Adherence to the guidelines and the pathological diagnosis of high-risk gastrointestinal stromal tumors in the real world

Nishida, Toshirou; Sakai, Yoshiharu; Takagi, Masakazu; Ozaka, Masato; Kitagawa, Yuko; Kurokawa, Yukinori; Masuzawa, Toru; Naito, Yoichi; Kagimura, Tatsuo; Hirota, Seiichi

doi:10.1007/s10120-019-00966-4

Cited by 20 publications

(19 citation statements)

References 20 publications

(42 reference statements)

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“…In general, 81% of the patients with high risk or metastatic disease, without adverse characteristics like comorbidities, too high tumor load or the PDGFRA p.D842V resistance mutation, received imatinib therapy. These results are in line with the recent study of Nishida et al [30]. Molecular analysis preceded imatinib therapy in 97% of the cases.…”

Section: Discussionsupporting

confidence: 92%

“…Guidelines for molecular analysis and targeted therapy have been developed to assist in the care of patients with GIST [19,20,[24][25][26]. Although many of these guidelines were revised several times, only a few studies investigated compliance to guidelines in clinical practice [27][28][29][30][31][32]. Insight into real-world clinical management of GIST patients may guide further optimization of access to state-of-the-art patient care.…”

Section: Introductionmentioning

confidence: 99%

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Nationwide evaluation of mutation-tailored treatment of gastrointestinal stromal tumors in daily clinical practice

Steeghs

Gelderblom

et al. 2021

Gastric Cancer

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Background Molecular analysis of KIT and PDGFRA is critical for tyrosine kinase inhibitor treatment selection of gastrointestinal stromal tumors (GISTs) and hence recommended by international guidelines. We performed a nationwide study into the application of predictive mutation testing in GIST patients and its impact on targeted treatment decisions in clinical practice. Methods Real-world clinical and pathology information was obtained from GIST patients with initial diagnosis in 2017–2018 through database linkage between the Netherlands Cancer Registry and the nationwide Dutch Pathology Registry. Results Predictive mutation analysis was performed in 89% of the patients with high risk or metastatic disease. Molecular testing rates were higher for patients treated in expertise centers (96%) compared to non-expertise centers (75%, P < 0.01). Imatinib therapy was applied in 81% of the patients with high risk or metastatic disease without patient’s refusal or adverse characteristics, e.g., comorbidities or resistance mutations. Mutation analysis that was performed in 97% of these imatinib-treated cases, did not guarantee mutation-tailored treatment: 2% of these patients had the PDGFRA p.D842V resistance mutation and 7% initiated imatinib therapy at the normal instead of high dose despite of having a KIT exon 9 mutation. Conclusion In conclusion, nationwide real-world data show that over 81% of the eligible high risk or metastatic disease patients receive targeted therapy, which was tailored to the mutation status as recommended in guidelines in 88% of cases. Therefore, still 27% of these GIST patients misses out on mutation-tailored treatment. The reasons for suboptimal uptake of testing and treatment require further study.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Nationwide evaluation of mutation-tailored treatment of gastrointestinal stromal tumors in daily clinical practice

Steeghs

Gelderblom

et al. 2021

Gastric Cancer

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“…Regarding the occurrence of air-fluid levels or bubbles in GISTs (Figs 2 , 3 and S5 – S7 ), there is a divergence of findings in previous studies. Some clinicians consider the T-B sign a manifestation [ 13 – 18 ], while others consider it a common risk factor adversely affecting prognosis in association with recurrence of GIST [ 7 , 19 – 26 ]. Moreover, rupture, perforation, or fistula formation in GISTs have not been well defined, and their definitions remain vague and controversial [ 27 – 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…Most previous studies indicated that GIST rupture was a risk factor for recurrence and poor prognosis [ 7 , 19 – 26 ]. However, these studies did not distinguish whether the tumor ruptured into the lumen and formed a tumor-intestine wall fistula or ruptured out of the lumen and involved the peritoneum and abdominal cavity.…”

Section: Discussionmentioning

confidence: 99%

Clinicopathological characteristics and prognosis of gastrointestinal stromal tumors containing air-fluid levels

Liu¹,

Gao

Peng

et al. 2021

PLoS ONE

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An air-fluid level within a gastrointestinal stromal tumor (GIST) is unusual and indicates the presence of a fistula within the lumen of the GI tract. Until recently, the optimal management of such patients was not clear-cut. This retrospective study investigated the clinicopathological characteristics, surgical procedures, pre-and post-operative management, and prognosis of patients with GIST containing an air-fluid level. Data of GIST patients, spanning 5 years, including 17 GIST patients with air-fluid levels in the experimental group and 34 GIST patients without air-fluid levels in the control group, were retrieved from two hospitals in China. The clinicopathological characteristics, types of surgery, management, and clinical outcomes of GIST patients were compared between the two groups. GISTs containing air-fluid levels were significantly different from GISTs without air-fluid levels regarding tumor morphology, NIH risk category, invasion of adjacent organs, and necrosis or ulceration. Most GIST patients with air-fluid levels (14/17, 82.4%) received open surgery, significantly higher than the 20.6% in the control group. Targeted therapy with Imatinib mesylate (IM) was implemented in all GIST patients in the experimental group (17/17, 100%); markedly higher than those (3/34, 8.8%) in the control group. During follow-up, recurrence and death rates (5.9% and 5.9%) in the experimental group were higher than those (2.9% and 0%) in the control group. Open surgery is commonly performed in GIST patients with air-fluid levels who also require targeted therapy with IM. The Torricelli-Bernoulli sign could be a risk factor, adversely affecting the patient’s prognosis.

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“…Gastrointestinal stromal tumors (GISTs) are rare tumors, accounting for approximately 1% of the primary gastrointestinal (GI) tract malignancies. However, they are the most frequently diagnosed mesenchymal neoplasms involving the GI tract (1)(2)(3)(4). GISTs originate from mesenchymal pluripotent stem cells, which are programmed to differentiate into interstitial Cajal cells (5).…”

Section: Introductionmentioning

confidence: 99%

Correlation analysis of multi-slice computed tomography (MSCT) findings, clinicopathological factors, and prognosis of gastric gastrointestinal stromal tumors

Xu¹,

Si²,

He³

2020

Transl Cancer Res TCR

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Background: Computed tomography (CT) findings and clinicopathological characteristics of gastric gastrointestinal stromal tumors (GISTs) have been reported in the past, however, studies on their association with prognosis are limited. We aimed to evaluate the correlation between multi-slice computed tomography (MSCT) findings and clinicopathological characteristics for the prognosis of gastric GISTs. Multiple independent factors influencing the prognostic assessment of gastric GISTs were recognized. Methods:The CT images and clinicopathological data of 155 patients with gastric GISTs were retrospectively analyzed. Progression-free survival of patients was obtained using the Kaplan-Meier method and compared using the log-rank test. Univariate and multivariate analyses were performed to evaluate the prognostic significance of CT imaging and clinicopathological factors.Results: Univariate analysis revealed that patient prognosis was associated with the size, shape, necrosis or cystic degeneration, margin, growth pattern, enhancement pattern, mitotic rate, and Ki-67 index of the tumor. Further, multivariate analysis indicated that tumor size and necrosis or cystic degeneration were significant independent prognostic factors for gastric GISTs.Conclusions: Tumor shape, necrosis or cystic degeneration, growth pattern, enhancement pattern, and mitotic rate were non-negligible criteria for improving the prognostic accuracy for GISTs, whereas tumor size, margin, and Ki-67 index were significant independent predictors identifying high-risk patients, facilitating personalized treatment to improve the prognosis of gastric GISTs patients. Thus, a combination of MSCT findings and clinicopathological features may be a valuable tool for assessing the prognosis of patients with gastric GISTs.

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Adherence to the guidelines and the pathological diagnosis of high-risk gastrointestinal stromal tumors in the real world

Cited by 20 publications

References 20 publications

Nationwide evaluation of mutation-tailored treatment of gastrointestinal stromal tumors in daily clinical practice

Nationwide evaluation of mutation-tailored treatment of gastrointestinal stromal tumors in daily clinical practice

Clinicopathological characteristics and prognosis of gastrointestinal stromal tumors containing air-fluid levels

Correlation analysis of multi-slice computed tomography (MSCT) findings, clinicopathological factors, and prognosis of gastric gastrointestinal stromal tumors

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