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

Zhi, Xiaofei; Jiang, Baofei; Yu, Junbo; Røe, Oluf Dimitri; Qin, Jun; Ni, Qingfeng; Sun, Liang; Xu, Minhui; Zhu, Jianwei; Ma, Lan

doi:10.1038/srep21541

Cited by 33 publications

(25 citation statements)

References 41 publications

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“…Although individual studies imply an advantage in terms of local recurrence-free survival for resection margins larger than 1 cm, marginal resections are considered appropriate as long as microscopically tumor-free margins are established [14,15]. In contrast to gastrointestinal carcinomas, systematic lymphadenectomy is not indicated in GIST since lymph node metastases are a rare event.…”

Section: Principles Of Surgery and Different Rationales For Preoperatmentioning

confidence: 99%

Neoadjuvant Therapy to Downstage the Extent of Resection of Gastrointestinal Stromal Tumors

Jakob¹,

Hohenberger²

2018

Visc Med

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Introduction: Gastrointestinal stromal tumors (GIST) are rare malignant tumors in terms of incidence, and they are not linked to specific symptoms. Often, primary tumors, particularly of the stomach, rectum, or rectovaginal space, are quite large when detected, and multivisceral resection seems to be the treatment of choice as the mainstay of therapy is complete tumor removal. If a gain-of-function mutation in the KIT gene is present, drug therapy with receptor tyrosine kinase inhibitors (RTKIs) might significantly downstage primary GIST tumors. Methods: A review of the literature was performed to identify the current evidence for preoperative treatment of GIST regarding toxicity, efficacy, and oncological outcome, including mutational data from our own database. Results: Four phase II as well as several cohort studies showed acceptable toxicity and no increased perioperative morbidity of preoperative imatinib. Progressive disease during preoperative treatment was a rare event, and partial response was achieved in 40-80% of all patients. For methodological reasons, the trials cannot prove an oncological long-term superiority of preoperative treatment. Conclusion: Preoperative therapy with imatinib is safe and recommended for patients with locally advanced GIST. Neoadjuvant imatinib therapy may enable less invasive and organ-sparing surgery, avoid tumor rupture during extensive resectional procedures, and improve the quality of perioperative RTKI treatment.

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Section: Principles Of Surgery and Different Rationales For Preoperatmentioning

confidence: 99%

Neoadjuvant Therapy to Downstage the Extent of Resection of Gastrointestinal Stromal Tumors

Jakob¹,

Hohenberger²

2018

Visc Med

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“…It seems that this strategy could attenuate the risk of recurrence for primary GIST after R1 resection. The results of a meta-analysis indicated that adjuvant imatinib therapy can decrease the risk of recurrence in primary GIST after R1 resection (HR 1.3), and in the group of patients after R1 resection without adjuvant therapy disease-free survival remained poorer [36]. Nevertheless, according to the analysis of databases of two adjuvant trials, i.e.…”

Section: Influence Of Perioperative Therapymentioning

confidence: 99%

“…Crosby et al [35] reported that in 10 out of 24 patients with negative microscopic margins in primary resection of small bowel GIST and negative lateral margins, peritoneal metastases were detected, which may support this theory. In a systematic review and meta-analysis evaluating the prognostic role of microscopically positive margins for primary GIST [36], which was based on 12 studies comprising 1,985 patients, it was concluded that a microscopically positive margin may have significant impact on disease-free survival (HR (hazard ratio) 1.6; p = 0.09) without influence on overall survival (HR 1.4).…”

Section: Margins and Risk Of Recurrencementioning

confidence: 99%

Is the Surgical Margin in Gastrointestinal Stromal Tumors Different

2018

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Background: Radical surgical excision is the mainstay of therapy of primary, nonmetastatic gastrointestinal stromal tumors (GIST) and margin status after surgery is a significant prognostic factor. Methods and Results: The aim of this paper is to review principles in primary GIST surgery, i.e. differences between R0, R1, and R2 resection, to describe how surgical margin status and tumor intraperitoneal rupture influence the patients' outcome, and how this may be effected by neoadjuvant and adjuvant treatment in locally advanced tumors. A systematic search of literature published between 2000 and 2018 was performed regarding this topic. Conclusion: Correct interpretation of margin status after surgery can be affected by many factors during operation and preparation of tissue.

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“…Successful diagnosis of small pre-malignant lesions and early-stage tumors can significantly benefit cancer treatment and improve the survival rate for patients 1–7 . In the past few decades, there have been numerous advances in fluorescence-based imaging tools for clinical diagnosis, surgical guidance, and therapeutic applications 8–13 .…”

mentioning

confidence: 99%

Affibody-targeted fluorogen activating protein for in vivo tumor imaging

et al. 2017

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Molecular imaging using near-infrared (NIR) fluorescence is useful for intraoperative imaging and real-time margin identification. Directly conjugated IR dyes possess useful properties for in vivo imaging, but conjugation often substantially alters the circulation dynamics of targeting moieties. We developed and characterized a new tumor-targeting probe, affiFAP, which consists of a protein that specifically binds EGFR (affibody) and a fluorogen activating protein (FAP). This compact molecular recognition reagent can reversibly bind and activate fluorescence of otherwise nonfluorescent dyes and allows tumor visualization with low nonspecific tissue staining. We demonstrate molecular pre-targeting of affiFAPs and subsequent systemic or topical application of fluorogenic dye to achieve high contrast, fast clearance, and good tissue penetration that may be used in clinical settings to molecularly define tumor margins.

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

Cited by 33 publications

References 41 publications

Neoadjuvant Therapy to Downstage the Extent of Resection of Gastrointestinal Stromal Tumors

Neoadjuvant Therapy to Downstage the Extent of Resection of Gastrointestinal Stromal Tumors

Is the Surgical Margin in Gastrointestinal Stromal Tumors Different

Affibody-targeted fluorogen activating protein for in vivo tumor imaging

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