumors outside the stomach

Wang

Song

2015

Oncology Letters

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The aim of the present study was to assess the clinicopathological features and prognostic factors of primary small gastrointestinal stromal tumors (GISTs) outside the stomach. The clinical data, clinicopathological features and prognostic factors of 20 patients with a pathologically-confirmed diagnosis of non-gastric GIST that were treated at Liaoning Cancer Hospital & Institute between July 2006 and December 2013 were retrospectively analyzed. In total, 15 patients were male and 5 were female, with a median age of 58 years (range, 44–82 years). A change in bowel habits was the original symptom of rectal small GISTs in 6 out of 8 patients, while patients with small GISTs in other locations demonstrated no overt symptoms and the lesions were detected by systematic examinations of other diseases or abdominal surgical procedures performed on other organs. In total, 19 patients out of the total 20 patients underwent surgery, and 1 patient with rectal GIST received continuous oral imatinib mesylate (400 mg once a day) instead of undergoing surgery. The mean diameter of tumors was 1.55±0.54 cm (range, 0.3–2.0 cm) and the median was 1.70 cm. The pathomorphology of the lesions was mainly spindle cell, and immunohistochemistry revealed the expression rate of cluster of differentiation (CD)117, CD34 and discovered on GIST-1 were 85, 80 and 70%. According to the mitosis index, small rectal GISTs were more frequent compared with other positions (P<0.05), while the frequency of small GISTs >1 cm in size was not significantly different from the frequency of small GISTs ≤1 cm in size (P=0.995). All 20 patients were followed up, with a median follow-up duration of 49.5 months (range, 10.5–94.4 months). At the end of the follow-up period, tumor recurrence occurred in 5 patients and 1 patient succumbed following progression. According to the analysis of the tumor sites, the RFS time of patients with small rectal GISTs was significantly different than the RFS time in patients with small GISTs in other positions. The clinical symptoms of non-gastric small GISTs were not evident and were challenging to detect. Small GISTs, regardless of size, possessed malignant potential and once detected, GISTs should be surgically resected. Lesions located in the rectum demonstrated an increased degree of malignancy and were more likely to recur. The tumor size and Ki67 index could not be considered as prognostic factors of non-gastric small GISTs.

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Section: Discussionsupporting

confidence: 90%

Clinicopathological features and prognosis of small gastrointestinal stromal tumors outside the stomach

Wang

Song

2015

Oncology Letters

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“…The management of GISTs is generally based on tumor size because biopsy is not recommended and mitotic index cannot be easily and accurately determined [13]. The National Comprehensive Cancer Network recommends surgical resection for tumors greater than 2 cm because of malignant potential, and lesions less than 2 cm can be conservatively followed up [14].…”

Section: Discussionmentioning

confidence: 99%

Surgical resection should be taken into consideration for the treatment of small gastric gastrointestinal stromal tumors

Yang

Feng

et al. 2013

World J Surg Onc

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BackgroundThe National Comprehensive Cancer Network (NCCN) recommends conservative follow-up for gastric gastrointestinal stromal tumors (GISTs) less than 2 cm. The aim of the present study was to investigate the clinical and pathological features of small gastric GISTs, re-evaluate the risk potential, and discuss the treatment strategy of small gastric GISTs.MethodsIn this retrospective study, 63 cases of small gastric GISTs (less than 2 cm) were resected surgically from May 2010 to March 2013 in our department. Clinicopathological factors were collected and the malignant potential of small gastric GISTs was analyzed.ResultsThe mitotic index of 14 out of 63 cases (22.22%) exceeded 5. The malignant potential of small gastric GISTs was related to tumor location (P = 0.0218). The mitotic index of 4 out of 8 GISTs (50%) located in gastric cardia exceeded 5, 8 out 28 GISTs (28.57%) located in the gastric fundus exceeded 5, and only 2 out of 27 GISTs (7.41%) located in the gastric body exceeded 5. We also discovered a good consistency between mitotic index and Ki-67 expression of small gastric GISTs.ConclusionsGastric GISTs less than 2 cm also have malignant potential. Thus, we recommended surgical resection of all small gastric GISTs once diagnosed.

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“…Of the 19 articles, 2 were excluded due to the insufficient reported data for the estimation of HR, 3 were excluded because they put R1 resection and R2 resection together, and 2 were excluded due to the small sample size (there are only 2 cases with R1 margin in both studies) 17 18 . Finally, a total of 12 studies 14 15 16 19 20 21 22 23 24 25 26 27 were included in this meta-analysis. Literatures screening process was shown in Fig.…”

Section: Resultsmentioning

confidence: 99%

Prognostic role of microscopically positive margins for primary gastrointestinal stromal tumors: a systematic review and meta-analysis

Zhi

Jiang

et al. 2016

Sci Rep

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The impact and management of microscopically positive margins in gastrointestinal stromal tumors (GISTs) remain unclear. The aim of this study is to estimate the prognostic value of surgical margins for disease-free survival (DFS) and overall survival (OS) in patients with primary GISTs. Twelve studies with 1985 GIST patients were included. The overall recurrence rate in R1 resection and R0 resection group was 0.364 (95% CI 0.299–0.429) and 0.296 (95% CI 0.161–0.430), respectively. Meta-analysis confirmed that a microscopically positive margin could significantly impact the disease-free survival (HR 1.596, 95% CI 1.128–2.258; I2 = 37.5%, P value = 0.091), but had no influence on overall survival (HR 1.430, 95% CI 0.608–3.363; I2 = 60.8%, P value = 0.013). Importantly, subgroup analysis revealed that adjuvant imatinib treatment could attenuate the risk of recurrence for primary GIST patients who received R1 resection. (HR 1.308, 95% CI 0.583–2.935; I2 = 53.2%, P value = 0.074). The level of evidence achieved in this study was “moderate” for DFS and “low” for OS. In conclusion, this study revealed that a microscopically positive margin is an unfavorable prognostic factor for GIST patients with R1 resection, and adjuvant imatinib treatment is proved to be effective.

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Predictors of Recurrence After Resection of Small Gastric Gastrointestinal Stromal Tumors of 5 cm or Less

Abstract: Predictors of recurrence of gastric GISTs of 5 cm or less were a high mitotic index and abnormal p53 expression. A positive microscopic resection margin was not associated with recurrence.

Cited by 18 publications

References 33 publications

Clinicopathological features and prognosis of small gastrointestinal stromal tumors outside the stomach

Clinicopathological features and prognosis of small gastrointestinal stromal tumors outside the stomach

Surgical resection should be taken into consideration for the treatment of small gastric gastrointestinal stromal tumors

Prognostic role of microscopically positive margins for primary gastrointestinal stromal tumors: a systematic review and meta-analysis

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