The standard diagnosis, treatment, and follow-up of gastrointestinal stromal tumors based on guidelines

Nishida, Toshirou; Blay, Jean‐Yves; Hirota, Seiichi; Kitagawa, Yuko; Kang, Yoon Koo

doi:10.1007/s10120-015-0526-8

Cited by 408 publications

(498 citation statements)

References 57 publications

(88 reference statements)

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“…This is markedly better than the 18-24 months seen with advanced GIST as a whole cohort in various studies, but in line with what has been seen in the BRF 14 study (PFS: 39.4 months) (17,22). The operable cancers (including locally advanced) had a median EFS of 58 months ( 5 year EFS: 50%), which is lower than published data (14,21) for operated and locally advanced cancers.…”

Section: Discussionsupporting

confidence: 79%

Early outcomes of exon 11 mutants in GIST treated with standard dose Imatinib

et al. 2017

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Background: The exon 11 KIT mutant gastrointestinal stromal tumors (GIST) is a heterogeneous cohort with variable biological behavior based on different mutational subtypes. Methods:Patients with histologically proven GIST with KIT exon 11 mutations were selected from a prospectively maintained database, and evaluated for clinical characteristics and event free survival (EFS). Patients were divided into mutations upstream to codon 557 (G1), mutations involving codon 557-558 (G2) and mutation downstream to codon 558 (G3).Results: A total of 90 patients satisfied the inclusion criteria for study. Substitutions, indels and duplications were seen in 23 patients. Deletions were seen in 67 patients, of which 44 patients had large deletions (>6 base pairs), while 23 has small deletions (<6 base pairs). Complex mutations were seen in 15 patients. G2 mutations were noted in 33 patients, while G1 and G3 mutations were seen 32 and 25 patients respectively. With a median follow-up of 26 months, estimated median EFS for the entire cohort was 55 months. The G2 cohort had an inferior EFS compared to the G1 and G3 cohorts (46 vs. 55 months), but this did not achieve statistical significance (univariate analysis: P=0.075). On multivariate analysis, patients undergoing radical intent surgery vs. no surgery (58 vs. 55 months; P=0.005) and G1 or G3 vs. G2 cohort (P=0.058) showed trend towards improved EFS. Conclusions:In patients with GIST exon 11 codon 557-558 mutation subset there is a trend towards an inferior survival even when treated with imatinib mesylate (IM).

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Section: Discussionsupporting

confidence: 79%

Early outcomes of exon 11 mutants in GIST treated with standard dose Imatinib

et al. 2017

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“…It is a common dogma that intestinal GIST are associated with worse prognosis compared with gastric GIST [1][2][3][4]. Additionally to the commonly accepted poor prognostic factors of tumor size and mitotic rate [5], the widely used Armed Forces Institute of Pathology (AFIP) classification of Miettinnen and Lasota [1] added GIST location as a third risk factor.…”

Section: Introductionmentioning

confidence: 99%

Revisiting a dogma: similar survival of patients with small bowel and gastric GIST. A population-based propensity score SEER analysis

et al. 2015

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Background The objective of the present analysis was to assess whether small bowel gastrointestinal stromal tumor (GIST) is associated with worse cancer-specific survival (CSS) and overall survival (OS) compared with gastric GIST on a population-based level. Patients and methods Data on patients aged 18 years or older with histologically proven GIST was extracted from the SEER database from 1998 to 2011. OS and CSS for small bowel GIST were compared with OS and CSS for gastric GIST by application of adjusted and unadjusted Cox regression analyses and propensity score analyses. Results GIST were located in the stomach (n = 3011, 59 %), duodenum (n = 313, 6 %), jejunum/ileum (n = 1288, 25 %), colon (n = 139, 3 %), rectum (n = 172, 3 %), and extraviscerally (n = 173, 3 %). OS and CSS of patients with GIST in the duodenum [OS, HR 0.95, 95 % confidence interval (CI) 0.76-1.19; CSS, HR 0.99, 95 % CI 0.76-1.29] and in the jejunum/ileum (OS, HR 0.97, 95 % CI 0.85-1.10; CSS, HR = 0.95, 95 % CI 0.81-1.10) were similar to those of patients with gastric GIST in multivariate analyses. Conversely, OS and CSS of patients with GIST in the colon (OS, HR 1.40; 95 % CI 1.07-1.83; CSS, HR 1.89, 95 % CI 1.41-2.54) and in an extravisceral location (OS, HR 1.42, 95 % CI 1.14-1.77; CSS, HR = 1.43, 95 % CI 1.11-1.84) were significantly worse than those of patients with gastric GIST. Conclusions Contrary to common belief, OS and CSS of patients with small bowel GIST are not statistically different from those of patients with gastric GIST when adjustment is made for confounding variables on a population-based level. The prognosis of patients with nongastric GIST is worse because of a colonic and extravisceral GIST location. These findings have implications regarding adjuvant treatment of GIST patients. Hence, the dogma that small bowel GIST patients have worse prognosis than gastric GIST patients and therefore should receive adjuvant treatment to a greater extent must be revisited.

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“…Most GISTs are usually detected by endoscopy as a SET. The standard treatment for GIST is en bloc complete resection that avoids rupture and damage to the pseudo-capsule of the tumor (17,18). Moreover, SETs with ulceration have a potential risk of tumor cell seeding into the abdominal cavity by communicating between endoluminal and extraluminal spaces.…”

Section: Endoscopic and Laparoscopic Approachmentioning

confidence: 99%

Laparoscopic and endoscopic cooperative surgery for gastrointestinal tumor

Niimi¹,

Ishibashi²,

Mitsui³

et al. 2017

Ann. Transl. Med.

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With technological progress of endoscopic submucosal dissection (ESD) in the last decade, several laparoscopic and endoscopic cooperative surgeries (LECS) for gastrointestinal tumor have recently been developed.LECS is definitely favorable to the minimization of surgical margin, which leads to functional and anatomical preservation of gastrointestinal tract. LECS for gastrointestinal tumor is mainly sorted by two categories: exposure procedures and non-exposure procedures between endoluminal and extraluminal spaces. Exposure procedures have the potential risk of gastric contents or tumor cells spilling out over the abdominal cavity, because the stomach wall has to be perforated intentionally during the procedure. In order to avoid the potential these risks, nonexposure procedures have been developed. Currently, the LECS concept has rapidly permeated for treatment of gastrointestinal tumor due to its certainty and safety, although there is still room for improvement to lessen its technical difficulty. This review describes the current LECS for gastrointestinal tumor based on the several articles.

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The standard diagnosis, treatment, and follow-up of gastrointestinal stromal tumors based on guidelines

Cited by 408 publications

References 57 publications

Early outcomes of exon 11 mutants in GIST treated with standard dose Imatinib

Early outcomes of exon 11 mutants in GIST treated with standard dose Imatinib

Revisiting a dogma: similar survival of patients with small bowel and gastric GIST. A population-based propensity score SEER analysis

Laparoscopic and endoscopic cooperative surgery for gastrointestinal tumor

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