Prognostic factors for primary gastrointestinal stromal tumours: are they the same in the multidisciplinary treatment era?

Cananzi, Ferdinando Carlo Maria; Lorenzi, Bruno; Belgaumkar, Ajay; Benson, Charlotte; Judson, Ian; Mudan, Satvinder

doi:10.1007/s00423-014-1160-3

Cited by 11 publications

(6 citation statements)

References 54 publications

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“…Consistently, studies by McCarter et al and Cananzi et al showed no significant difference in RFS in GIST undergoing R0 and R1 resection. 38,39 In 2012, the European Society for Medical Oncology (ESMO) guideline deleted microscopic margins as a prognostic factor for GISTs. 40,41 These results suggested that R0/R1 may not be associated with GIST recurrence and may not be suitable for SMT evaluation because the tumor is often enucleated along with the capsule.…”

Section: Discussionmentioning

confidence: 99%

Predictors of the difficulty for endoscopic resection of gastric gastrointestinal stromal tumor and follow‐up data

Wang

Zhang

et al. 2021

J of Gastro and Hepatol

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Section: Discussionmentioning

confidence: 99%

Predictors of the difficulty for endoscopic resection of gastric gastrointestinal stromal tumor and follow‐up data

Wang

Zhang

et al. 2021

J of Gastro and Hepatol

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“…Ki67 is an important prognostic factor that has been implicated in recurrence and survival and should be included in pathologist’s report[ 118 , 119 ] (See Table 3 ). The depth of tumor infiltration, including serosal penetration has been proposed as a prognostic factor for patients with GISTs with significantly poorer prognosis compared to its absence[ 120 , 121 ].…”

Section: Role Of Pathologistmentioning

confidence: 99%

Gastrointestinal stromal tumors: A multidisciplinary challenge

Sánchez-Hidalgo¹,

Durán²,

Molero-Payan³

et al. 2018

WJG

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Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors located in the alimentary tract. Its usual manifestation is gastrointestinal bleeding. However, small asymptomatic lesions are frequently detected as incidental finding. Characteristically, most GISTs (> 95%) are positive for the KIT protein (CD117) by IHC staining and approximately 80%-90% of GISTs carry a mutation in the c-KIT or PDGFRA genes. Mutational analysis should be performed when planning adjuvant and neoadjuvant therapy, due to its possible resistance to conventional treatment. The arise of tyrosine kinase inhibitor has supposed a revolution in GISTs treatment being useful as adjuvant, neoadjuvant or recurrence disease treatment. That is why a multidisciplinary approach to this disease is required. The correct characterization of the tumor at diagnosis (the diagnosis of recurrences and the evaluation of the response to treatment with tyrosine kinase inhibitors) is fundamental for facing these tumors and requires specialized Endoscopist, Radiologists and Nuclear Medicine Physician. Surgery is the only potentially curative treatment for suspected resectable GIST. In the case of high risk GISTs, surgery plus adjuvant Imatinib-Mesylate for 3 years is the standard treatment. Neoadjuvant imatinib-mesylate should be considered to shrink the tumor in case of locally advanced primary or recurrence disease, unresectable or potentially resectable metastasic tumors, and potentially resectable disease in complex anatomic locations to decrease the related morbidity. In the case of Metastatic GIST under Neoadjuvant treatment, when there are complete response, stable disease or limited disease progression, complete cytoreductive surgery could be a therapeutic option if feasible.

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“…All high-risk patients with detectable ctDNA during surgical treatment displayed a complete response with no detectable tumor-specific ctDNA four weeks following surgery. Although there is a variation of ctDNA shedding intraoperatively among patients with high-risk GIST tumors, all patients with non-radical surgery, known to correlate with poor prognosis (37,38), were ctDNA positive. Our and other data (33) show that tumor-specific mutations that occur as insertions or deletions are more likely to be ctDNA positive.…”

Section: Discussionmentioning

confidence: 91%

Monitoring Circulating Tumor DNA During Surgical Treatment in Patients with Gastrointestinal Stromal Tumors

Johansson

Berndsen

Lindskog

et al. 2021

Molecular Cancer Therapeutics

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The majority of patients diagnosed with advanced gastrointestinal stromal tumor (GIST) are successfully treated with a combination of surgery and tyrosine kinase inhibitors (TKIs). However, it remains challenging to monitor treatment efficacy and identify relapse early. Here, we utilized a sequencing strategy based on molecular barcodes and developed a GIST-specific panel to monitor tumor-specific and TKI resistance mutations in cell-free DNA and applied the approach to patients undergoing surgical treatment. Thirty-two GIST patients were included, and 161 blood plasma samples were collected and analyzed at routine visits before and after surgery and at start, during, and end of surgery. Patients were included regardless of their risk category. Our GIST-specific sequencing approach allowed detection of tumor-specific mutations and TKI resistance mutations with mutant allele frequency < 0.1 %. Circulating tumor-DNA (ctDNA) was detected in at least one timepoint in 9 out of 32 patients, ranging from 0.04% to 93% in mutant allele frequency. High-risk patients were more often ctDNA-positive than other risk groups (p < 0.05). Patients with detectable ctDNA also displayed higher tumor cell proliferation rates (p < 0.01) and larger tumor sizes (p < 0.01). All patients who were ctDNA-positive during surgery became negative after surgery. Finally, in two patients who progressed on TKI treatment, we detected multiple resistance mutations. Our data show that ctDNA may become a clinically useful biomarker in monitoring treatment efficacy in high-risk GIST patients and can assist in treatment decision making.

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Prognostic factors for primary gastrointestinal stromal tumours: are they the same in the multidisciplinary treatment era?

Abstract: In the multidisciplinary management of GIST, serosal perforation may represent an additional predictor of recurrence along with mitotic rate. Complete macroscopic surgical resection is the most reliable prognostic factor, and an aggressive surgical approach should be advocated.

Cited by 11 publications

References 54 publications

Predictors of the difficulty for endoscopic resection of gastric gastrointestinal stromal tumor and follow‐up data

Predictors of the difficulty for endoscopic resection of gastric gastrointestinal stromal tumor and follow‐up data

Gastrointestinal stromal tumors: A multidisciplinary challenge

Monitoring Circulating Tumor DNA During Surgical Treatment in Patients with Gastrointestinal Stromal Tumors

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