Which Is the Optimal Risk Stratification System for Surgically Treated Localized Primary GIST? Comparison of Three Contemporary Prognostic Criteria in 171 Tumors and a Proposal for a Modified Armed Forces Institute of Pathology Risk Criteria

Goh, Brian K. P.; Chow, Pierce K. H.; Yap, Wai-Ming; Kesavan, Sittampalam; Song, In-Chin; Paul, Pradeep G.; Ooi, B. S.; Chung, Yaw-Fui Alexander; Wong, Wai‐Keong

doi:10.1245/s10434-008-9969-z

Cited by 109 publications

(83 citation statements)

References 25 publications

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“…Nonetheless, neoplasms with muscle differentiation showed greater disease-free intervals 17 . However, the authors point out that these results need to be evaluated carefully, since the tumors with muscle differentiation had a less aggressive biological course.Regarding the two GIST prognostic characterization systems, there was evidence of association with prognosis in both Fletcher et al 7 and Miettinen et al 11 classification, which was also found by other authors 14,18,24,25 .However, in this series we found a better risk statistical correlation with the Miettinen et al 11 classification. This can be explained by the introduction of a third criterion (location), the study of more than 2,000 cases, with long follow-up of patients and mainly the greater stratification of the risk categories, allowing a reclassification of the neoplasias 25 .…”

supporting

confidence: 86%

“…Regarding the two GIST prognostic characterization systems, there was evidence of association with prognosis in both Fletcher et al 7 and Miettinen et al 11 classification, which was also found by other authors 14,18,24,25 .…”

supporting

confidence: 67%

“…The differential diagnosis includes: desmoid tumor, inflammatory myofibroblastomas, leiomyoma, inflammatory fibroid polyp, neuroma, neurossarcoma, sarcomatoid mesothelioma and metastatic melanoma 7,9,10 GIST prognosis is still matter of discussion. Currently there are different classifications 7,[11][12][13][14][15] aimed to stratify tumors into groups, linking them to a higher or lower risk of tumor recurrence and/or distant metastasis 8,12 . Of all the classifications mentioned above, the two most commonly used are the one of Fletcher et al 7 and Miettinenet al 11 .…”

Section: Introduction Introduction Introduction Introduction Introducmentioning

confidence: 99%

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Comparative study of the different degrees of risk of gastrointestinal stromal tumor

Oliveira

Filho

Iglesias

et al. 2015

Rev. Col. Bras. Cir.

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ABSTRACT ABSTRACT ABSTRACTObjective Objective Objective Objective Objective: To evaluate the applicability of the main categories of risk and morphological factors in the prognosis of gastrointestinal stromal tumors. MethodsMethods Methods Methods Methods: we retrospectively studied fifty-four cases of GIST, assessing the main prognostic factors of this neoplasis: risk levels, topography, size, mitotic index, necrosis, histological subtype and immunophenotype. We also verified their association and the reduction of overall survival. Results Results ResultsResults Results: Univariate analysis showed that tumors with mitoses number greater than 5 per 50CGA (high-power fields), the presence of necrosis and a high risk for both the systems proposed by Fletcher and Miettinen had a significant association with reduced survival (p = 0.00001, 0.0056, 0.03 and 0.009, respectively). The remaining analyzed factors (size, histological subtype, topography and immunophenotype) had no such association. Multivariate analysis (Jacard index) showed that the Miettinen degree of risk was the one that best correlated with prognosis. Conclusion Conclusion Conclusion Conclusion Conclusion: the risk criteria of Fletcher and Miettinen are important in assessing the prognosis of patients with gastrointestinal stromal tumors, especially the latter, which adds to the mitotic index and the presence of tumor necrosis. G astrointestinal stromal tumors (GIST) are the most common mesenchymal neoplasms of the gastrointestinal tract 1 , their incidence being estimated at 14 to 20 cases per million population 2 ; they are more frequent in male patients older than 50 years old 3 . The pathogenesis is related to mutational changes in two tyrosine kinase receptors: KIT and PDGFR-alpha (plateletderived growth factor receptor alpha) on the surface of the interstitial cells of Cajal, the former being the most common (85% of cases) 4,5 . Gastrointestinal stromal tumors can develop in any topography, from the esophagus to the rectum. However, they are more common in the stomach (50% to 60%), followed by small intestine (20% to 30%), colon (10%), rectum or esophagus (5%) 6 . Macroscopically, the tumor lesions often have a nodular form, transmural involvement and submucosal growth, with ulceration of the mucosa or not. In light microscopy, histology reveals three types: the most common spindle (70%), epidermoid (20%) and the mixed type (10%), when there is combination of epithelioid and spindle ones 7 . Key wordsThe diagnosis of stromal neoplasms is based on immunohistochemical study with CD117 marker, expressed in most such neoplasias 1 . Noteworthy are also other markers: DOG 1, nestin, theta protein kinase C and carbonic anhydrase II 8 . The differential diagnosis includes: desmoid tumor, inflammatory myofibroblastomas, leiomyoma, inflammatory fibroid polyp, neuroma, neurossarcoma, sarcomatoid mesothelioma and metastatic melanoma 7,9,10 GIST prognosis is still matter of discussion. Currently there are different classifications 7,[11][12...

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confidence: 86%

supporting

confidence: 67%

Section: Introduction Introduction Introduction Introduction Introducmentioning

confidence: 99%

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Comparative study of the different degrees of risk of gastrointestinal stromal tumor

Oliveira

Filho

Iglesias

et al. 2015

Rev. Col. Bras. Cir.

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“…The dramatic effect of imatinib has led to an increased awareness of these tumours and this coupled with developments in diagnosis including detection of CD117 and CD34 may have led to higher incidence rates comparative to the pre-imatinib era. Goettsch et al described an incidence rate of 2.1/million in 1995 and 12.7/million in 2003 [18]. The Norweigan study demonstrated a rate increase from 1.8 per million per million to 12.5 per million comparing 1980-1984 data to 2000-2004 [8].…”

Section: Discussionmentioning

confidence: 96%

A Retrospective Study of the Incidence of GIST in Scotland from 1995 to 1999

Js¹,

Nowicki²,

G³

et al. 2014

J Clin Exp Pathol

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“…Several studies have investigated the main resultant predictors (9,(13)(14)(15). Some factors are widely recognized as being predictive of recurrence, and several risk stratification scales have been proposed (2,(16)(17)(18)(19)(20). Despite these risk assessments, approximately 10% of GISTs have an unexpected course, suggesting that many other factors affect their behavior.…”

Section: Original Articlementioning

confidence: 99%

Characterization of malignant gastrointestinal stromal tumors—a single center experience

Mandrioli¹,

Mastrangelo²,

Masetti³

et al. 2017

J. Gastrointest. Oncol.

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Background: The recurrence rate, related to the unpredictable behavior of gastrointestinal stromal tumors (GISTs), continues to be a major topic of investigation, since no actual risk evaluation scales have proven to be exceedingly effective in predicting prognosis. We therefore focus in this study on investigating the predictive variables of disease recurrence. Immunohistochemical profile, KIT and the platelet-derived growth factor receptor-alpha (PDGFR-α) gene mutations, tumor size, tumor site, mitotic index, synchronous tumors, adjuvant therapy, symptoms and gender were considered and analyzed as predictive variables. The receiver operating characteristic (ROC) analysis was used to determine the optimal cut-off value for tumor dimension to predict recurrence. Results:The median follow-up (FU) was 20 months (range, 6-86 months). A first-line adjuvant therapy was performed in nine patients. Disease relapse occurred in five cases. The tumor size and the mitotic index were the strongest predictive factors (P<0.001). The optimal maximum value for the tumor size was 7 cm [area under the curve (AUC) =0.955]. Conclusions:In light of the most recent evidence, a tumor size of 7 cm should be considered the threshold value for malignancy, and smaller GISTs with low mitotic counts as tumors with a low-grade risk.

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Which Is the Optimal Risk Stratification System for Surgically Treated Localized Primary GIST? Comparison of Three Contemporary Prognostic Criteria in 171 Tumors and a Proposal for a Modified Armed Forces Institute of Pathology Risk Criteria

Cited by 109 publications

References 25 publications

Comparative study of the different degrees of risk of gastrointestinal stromal tumor

Comparative study of the different degrees of risk of gastrointestinal stromal tumor

A Retrospective Study of the Incidence of GIST in Scotland from 1995 to 1999

Characterization of malignant gastrointestinal stromal tumors—a single center experience

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