The Effect of Surgery and Grade on Outcome of Gastrointestinal Stromal Tumors

Abstract

We believe that the clinical behavior of these tumors can be predicted by reproducible prognostic factors. Design and Setting: A retrospective review of all patients (N=70) with GIST treated at a tertiary care center from 1973 to 1998. Patients: Adequate data for evaluation were available for 69 patients. Male-female distribution was 40:29. Median age was 60 years. Median follow-up duration was 38 months. Main Outcome Measures: Tumor grade, stage, and histologic subtype at presentation; effect of grade, surgery and adjuvant therapy on recurrence, salvage, and survival. Results: Tumor distribution included 61% in the upper, 23% in the middle, and 16% in the lower digestive tract, with a median tumor size of 7.9 cm (range, 1.8-25 cm). Tumors with more than 1 mitosis per 10 highpower fields constituted 57% of neoplasia in the series. Distant disease at initial visit occurred in 49% of patients. Complete gross resection occurred in 59% of patients. After complete resection, the 5-year survival rate was 42%, compared with 9% after incomplete resection (hazard ratio=0.27, PϽ.001). Neither radiation nor chemotherapy demonstrated any significant benefit. Among 39 patients who were disease free after complete resection, 2% developed lymph node recurrence, 25% developed local recurrence, and 33% developed distant recurrences (54% liver, 20% peritoneum). By multivariate analysis the risk of local and/or distant metastases was significantly increased for tumors with more than 1 mitosis and size larger than 5 cm (PϽ.05). Multivariate analysis in all 69 patients revealed that incomplete resection, age greater than 50 years, non-smooth muscle histological feature, tumor with more than 1 mitosis, and tumor size larger than 5 cm significantly decreased survival. Conclusion: Complete gross surgical resection is presently the only means of cure for GIST. Tumors with more than 1 mitosis and a size larger than 5 cm have an especially poor prognosis, with decreased survival, and increased local and/or distant recurrence.

Management of Gastrointestinal Stromal Tumors in the Imatinib Era: Selected Case Studies

“…Historically, the 5-year survival rate has been approximately 35%-65% among patients able to undergo complete resection. Among patients with unresectable disease, the median survival time is 10-20 months [6][7][8][9][10]. These observations suggest that microscopic disease often persists despite surgical resection of solid tumors.…”

Gastrointestinal Stromal Tumors

“…GIST rarely metastasize to lymph nodes [67][68][69][70] and therefore regional lymphadenectomy is generally not required. Furthermore, organ-sparing resection (segmental resection, etc.)…”

“…is oncologically appropriate and should thus be aimed for. The primary goal is to remove the tumor with tumor free margins since 5-year overall survival in GIST patients with complete gross resection has been estimated at 42% compared to only 9% overall survival if the excision was incomplete [70]. GIST can usually be lifted away from surrounding structures, rarely spread into adjacent organs and therefore offer an excellent opportunity for laparoscopic tumor resection with efficacy and recurrence rates similar or superior to historical open surgical controls [71][72][73][74].…”

A Retrospective Evaluation of Patients with Operable Gastrointestinal Stromal Tumor

“…Lokalize hastalıkta küratif tedavi yöntemi cerrahi rezeksiyondur. Cerrahi tedavinin primer amacı tümörsüz cerrahi sınır (R0) elde edecek şekilde kitleyi çıkarabilmektir (8). Ancak R0 rezeksiyonun yapılabildiği hastaların bile yaklaşık yarısında 5 yıl içinde nüks veya metastaz gelişmektedir (9).…”